- ^ '% .; »°VV* \ I B > * -p. \ v ' -^r. X ,- , «v ,. .^ 1 ^7 A^" 3 <.°" A *• A " A ' A X X , o « c 0' s ^ V* *^ -30 ST* ^ ^ ' ^ ,\X 4. -7*/ * 1 A^ ° -V ^ . ^ ■* "V O -0 V L * A *■< ^ V* f : A b0 ^ ^ ", •v "V> A + >, A^ x ^ » % cV * ' -o- ' Up; « o u X -^ jPa \ v ^, A * a i ■•°/;^> #' % A^ * - V v. * A -a ■* A A c ° N c * ^ - *>. * o s o > A ^ A 0> ' •x^ -^ "O ,y A OJ- ^> it , ^ A' X ^L. 2 ^ ^ » , ! / C' / NEW REMEDIES: FORMULA tol FOR THEIR ADMINISTRATION. BY ROBLEY DUNGLISON, M. D., PROFESSOR OF THE INSTITUTES OF MEDICINE, ETC., IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. SIXTH EDITION, ajitjr €ihn%ht SbWithn*. PRODESSE QUAM CONSPICI. PHILADELPHIA : BLANCHARD AND LEA. 1851. 35 ll t e X e "D, according to Act of Congress, in the year 1851, By Robley Dunglison, M. D., the Clerk's Office of the District Court of the Eastern District of Pennsylvania. WM. S. YOUNG. PRINTER. PREFACE TO THE SIXTH EDITION. The last few years have been rich in valuable gifts to Thera- peutics; and amongst these, ether, chloroform, and other so called anaesthetics, are worthy of special attention. They have been introduced since the appearance of the last edition of the " JVevj Remedies." Other articles have been proposed for the first time, and the experience of observers has added numerous interesting facts to our knowledge of the virtues of remedial agents pre- viously employed. To include all these, it has been necessary to add very greatly to the dimensions of the present edition. The therapeutical agents now first admitted into this work, some of which have been newly introduced into pharmacology, and the old agents brought prominently forward with novel ap- plications, and which may consequently be regarded as New Remedies, are the following: — Adansonia digitata, Benzoate of Ammonia, Valerianate of Bismuth, Sulphate of Cadmium, Chlo- roform, Collodion, Cantharidal Collodion, Cotyledon Umbilicus, Sulphuric Ether, Strong Chloric Ether, Compound Ether, Hura Braziliensis, Iberis Amara, Iodic Acid, Iodide of Chloride of Mer- cury, Powdered Iron, Citrate of Magnetic Oxide of Iron, Citrate of Iron and Magnesia, Sulphate of Iron and Alumina, Tannate of Iron, Valerianate of Iron, Nitrate of Lead, Lemon Juice, Citrate of Magnesia, Salts of Manganese, Oleum Cadinum, Arsenite of Quinia, Hydriodate of Iron and Quinia, Sanicula Marilandica, and Sumbul. IV PREFACE. To increase the practical value of the work to the therapeutical inquirer, the author has added to the Index of Diseases the parti- cular pages in which the various remedies prescribed in those dis- eases are referred to. ROBLEY DUNGLISON. Philadelphia, 18 Girard St., March, 1851. Electro -Magnetismus. Since the above was written, the author has received a work by Dr. Froriep, 1 of Berlin, in which he gives cases of good effects produced by Electro-Magnetism, in "rheumatic effusions spread over the body" — acute, subacute and chronic; in hemiplegia rheumatica, rheumatic neuralgia, rheu- matic facial palsy, spasmodic contractions of the muscles of the face, writers' cramp, rheumatic paralysis of the forearm, hip, muscles of the thigh and leg, &c, &c. He rarely employed any remedial agency along with it, being desirous of ascertaining, without the possibility of doubt, its real effect. Currents were transmitted through the medium of sponges saturated with salt and water, and applied to the skin, or by acupuncturation, when it was requisite to act energetically on parts deeply seated, by introducing two needles of platinum in the course of a nerve. Dr. Froriep's testimony is highly confirmative of the good effects ascribed to Electro-Magnetism in certain diseases, in the body of this work. 2 1 On the Therapeutic application of Electro-Magnetism in the Treatment of Rheu- matic and Paralytic Affections. By Robert Froriep, Doctor in Medicine and Surgery, Public Professor of General Surgery in the University of Berlin, &c., &c, &c. Trans- lated from the German by Richard Moore Lawrance, M. D., Surgeon-Extraordinary to H. R. H. the Duke of Saxe Coburg and Gotha. London, 1850. a See page 296. PREFACE TO THE FIRST AND SECOND EDITIONS, The information concerning the remedies of more recent intro- duction lies scattered in so many works, that it cannot be accessible to the mass of physicians. The author has, consequently, believed, that he would be rendering a service to the profession by concen- trating the results of experience within reasonable limits, so that they may be readily available to all. The majority of the new agents — it will be found — have been furnished by modern chemistry; and their employment has been attended with this advantage, that — when properly prepared — they are not liable to uncertainty in their opera- tion; whilst the various plants from which strychnia, emetia, quinia, &c, are obtained, are liable to irregularity of action, owing to faulty desiccation, to the season in which they are culled, &c.4&c. — ob- jections which cannot apply to the active principles when separated from them. Owing to the difficulty of sifting the results of true from those of false observation, the author has esteemed it proper to give, as far as he was able, the recorded experience of all who have employed the remedies in question. It need scarcely be said, that to make a correct observer and a good therapeutist, a knowledge of every department of medical science is demanded. Anatomy, physiology, pathology, and materia medica are, indeed, but introductory to the great object which the practitioner ftas in view — the alleviation and removal of suffering. Were it other- wise, it would be but necessary to institute empirical trials, in every case of disease, witjh various articles in and out of the received lists of the materia medica, and from such vague trials to endeavour to deduce what is termed "experience." The erroneous idea prevails too extensively, that every one is ca- pable of profiting by observation, and that, therefore, all who have had the same amount of experience, must be equally capable of treating disease. Setting aside, however, the consideration of the differences that must necessarily result from the varied powers of in- dividuals, it can scarcely be maintained, that he whose attention has VI „ PREFACE. not been properly directed to the study of the preliminary branches which have been enumerated, and whose mind has not been trained in tracing the relation between cause and effect, can ever duly profit by mere experience in that which has teen properly termed "the most inductive of all sciences." 1 To treat disease methodically and effectively, the nature of the actons of the living tissues, in both the healthy and morbid conditions, must be correctly appreciated ; the effects which the articles of the materia medica are capable of exerting under both those conditions, must be known from accurate observations, and not until then can the practitioner prescribe with any well-founded prospect of success. Numerous errors would be perpetrated, were we to profess, and to carry out such profession, that we are guided by experience only, unless that experience had been gained by a due consideration of all the physiological, pathological, and therapeutical bearings of the sub- ject. In illustration of this, the well-known case cited by Dr. Paris in his Life of Sir Humphry Davy may be adduced. The enthusi- astic Beddoes, having hypothetically inferred that the inhalation of the nitrous oxide might be a specific for palsy, a patient was selected for trial, and placed under the care of Davy — at the time assistant to Beddoes. * Before administering the gas, Davy thought of ascertaining the temperature of the body by the thermometer placed under the tongue. The paralytic, deeply impressed by Dr. Beddoes with the certainty of the success of the remedy, of which he knew nothing — soon after the thermometer was placed in his mouth, believing this to be the great curative agent — declared that he felt somewhat better. Nothing more was, therefore, done; and he was requested to return on the following day. The same form was then gone through with the same results; and, at the end of a fortnight, the sick man was dis- missed cured, no agent of any kind having been employed except the thermometer. Now, if the reasoning powers were not duly exerted, experience would obviously -teach, as the result of this case, that the thermome- ter is an anti paralytic. The rational therapeutist is not, however, satisfied with this knowledge of the fact, for "fact it is." He in- quires into the mode in which the effect was induced, and he is not long in referring it to the influence exerted by the moral over the phy- sique; and he classes the thermometer with Perkinism, animal roag- 1 Propterea sola experientia absque doctrina et ratione incerta est et conjecturalis. Qui enim novit rhabarbarura purgare bilem, nescit tamen quando, quibus, et cui rnorbo prosit, nisi sit medicus doctus et peritus. Piimcros. De vulgi erroribus in medicina, ib. i. cap. xl. Amstelod. 1639. PREFACE. Vli netism, and their 1 congenerous arts, — amongst articles that act chiefly through the new impressions which they make on the senses. It might seem to those who are unacquainted with medical history* that in periods approaching our own, no such illogical inferences could be deduced, and that it has been the custom with the profession for ages to bestow all due caution and the most rational inquiry in the collection of facts. Such, however, is far from being the case. It is, indeed, humiliating to reflect on the credulity or faulty observation that has existed among nations, who have successfully cultivated many of the other branches of natural science. It ought scarcely to be credited, and yet it is nevertheless true, that the aqua spermatis ranamm or "water of frog's spawn" was to be found not very long ago in the Pharmacopoeia of Sardinia; and the aqua hirundi- num cum castoreo or "water of swallows with castor" in those of Manheim and Wirtemberg. The latter preparation is directed to be made as follows : — Take of young swallows bruised in a mortar, forty; rue, two handfuls; castor, one ounce; white wine, three pints. This disgusting preparation was given in hysteria and epilepsy. Again; the bufones exsiccati or "dried toads" were in the Pharma- copoeias of Spain and Wirtemberg, — having been formerly adminis- tered in powder, as a diuretic, in dropsy. In another work, 1 the au- thor has cited many examples as strange as those instanced, and it would be easy to enumerate still more. In a recent French journal, and in an article by M. Ricord — the distinguished physician to the Venereal Hospital of Paris— we have an example of the pertinacity with which ancient prepossessions and inculcations adhere to us, and how difficult it is to think and to act according to the unbiassed suggestions of our own observation and reflection. In the treatment of blennorrhagic epididymitis or swelled testicle from gonorrhoea, M. Ricord recommends compression to be made by means of the "sparadrap " or plaster of Vigo with mercury. The history of the plaster of Vigo is singular. Although still in the Pharmacopoeia of Paris, it resembles its prototypes but in name. In the Pharmacopoeia of Wirtemberg, it is directed to be formed of living frogs and living earth-worms, boiled with various inert and by us rejected herbs in white wine and vinegar, — the decoction being strained, and added to olive oil, litharge, oil of bayberries, turpentine, yellow wax, olibanum, euphorbium, and liquid storax, all melted together, 1 General Therapeutics, p. 55. Philad. 1836. [See, also, his General Therapeutics and Mat. Medica, 5th edit. i. 66. Philad. 1850.] Vlll PREFACE. Yet it is scarcely possible to conceive, that the frog's spawn could have been supposed to yield a product on distillation differing from that of other animal substances when subjected to the same process; that the swallows — in the preparation cited — added any thing to the antispasmodic virtues of the caste*, or that the living frogs and earth- worms exerted any efficacy in the sparadrap de Vigo — a plaster em- ployed for compressing tumours, and for which purpose we use one of simple adhesive constituents. They have all been properly re- jected from the lists of our medicinal agents, and are looked upon as irrational; yet we are compelled to infer from the fact of their having been received, in some countries, into officinal publications — into the pharmacopoeias, which emanate from congregations of those of our profession, who are esteemed learned by education and by practice — that they were originally admitted under the sanction of fancied ex- perience. In the darker periods of medical history, monstrous and revolting polypharmacal preparations were introduced, and nothing but the blindest devotion to authority or to established custom could have occasioned their retention. It is not long since the Theriac of An- dromachus — itself but a modification of the Antidotum Mithridatum — was dismissed from the British pharmacopoeias. It consisted of seventy-two articles, and was a farrago — as Dr. Heberden observed — that had "no better title to the name of Mithridates than — as it so well resembles — the numerous undisciplined forces of a barbarous king, made up of a dissonant crowd collected from different countries, mighty in appearance, but in reality an ineffective multitude, that only hinder each other." The electuarium opiatum polypharmacum of the Parisian codex — the descendant of the old theriac, with even an additional number of ingredients — contains acrid substances, 5; as- tringent, 5; bitter, 22; indigenous aromatics, 10; umbelliferous aro- matics, 7; balsams and resinous substances, 8 ; fetid ingredients, 6; narcotics, 1; earthy substances, 1; gummy or amylaceous, 4; sac- charine, 3. Total, 72 — and one of these the flesh of the viper; a little more than a grain of opium — which may be regarded as a prin- cipal effective ingredient — being contained in a dram of the compound. Yet, when the question arose in the London College of Physicians, as to what should be the fate of this "many-headed monster," and when it was proposed by Dr. Heberden, that it should be ejected from the pharmacopoeia, — on a division, it was found that there were thir- teen votes for retaining and fourteen for rejecting it. Its ostracism was determined by a majority of one only, in a learned body twenty- seven of whose members were present. PREFACE. IX Such was the fate of a "heterogeneous farrago," which, as Dr. Paris has remarked, "can be vindicated upon no principle of combination," and yet enjoyed the confidence of physicians for ages — a confidence unquestionably founded, in their belief, on experience, but experience based upon defective observation, and, consequently, on erroneous inferences — the results being consecutive rather than consequent, and bearing no relation whatever to the assigned cause. Happily, more correct ideas are beginning to be entertained on the subject of true experience. It is now felt — to employ the language of a distinguished surgeon — Professor Liston — that the greatest num- ber of well-assorted facts on a particular subject constitutes experience, whether these facts have been culled in five years or in fifty. A better system, too, of observation generally prevails, so that we have dis- carded the absurd and revolting agents that are still retained in the books of authority of some European countries. Much, however, remains to be done. The catalogue of the Materia Medica is yet overstocked, and the pruning knife has still to be applied, to lop off many of the redundancies which have been proved to be such by the more accurate attention that is daily paid to tracing the due relation between cause and effect. "To purchase a clear and warrantable body of truth," as Sir Thomas Browne has well observed, "we must forget and part with much we know." Every one will be compelled to admit, that it is the duty of the correct therapeutist to doubt the existence of qualities in any article until they have been adequately proved. When such is the case, no reasoning can set aside facts ; but unless the evidence be overpowering, it is equally his duty to remain in doubt, especially should reflection suggest to him strong grounds for believing, that the number of obser- vations has been insufficient, that they have not been properly made, or are unconsequential. To enable the profession to form an accurate estimate of the value of remedies of more recent introduction, or of the older remedies whose use has been revived under novel applications, the present volume was undertaken by the author. In Germany, several works exist on this subject, and that of Riecke — to which the author has repeatedly referred — served as a basis for many of the articles; his observations, however, do not come down farther than the year 1836. Some of the statements — especially in relation to the observations of certain of the German physicians — are given on Riecke's authority, X PREFACE. for he has rarely appended references, by which the correctness of his assertions could be tested. 1 It has been a great object with the author to furnish exact references to works in which farther information may be obtained, and the number of these will show, that he has devoted no small amount of time and attention to the subject. He has likewise added the results of his own experience in public and in private. The motto which he has selected — prodesse quam conspici — conveys, in epitome, his feelings. His sole object has been, " to be useful" — and if he has succeeded, the re- ward is ample. ROBLEY DUNGLISON. Philadelphia, October 15, 1839. 1 Recently, a second and enlarged edition of Riecke's work has appeared; but the therapeutical additions to it are by no means as numerous as the author had expected to find them. He has, consequently, made but few extracts from it in the present edition. It is entitled " Die neuern Arzneimittel, ihre physischen und chemischen Eigenschaften, Bereitungsweisen, Wirkungen auf den gesungen und kranken Organismus, und therapeu- tische Beniitzung. Von Victor Adolf Riecke, Dr. Med., Mitglied des Vereins fur Heilkunde in Preussen, u. s. w.; zweite, vollig umgearbeitete Auflage. Stuttgart, 1840." [Note to Preface of edition of 1841.] ALPHABETICAL LIST OF REMEDIES. Abeille mellifique, 703. Acetas chinicus, 605. morphicus, 523. morphii, 523. quinicus, 605. strychnicus, 664. Acetone, 645. Acetum ligneum, 13. lignorum empyreumaticum, 13. pyrolignosum, 13. Acid, acetic, empyreumatic, 13. auric, 127. benzoic, 17. chromic, 701. cyanhydricj 23. gallic, 20. hydriodic, liquid, 486. hydrocyanic, 23. medicinal, 24. lactic, 36. muriatic, dephlogisticated, 182. oxygenated, 182. nitric, 701. nitro-muriatic, 187. of milk, 36. oxymuriatic, liquid, 189. prussic, 23. pyroligneous, 13. pyrolignic, 13. tannic, 38. Acide hydrocyanique, 23. benzoique, 17. chromique, 701. gallique, 20. iodique, 491. lactique, 36. nitrique, 701. prussique, 23. pyro-acetique, 13. pyroligneux, 13. pyrolignique, 13. tannique, 38. Acidum aceticura empyreumati- cum, 13, benzoicum, 17. benzoicum per sublimationem,17. borussicum, 23. cahincicum, 148. Acidum caincse, 148. chromicum, 701. gallicum, 20. hydrocyanicum, 23. iodicum, 491. lacteum, 36. lacticum, 36. lactis, 36. ligni pyro-oleosum, 13. marinum dephlogisticatum, 182. muriaticum oxygenatum, 182. muriaticum oxygenatum ad con- tagia, 182. nitricum, 701. prussicum, 23. pyro-aceticum, 13. pyrolignosum, 13. pyroxylicum, 13. quercitannicum, 38. tannicum, 38. zooticum, 23. zootinicum, 23. Aconite, extract of, alcoholic, 51. • extract of, ammoniated, 50. Aconitia, 45. Aconitine, 45. Aconitium, 45. Acqna balsamica arteriale ; 82. Acqua Binelli, 82. g Acqua Brocchieri, 84. Acqua Monterossi, 83. Actaea racemosa, 212. Actee, 212. Acupuncturation, 51. Acupuncture, 51. Adansonia digitata, 702. Adstringirende Brazilische Rinde, 252. .Esculin, 410. iEstfulus hippocastanum, 410. ^Ether chloricus, 196. hydrocyanicus, 60. lignosus, 645. prussicus, 60. pyro-aceticus, 645. sulphuricus, 61. sulphuricus phosphoratus, 544. vitriolicus, 61. xu ALPHABETICAL CONTENTS. Aetzroggen, 312. Afterkorn, 312. Agaric blanc, 138. white, 138. Agaricus albus, 138. Agathosma crenatum, 293. Agathotes chirayita, 399. Aimant, 496. Air -douches into the Eustachian tube, 436. Akonitin, 45. Akupunktur, 51. Alaunerde, reine, 101. Alcali vegetabile salito-dephlogisti- caturn, 581. Alcohol, mesitic, 645. sulphuris, 668. Alcooi de soufre, 668. Alexiteriura chloricum, 182. Almond, bitter, water of, 80. Alumina, acetate- of, 74. pure, 101. salts of, 74. sulphate of, 74. Aluminae sales, 74. Alumine factice, 101. sels d', 74. Aluminii oxidum, 101. Aluminum, chloride of, 74. Ammonia, arseniate of, 104, benzoate of, 19. hydriodate of, 490. phosphate of, 76. Ammoniae arsenias, 104. ferro-citras, 342. phosphas, 76. Ammoniak arseniksaures, 104. Ammoniaque, arseniate d ; , 104, phosphate d', 76. Ammoniated counter-irritants, 245. Ammonii iodidum. 490. Ammonium arsenicum, 104. arseniksaures, 104. hydroiodicum, 490. iodatum, 490. iodide of, 490. phosphorsaures, 76. Amylum iodatum, 490. Anthrakokali, 80. sulphuretted, 80. Antidynous counter-irritants. 245. Apfelgranate, 402. Apis domestica, 703. mellifica, 703. Aqua amygdalarum, 80. arsenicalis Pearsonii, 105. balsamica arterialis, 82. Aqua Binellii, 82. Brocchierii, 84. chlorini, 189. lauro-cerasi, 30, 81. natri oxymuriatici, 643. oxygenata-muriatica, 189. oxygeno-muriatica, 189. oxymuriatica, 189. picis liquidse, 89. Argent, chlorure d', 94. et d'ammoniaque chlorure d ; , 95. cyanure d', 97. iodure d', 98. oxide d', 99. preparations d', 92. Argenti chloridum, 94. chloruretum, 94. cyanidum, 97. cyanuretum, 97. et ammoniaci chloruretum, 95. et ammoniae chloridum, 95. ioduretum, 98. iodidum, 98. muriatico-ammoniati liquor, 96. oxidum, 99. prasparata, 92. Argentum chloratum, 94. cyanogenatum, 97. divisum, 101. hydrocyanicum, 97. iodatum, 98. limatum, 101. muriaticum, 94. muriaticum an oxydatum, 99. salitum, 94. Argil, pure, 101. Argilla pura, 101. Armoise commune, 108. Arnica, 103. montana, 103. plauensis. 103. Arnique, 103. Arsenias ammonias, 104. potassae acidus, 336. Arseniate of soda, 105. Arsenic, hydriodate of, 106. iodide of, 106. and mercury. double iodide of,429. iodure de, 106. teriodide of, 106. Arsenici, 106. hydriodas, 106. et hydrargyri hydriodas. 429. et hydrargyri iodidum, 429. iodidum, 106. ioduretum, 106. ALPHABETICAL CONTENTS. Xlll Arsenici teriodidum, 106. Arsenicum iodatum ; 106. Arsenikiodiir, 106. Arseniksaures ammonium, 104. Arsenite of potassa, 105. Artanthe elongata, 506. Artemisia vulgaris, 108. extractum resinosum, 111. Aspidium filix mas, 381. Assacou, 715. Athyrium filix mas, 381. Atropia, 113. Atropin, 113. Atrophia, 113. Atropine, 113. Atropinum, 113. Atropium, 113. Auri chloretum, 120. chloretum cum chloretonatri, 122. chloridum, 120. chloru return, 120. cyanidum, 125. cyanuretum, 125. et sodii chloridum, 122. et sodii chloruretum, 122. et sodii perchloruretum, 122. iodidum, 126. ioduretum, 126. murias, 116. nitromurias, 127. oxidum, 127. peroxidum, 127. prseparata, 116. pulvis, 129. terchloridum, 116. tercyanidum, 125. teroxydum, 127. Aurico-natricum murias, 122. Auriferes composes, les, 117. Auro-terchloride of sodium, 122. Aurum chloratum, 116. chloratum natronatum, 122. cyanatum, 125. cyanicum, 125. cyanogenatum, 125. hydrocyanicum, 125. iodatum, 126. limatum, 129. metallicum, 129. muriaticum, 116. muriaticum natronatum, 122. nitro-muriaticum, 127. oxydatum. 127. oxydulatum muriaticum, 116. salitum, 116. eesquichloratum natronatum, 122. Bachelor's buttons, 538. Balaustier, 402. Ballota lanata, 130. Ballota wollige, 130. Ballote cotonneuse, 130. Bandwurmwaldfarrn, 381. Bang, 166. Banksia Abyssinica, 139. Baobab, 702. Barii iodati hydras, 132. iodidum, 132. Barium iodatum, 132. iodide of, 132. Bark, resinous constituents of, 636. astringent, of Brazil, 252. Barosma crenata, 293. Baryt hydriodsaurer, 132. Baryta hydriodica, 132. hydriodate of, 132. Barytse hydriodas, 132. Barytin, 680. Barytium iodatum, 132. Baryumiodiir, 132. Baumnuss, 493. Bebeeria, 133. JBebeerin, 133. Bebeerina, 133. Bebeerin Bee, 703. Beifusswurzel, 108. extract, 111. gemeiner, 108. Benzoate of ammonia, 19. Benzoesaure, 17. Berberin, 136. Berberina, 136. Berberine, 136. Berberinum, 136. Berberisgelb, 136. Bergerthran, 545. Berliner Blau, 345. Betoine des Savoyards, 103. Biene, 703. Bignonenbaum, 137. Bignonia catalpa, 137. Bile, ox, 708. Bile, swine, 711. Bilis porcina, 711. Bilis taurina, 708. Binellisches Wasser, 82. Biogamia, 398. Biomagnetismus, 398. Bismuth, valerianate of, 704. Bismuthi valerianas, 704. Bismuthum valerianicum, 704. Bisulphuretum carbonii, 668. Bitter almonds, water of, 80. oil of. 81. XIV ALPHABETICAL CONTENTS. Bittererde citronensaures, 501. Bittermandehvasser, 80. Blankenheimer Thee, 390. Blau, Berliner, 345. Pariser, 345. Blaud's Pills, 373. Blaueaure, 23. Blausaures eisenoxydul Zinkoxid, 695. Quecksilber, 413. Blau stoffei sen, 345. BlaustofFgold, 125. Blaustoffkalium, 538. BlaustofTquecksilber, 413. Blaustoffsilber, 97. Blaustoffzink, 694. Ble cornu, 312. Bled avorte, 312. farouche, 312. Blei hydriodsaures, 578. iodwasserstoffsaures, 578. Bleichpulver, 153. Bleiiodid, 578. Bleioxyd, salpetersaures, 723. Bleitannat, 580. Bleu de Prusse, 345. Blue, Prussian, 345. Berlin, 345. Boccho, 293. Bocchoe, 293. Bole, Armenian, 101. Boletus albus, 138. laricis, 138. ♦ purgans, 138. Boocho, 293. Brayera anthelmintica, 139. Brechnuss, 538. Brome, 141. Bromeisen, 338. Brometurn ferricum, 338. hydrargyrosum, 412. Bromhydras kalii, 585. potassae, 585. potassii, 585. Bromidum potassii, 585. Bromin, 141. Bromina, 141. Bromine, 141. Bromineum, 141. Brominium, 141. Brominum, 141. Bromium, 141. Bromkalium, 585. Bromquecksilber, 412. doppelt, 412. Bromquecksilber in maximum, 412. Bromum, 141. Bromure de potassium, 585. Bromnretum kalii, 585. potassii, 585. Bromwasserstoffsaures eisenoxyd, 338. kali, 585. Brucia, 145. Brucin, 145. Brucina, 145. Brucine, 145. Brush, galvanic, 398. metallic, 398. Buccublatter, 293. Buchu, 293. Buckeye, 410. Buckhu, 293. Bugbane, 212. Buranhem, 512. Butyrum zinci, 688. Cade Oel, 721. Cadmii sulphas, 705. Cadmium sulphuricum, 705. Cadmium schwefelsaures, 705. Cadmium, sulphate of, 705. Cseruleum Beroliniense, 345. Borussicum, 345. Cahincae radix, 147. Cainanae radix, 147. Cainca root, 147. Caincae acidum, 147. Caincawurzel, 147. Calcar, 312. Calcaria chlorata, 153. chloretum, 153. chlorica. 153. Calcariae chlorum, 153. Calcii bichloruretum, 153. oxychloruretum, 153. oxydi chloruretum, 153. proto-chloru return, 153. Calcis bichloruretum, 153. chloridum, 153. hypochloris, 153. oxymurias, 153. Calcium, oxide de, chlorure d", 153. protoxichlorure de, 153. Calendula Alpina. 103. officinalis, 150. sativa, 150. Calendulin, 150, Caltha alpina, 103. sativa, 150. Calx chlorinata, 153. oxymuriatica, 153. Candytuft, bitter, 716. ALPHABETICAL CONTENTS. XV Caninanae radix, 147. Caniraminum, 145. Caniramium, 145. Cannabine, 166. Cannabis indica, 164. Caper spurge, 334. Carboneum trichloratum, 705. chloratum, 196. Caro vitulina tosta, 173. Carbo animalis, 173. carnis, 173. mineralis, 339. Carbon, sesqui-chloride of, 705. sesqui-iodide of, 176. sesqui-ioduret of, 176. terchloride of, 196, 705. trichloratum, 705. chloratum, 196. Carboneum sulphuratum, 668. chloratum, 196. trichloratum, 705. Carbonis sesqui-chloridum, 705. sesqui-iodidum, 176. sesqui-ioduretum, 176. trichloridum, 705.. Carbonicum chloratum. 705. Carbonium iodatum, 176. Carbure de soufre, 668. Carburet of sulphur, 668. Carragaheen moss, 210. Carageen moss, 210. Carrageenin, 210. Castanea equina, 410. pavina, 410. Catalpa, 137. arborea, 137. arborescens, 137. cordifolia, 137, tree, 137. Catapuce, 334. Cataputia minor, 334. Catawba tree, 137. Catheterism of the Eustachian tube, 436. Cephaelinum, 309. Cerussa nigra, 339. Cetrarin, 177. Cetrarina, 177. Cetrarine, 177. Cetrarinum, 177. Chanvre Indien, 164. Charbon, animal, 173. Charcoal, animal, 173. Chaux, chlorate de, 153. chlorure de, 153. muriate suroxigene ou oxigene de, 153. Chaux, oxichlorure de, 153. oximuriate de, 153. souschlorate de, 153. Chestnut, horse, 410. Chimaphila, 179. Chimophila, 179. ChinastofF, 603. Chinicus citras, 607. hydrochloricus, 612. tiinii acetas. citras, 607. ferrocyanas, 608. hydrochloras, 612. murias, 612. Chinii nitras, 613. phosphas, 613. sulphas, 614. tannas, 635. Chinin, 603. arseniksaures, 606. citronensaures. 607. citronsaures, 607. eisenblausaures, 608. essigsaures, 605. gerbesaures, 635. gerbstofFsaures, 635. hydrochlorsaures, 612. iodwasserstofFsaures, 610. milchsaures, 611. phosphorsaures, 613. salpetersaures, 613. salzsaures, 612. schwefelsaures, 614. sulphat, 614. tanninsaures, 635. valeriansaures, 633. zitronsaures, 607. Chinini acetas, 605. citras, 607. phosphas, 613. Chininum, 603. aceticum, 605. citricum, 607. hydriodicum, 610. laeticum, 611. muriaticum, 612. resino-sulphuricum, 636. salitum, 612. tannicum, 635. valerianicum, 633. Chinioidine, 636. Chinium, 603. aceticum, 605. citricum, 607. ferro-cyanogenatum, 608. ferro-hydrocyanicum, 608. hydrochloricum, 612. XVI ALPHABETICAL CONTENTS. Chinium muriaticura, 612. nitricum, 613. phosphoricum, 613. salitum, 612. sulphuricum, 614. tannicum, 635. Chinoidine, 636. Chinolein, 716. Chiococcae radix, 147. Chirayita, 399. Chiretla, 399. Chlor, 182. Chloras kalicus depuratus, 581. Chloras potassicus, 581. Chlorate de potasse, 581. Chlorblei, 722. Chlorcalciumoxyd, 153. Chlore, 182. eau de, 189. liquide, 189, Chloretum auri, 120. cum chloreto natrii, 122. calcariae, 153. zinci, 688. Chlorflussigkeit, 189. Chlorgas, 182. Chlorgold, 120. natrium, 122. Chlorsilber. 94. Chlorgoldnatronium, 122. Chlorhydrasmorphicus, 527. quinicus, 613. Chlori aqua, 189. liquor, 189. Chloride of gold and sodium, 122. of soda, 643. of zinc, 688. Chlorine, 182. solution of, 189. Chlorineum, 182. Chlorini aqua, 189. Chlorinium, 182. Chlorinum, 182. Chlorkalk, 153. ChlorkohlenstofT, dreifach, 705. Chlornatron, 643. Chlornatrum, 643. Chloroform, 196. Chlorplatin, 577. Chlorplatinnatrium, 578. Chlorsaures kali, 581. natrum, 643. Chlorsilber, 94. Chlorsodaflussigkeit, 643. Chlorum, 182. calcariae, 153. liquidum, 189. Chlorure d'arirent, 94. d'or, 120. d'or et sodium, 22. d'oxide de sodium, 643. de plomb, 722. de soude, 643. Chloruretum argenti, 94. argenti et ammonias, 95. auri, 120. auri et sodii, 122. oxidi calcii, 153. oxidi sodii, 643. potassae oxidatum, 581. zincicum, 688. Chlorwasser, 189. Chlor. wasseriges, 189. Chlorzink, 688. Chondrus, 210. crispus, 210. polymorphus, 210. Christophskraut, traubenformiges, 212. Chromium, peroxide of, 701. Chromsaure, 701. Chrysanthemum, 150. Churrus, 166. Cicutinum, 706. Cimicifuga, 212. Cinchonia, 215. iodide of, 610. Cinchonin, 215. Cinchonine, 215. Cinchoninum, 215. Citras chinicus, 607. ferricus, 341. quinicus, 607. Citronensaft, 728. Clavus secalinus, 312. siliginis, 312. Clou de seigle, 312. Codeia, 218. Codeine, 218. Codeinum, 218. Cod-liver oil, 545. Cohort, 212. Cohosh, 212. Colchicia, 224. Colchicum, 223. autumnale, 223. Colchique, 223. Collodion, 232. cantharidal, 236. Collodium, 232. tinctum, 235. Compressio, 237. Compression, 237. methodical, 237. ALPHABETICAL CONTENTS. XV 11 Coneine, 706. Conia, 706. Conicinum, 706. Contra-irritation, 245. Contre-irritation, 245. Corrigeen moss, 210. Cortex adstringens Brasiliensis, 252. Corylus rostrata, 254. Cotyledon umbilicus, 707. Counter action, 245. Counter-irritant lotions, Granville's, 245. ammoniated, 245. antidynous, 245. Gondret's, 245. Granville's, 245. Raspail's, 245. Counter-irritation, 245. Cousso, 139. Crayon noir, 339. Creasote, 255. Crocus martis aperiens, 376. Croton oil, 561. Crusadinha raiz, 147. Cubeba, 281. Cubeben, 281. Cubebenpfeffer, 281. Cubebin, 282. Cubebs, 281. Cusso, 139. Cyanather, 60. Cyaneisen, 345. Cyaneisenzink, 695. Cyanetum hydrargyri. 403. kalii, 588. zinci, 694. zinci et ferri, 695. Cyangold, 125. Cyan hydras potassse, 588. kalicus, 588. zincicus, 694. Cyanidum kalii, 588. mercurii, 413. potassii, 588. Cyankalium, 588. Cyanquecksilber, 413. Cyansilber, 97. Cyanure d 'argent, 97. d'or, 125. de mercure, 413. de potassium, 588. de zinc, 694. Cyanuret of ethule, 60. Cyanuretum argenti, 97. auri, 125. auricum, 125. ferrozincicum, 695. B Cyanuretum hydrargyri, 413. potassicum, 588. zincicum, 694. zinci et ferri, 695. Cyanwasserstoffather, 60. CyanwasserstofTsaure, 23. Cyanzink, 694. Delphia, 287. Delphin, 287, Delphina, 287. Delphinia, 287. Delphinine, 287. Delphium, 287. Derosne'sches opiumsalz, 535. Digitalia, 289. Digitalin, 289. Digitalina, 289. Digitaline, 289. Digitalinum, 289. Diosma, 293. Diosmin, 294. Dogwood, Jamaica, 722. Donovan's solution, 429. Doronic d'Allemagne, 103. Doronicum Germanicum, 103. plantaginis folio, 103. Drops, fever. Warburg's, 135. Druck, 237.' Duftstrauchblatter, 293. Eau d'amandes ameres, 80. de Binelli, 82. de Brocchieri, 84. de chlore, 189. de goudron, 89. de Javelle, 643. medicinale d'Husson, 223. styptique de Brocchieri, 84. Eisen, blausaures, 345. Eisenbromid, 338. Eisenchinin, citronensaures, 345. Eisencyaniircyanid, 345. Eiseniodiir, 349. Eisen, kohlensaures, 371, 376. Eisenoxyd, braunes, 376. eisenblausaures, 345. ^ gerbesaures, 379. iodwasserstoffsaures, 349. kohlensaures, 376. milchsaures, 359. mit ammoniak, 342. salpetersaures, 361. Eisenoxydhydrat, 364. Eisenoxydul arsensaures, 336. arseniksaures, 336. blausaures, 345. XVill ALPHABETICAL CONTENTS. Eisenoxydul citronsaures, 341. hydriodsaures, 349. iodwasserstoffsaures, 610. kohlensaures, 364, 376. milchsaures, 359. Eisenpraparate, 335. Eisenzink, blausaures, 695. Eisenzinkcyaniir, 695. Eleclricitas. See Galvanismus. animalis, 392. galvanica seu metallica, 393. Electricity, galvanic, 392. magnetic, 296. Electro-magnelismus, iv, 296. Electropunctura, 303. Electropuncturation, 303. Elixir of opium, M'Mimn's, 530. Emeta, 309. Emetia, 309. Emetina, 309. Emetium, 309. Emetine of the violet, 309. indigenous, 309. Epurge, 334. Ergot, 312. Ergota, 312. Ergotin, 331. Esprit pyroacetique, 645. Essigalkohol, 645. Essiggeist, 645. Essigsaures morphium, 523. Ether, acetic, injections of, into the Eustachian tube, 440. chloric, 196. chloric, strong, 207. compound, 209. hydrocyanic, 60. prussic, 60. pyroacetic, 645. sulphuric, 61. sulphurique, 61. Etherine, hydrocyanate of, 60. Ethyle, cyanuret of, 60. Eupatorium huaco, 407. Euphorbia lathyris, 334. Euphorbie, purgirkorner, 334. Exoneurism, 398. Extract, alcoholic, of nux vomica, 538. Extractum filis maris, 140. nucis vomicse alcoholicum, 538. opii aceticum, 526. resinosum radicis artemisiae, 111. Exlrait alcoholique de noix vo- mique, 538. de guarana, 569. savonneux de Purine, 675. Extrakt geistiges der Krahenaugen, 538. Fallkraut, 103. Farrenkraut, 381. mannlein, 381. mannliches, 381. Fel bovinum, 708. bovis, 708. tauri, 708. Fer, arseniate de, 336. bromure de, 338. carbure de, 339. citrate de, 341. cyanure de, 345. deutoxicyanure de, hydrate, 345. hydrate, deutocyanure de, 345. hydriodate de, 349. iodure de, 349. lactate de, 359. nitrate de, 361. preparations de, 335. protocarbonate de, 371. protoiodure de, 349. reduit par hydrogene, 335. souscarbonate de, 376. tannate de, 379. tritohydrocyanate ferrure de, 345. tritohydroferro-cyanate de, 345. valerianate de, 380. Fern, male, 381. shield, male, 381. Ferri et aluminse sulphas, 711. ammonio-citras, 342. et ammoniac citras, 342. arsenias, 336. borussias, 345. bromidum, 338. carbonas, 371, 376. carbonas prsecipitatus, 376. carbonas saccharatum, 372. carburetnm, 339. carburetum nativum, 339. citras, 341. cyanuretum, 345. deuto-carbonas fuscus, 376. ferrocyannretum, 345. ferro-sesquicyanidum, 345. hydriodas, 349. hydrobromas, 338. iodidnm, 349. ioduretnm, 349. lactas, 359. et magnesias citras, 344. nitras^36I. nitratis liquor, 361. nitrici oxydati liquor, 361. oxydi ferrocyanas, 345. ALPHABETICAL CONTENTS. XIX Ferri oxydulatum hydrocyanicum, 345. oxydum fuscura, 376. oxydum hydratum, 364. oxydum rubrum, 376. percyanidum, 345. pernitras, 361. persesquirritratis liquor, 361. praeparata, 335. protocarbonas, 371. prussias, 345. pulvis, 335. et quiniae citras, 345. sesquicyanidum, 345. sesquioxidum hydratum. 364. sesquioxydum, 364, 376. subcarbonas, 376. tannas, 379. valerianas, 380. Ferrugo, 364. Ferrum ammoniaco-citricum, 342. arseniatum, 336. arsenicum oxydulatum, 336. borussicum, 345. bromatum, 338. carbonatum, 364, 376. carbonatum praecipitatum, 376. carbonicum oxydulatum, 376. carbonicum saccfc carburetum, 339. citricum, 341. citricum cum ammoniaco, 342. cyanogenatum, 345. cyanuretum, 345. hydriodatum, 349. hydrobromicum oxydatum, 338. hydrocyanicum, 345. hydroiodicum oxydulatum, 349. iodatum, 349. lacticum, 359. nitratum. 361. nitricum oxydatum, 361. oxydatum hydratum, 364. oxydulatum hydrocyanicum, 345. oxydum hydricum, 364. perbromatum, 338. supercarbu return, 339. tannicum, 379. valerianicum, 380. zooticum. 345. Fiel de Bceuf, 708. Filix mas, 381. Firing, 251. Flechtenbitter der Islandischen Flechte, 177. Fleischkohle, 173. Flores Benzoes, 17. Flores Benzoini, 17. Flowers of Benjamin, 17. Formylsuperchlorid, 169. Formylsuperiodid, 176. Fougere male, 381. Fucus amylaceus, 383, crispus, 210. Irlandicus, 210. lichenoides, 383. Fuligo, 385. fornacum, 385. ligui, 385. splendens, 385. Fuligokali, 389. Fumigatio muriatico-oxygenata, 182. Fumigation de chlor, 182. de Guyton, 182. Guytonienne, 182. hygienique, 182. Fumigations, Guyton-Morveau, 182. Fungus of the larch, 138. laricis, 138. Galeopsis angustifolia, 390. dubia, 390. grandiflora, 390. ochroleuca, 390. prostrata, 390. segetum, 390. versicolor, 391. villosa, 391. Gall, ox, 708. swine, 708. Gallussaure, 20. Galvanic brush, 398. plates, 393. suppository, 399. Galvanisation localisee, 397. Galvanism, 392. Galvanopuncture, 303. Gebarpulver, 312. Gegenreizung, 245. Gentiana chirayita, 399. Gerbsaure, 38. Gerbestoff, 38. GerbestorTblei, 580. Gichtthran, 545. Gigartina lichenoides, 383. GJanzruss, 385. Glycerin, 400. Glycerina, 400. Glyceryle. hydrate of oxide of, 400. Glyceryloxyd, 400. Glyzenn, 400. Goharem, 512. Gold and soda, hydrochlorate of, 1 22. muriate of, 122. XX ALPHABETICAL CONTENTS, Gold and sodium, chloride of, 122. chlorid, 120. chlorid, saures, 120. chloride of, 120. cyanid, 125. cyanide of, 125. cyanuret of, 125. iodid, 126. iodide of, 126. iodur, 126. ioduret of, 126. krystalle, 120. metallic, 129. metalJisches, 129. muriate of, 120. natrium-chlorid, 122. natrum-chlorid, 122. natrum, salzaures, 122, nitro-muriate of, 127. oxide of, 127. oxyd, 127. oxyd, blausaures, 125. oxyd, hydrochlorsaures, 120. oxydirtes, 127. oxydiil, salzaures, 120. oxynatrium, salzsaures, 122. peroxide of, 127. praparate, 116. preparations of, 116. . pulver, 129. salpetersalzsaures, 127. salz, Figuier's, 122. salzsaures, 120. saure, 127. sodahaltiges, salzaures, 122. terchloride of, 120. tercyanide of, 125. Gondret's counter-irritants, 245. Gracilaria lichenoides, 383. Granatapfelbaum, 402. Granatbaum, 402. Granatillol, 561. Granatin, 403, 503. Granatum, 402. Granville's counter-irritants, 245. Graphites, 339. Green, winter, 179. Grenadier, 402. Grenadin, 403, 503. Guaco, 407. Guarana, 569. Guarana-samenteig, 569. Guncotton, ethereal solution of, 232. Gunjah, 166. Habbi, 139. Hachisch, 166. Haemospasia, 712. Haemostasis, 713. Hagenia Abyssinica, 139. Hahnensporn, 312. Haloidum oxygenatum, 581. Hanf, 164. Hanfnessel grossblumigte, 390, Harnstoff, 675. Harnstoff, salpetersaures, 677. Haschisch, 164. Haschischine, 166. Hazel, beaked, 254. Hemospasie, 712. Hemostasie, 713. Hemp, Indian, 164. Henricea pharmacearcha, 399. Herba sideritidis, 390. Herbe a pisser, 179. Herbe Saint Christophe, 212. Herbstblume, 223. Herbstzeitlose, 223. Hippocastanum, 410. Hohlzahns, grossbliithige, 390. Holzessig, 13. Holzessigsaure, 13. Holzsaure, 12. brenzliche oder brandige, 13. Honeybee. 703. Honigbiene, 703. Hopfenmehl, 718. Hopfenstaub, 718. Hornblei, 722. Hornseed, 3 12. Hornsilber, 94. Horse chestnut, 410. Huaco, 407. Huile de foi de poisson, 545. de cade, 721. de genevrier, 721. de morue, 545. de pignon d'Inde, 561. volatile de moutarde, 559. Hundsnessel, gelbe oder grossblii- thige, 390. Hura Braziliensis, 715. Hydrargyri bibromidum, 412. bicyanidum, 413. biiodatum, 421. biniodidum, 421. borussias, 413. bromidum, 412. cyanetum, 413. cyanidum, 413. cyanuretum, 413. deuto-bromidum, 412. deuto-ioduretum, 421. deutonitras, 427. dipernitras, 427. ALPHABETICAL CONTENTS. XXI Hydrargyriet arsenici iodidum,429. et quinise proto-chloridum, 715. hydrocyanas, 413. iodidulatura, 418. iodidum, 418. rubrum, 421. nitras, 426. nitratum, 426. perbromidum, 412. periodidum, 420. pernitratis liquor, 428. praeparata, 412. protobromidum, 412. proto-iodidum, 418. proto-ioduretum, 418. protonitras, 426. prussias, 412. subiodidum, 418. supernitras, 427. Hydrargyrum biiodalum cum kalio iodato, 592. biniodidum, 421. borussicum, 413. bromatum, 412. cyanetum,413. cyanogenatum, 413. hydrocyanicum, 413. iodatum, 418. cum chlorido mercurii, 491. flavum, 418. rubrum, 421. iodidum, 418. iodidulatum, 418. nitricum oxydatum, 427. nitricum oxydulatum, 426. perbromatum, 412. periodatum, 421. subiodatum, 418. zooticum, 413. Hydras ferricus, 364. Hydriodas ammonias, 490. kalicus, 595. lixiviae, 595. Hydriodate of ammonia, 490. of potassa, 595. Hydriodic acid, liquid, 486. Hydrobromsaures kali, 585. Hydrochloras morphicus, 527. chinicus, 612. Hydrocyanas kalicus, 588. zincicus, 694. Hydrocyanather, 60. Hydrocyanate of etherine, 60. Hydrocyanic ether, 60. Hydrocyansaure, 23. Hydroiodas kalicus, 595. lixivise, 595. Hydroiodsaures Eisenoxydul, 349. Hypochloris sodicus aqua solutus, 643. Iberis amara, 716. Indicum, 432. Indicus color, 432. fndig, 432. Indigo, 432. Indigum, 432. Infusum picis liquidae, 89. picis empyreumaticEe liquids, 89. Injections of air, &c. into the Eusta- chian tube, 436. Iod, 443. Iodammonium, 490. Iodarsen, 106. Iodarsenik, 106. lodatherid, 176. Iodbaryum, 132. Iodblei, 578. Iodchlorquecksilber, 492. lode, 443. Iodeisen, 349. Iodetum hydrargyricum, 421. hydrargyrosum, 418. zinci, 698. lodgold, 126. Iodhydras kalicus seu potassa?, 595. Iodhydrargyrate of ioduret of potas- sium, 592. Iodhydrargyrite de chlorure mer- cureux, 491. Iodic acid, 491. Iodide of ammonium, 490. of arsenic, 106. of carbon, 176. of chloride of mercury, 491. of iron, 349. of potassium, 595. of quinia, 610. of silver, 98. of starch, 490. of sulphur, 673. of zinc, 698. Iodidum ammonii, 490. amyli, 490. argenti, 98. arsenici, 106. baryi, 132. carbonis, 176. hydrargyri chloridi, 491. hydrargyricum, 421. hydrargyrosum, 418. plumbi, 575. potassii, 595. XX11 ALPHABETICAL CONTENTS. Iodidum quinise, 610. Iodine, 443. lodinum, 443. Iodinschwefel, 673. Iodium, 443. Iodkalium, 595. Iodkohlenstoff, 17(5. lodkohlenwasserstofT, 176. Iodoforma, 176. Iodohydrargyrate of potassium, 592. of ioduret of potassium, 592. Iodquecksilber doppelt, 421. gelbes, 418. in maximum, 42L in minimum rothes, 421. Iodsaure, 491. Todschwefel, 673. lodsilber, 98. Iodstarke, 490. Iodstarkmehl, 490. Iodum, 433. Iodure d ? amidon, 490. de carbon, 176. de fer, 349. plombique, 578. de potassium, 595. de quinine, 610. de soufre, 673. double de mercure et de mor- phine, 432. Ioduret of quinia, 610. of silver, 98. of sulphur, 673. Ioduretum ammonii, 490. arayli, 490. argenti, 98. arsenici, 106. barytii, 132. carbonii, 176. hydrargyrosum, 418. potassicum, 595. quiniae, 610. IodwasserstofTsaure Schwererde, 132. IodwasserstofFsaures Eisenoxydul, 349. Iron, ammonio-citrate of, 342. and alumina, sulphate of, 711. and magnesia, citrate of, 344. and quinia, citrate of, 345. arseniate of, 336. bromated or bromide of, 338. carbonate of, 371. carburet of, 339. citrate of, 341. citrate of magnetic oxide of, 342. Iron, cyanuret of, 345. hydriodate of, 349. hydrobromate of, 338. hydro-oxide of, 364. iodated, 349. iodide of, 349. ioduret of, 349. lactate of, 359. nitrate of, solution of, 361. oxide of, hydrated, 364. oxy hydrate of, 364. peroxide of, 376. peroxide of, hydrated, 364. pernitrate of, 361. persesquinitrate of, solution of, 361. potassio-citrate of, 342. preparations of, 335. proto-carbonate of, 371. proto-iodide of, 349. proto-ioduret of, 349. protoxide of, hydriodate of, 349. protoxide of, lactate of, 359. prussiate of, 345. sesquioxide of, 376. sesquioxide of, hydrated, 364. sodio-citrate of, 342. subcarbonate of, 376. tritoxide of, hydrated, 364. valerianate of, 380. Irritamentum metallorum seu me- tallicum, 392. Johanniswurzel, 381. Juglans regia, 493. Kabliauthran, 545. KahincsB radix, 147. Kali blausaures, 588. borussicum, 588. bromwasserstoffsaures, 585. chloricum, 581. chlorinicum, 5S1. chlorsaures, 5S1. cyanwasserstoffsaures, 588. elainicum, 641. hydriodicum, 595. hydriodsaures, 595. hydrobromicum, 585. hydrobromsaures, 585. hydrocyanicum, 588. hydroiodat, 595. hydroiodinicurn, 595. hyperoxygenirt salzsaures, 581. iodvvasserstoffsaures, 595. iodatum hydrargyratum, 592. muriaticum hyperoxygenatum, 581. olsaures, 641. ALPHABETICAL CONTENTS. xxm Kali oxychloricum, 581. oxydirt, salzsaures, 581. oxymuriaticum, 581. salpetersaures, 724. Kalii cyanuretum, 588. cyanetum, 588. cyanidurn, 588. iodidum, 595. Kaliseife, 641. Kalium bromatum, 585. bromid, 585. bromiir, 585. cyanid, 588. cyanogenatum, 588. cyaniir. 588. hydriodatum hydrargyratum, 592. iodatum, 595. iodiir, 595. Kalk, chlorigsaure, 153. oxydirt salzsaures, 153. Kalkchlorid, 153. Kaminruss, 385. Kaniramin, 145. Katalpa, 137. Katzermaul, 390, Kinine, 603. Kinini citras, 607. Kininum, 603. Kinium, 603. Klapperschlangenwurzel, 212. Klaprothii sulphas, 705. Knorpeltang, krauses, 210. Kodein, 218. Kohle mineralische, 339. thierische, 173. Kohlenschwefel, fliissiger, 668. KohlenstofTeisen, 339. Kohlenstofftrichlorid, 705. Kohlensulfurid, 668. Konigswallnuss, 493. Kosso, 139. Kousso, 139. Krahenaugen, 538. Krahenaugen bitter, 649. geistiges, extrakt der, 538. KrahenaugenstofF, 649. Krauser Tang, 210. Kreasot, 255. Kreasote, 255. Kreasoton, 255. Kreasotum, 255. Kreosote, 255. Krotonol, 561. Kubebenpfeffer, 281. Kubebin, 282. Labarraque's disinfecting liquid, 163, 643. Lactas ferrosus, 359. Lactucarium, 496. Lathyris, 334. Lattichopium, 496. Lattigbitter, 496. Lattigmilchsaft, 496. Lead, black, 339. chloride of, 722. iodide of, 578. ioduret of, 578. nitrate of, 723. tannate of, 580. Leberthran, 545. Lemonade, magnesian, 501. Lemonjuice, 728. Leonurus Janata, 130. Leopard's bane, 103. Lerschenschwamm, 138. Letheon, 61. Lettuce opium, 496. Leucolein, 716. Leukoleinum, 716. Liebersche Brust oder Auszeh- rungskrauter, 390. Lichen carrageen, 210. Lime, chloride of, 153. chlorinated, 153. chlorite of, 153. chloruret of, 153. hypochlorite of, 153. oxymuriate of, 153. Limon, sue de, 728. Liqueur desinfectante de Labarra- que, 163, 643. Liquid, disinfecting, Labarraque's, 163, 643. adhesive, Maynard ? s, 232. Liquor acidi muriatici oxygenati, 189. alexiterius oxygenatus, 189. argenti muriatico ammoniata, 96. chlori, 189. disinfecting, of Labarraque, 163. ferri iodidi, 352. ferri nitratis, 361. ferri nitrici oxydati, 361. ferri persesquinitratis, 361. hydrargyri et arsenici iodidi, 430. hydrargyri pernitratis, 428. hydrargyri supernitratis, 428. hydriodatis arsenici et hydrargy- ri, 430. morphiee citratis, 529. natri chloreti, 643. opii, 526. XXIV ALPHABETICAL CONTENTS. Liquor opii sedativus, 526. sodoe chloridi, 643. chlorinatse, 643. Lithanthrakokali, 80. Lithia, carbonate of, 717. Lithiae carbonas, 717. Lithine, carbonate de, 717. Lithion kohlensaures, 717. Lithium, kohlensaures, 717. Lithon kohlensaures, 717. Lupulin, 718. Macrotrys racemosa, 212. Magnes, 498. Magnesia and iron, citrate of, 344. Magnesia, citrate of, 501. citronensaures, 501. Magnesia? citras, 501. Magnesian lemonade, 501. Magnesie. citrate de, 501. Magnet, 498. Magnetes, 498. Magnetic electricity, 296. Magnetism, animal, 398. Magnetstein, 496. Malambo, 505. Malogranatum, 402. Manganese, salts of, 720. sulphate of, 718. Manganesii sulphas, 718. Manganoxydul, schwefelsaures, 718. Manganum sulphuricum oxydula- tum, 718. Mannastoff, 503. Mannazucker, 503. Mannite, 503.' Mannitum, 503. Mannleinwurmtiipfelfarrn, 381. Marigold, garden, 150. single, 150. Marronier, 410. d'Inde, 410. Matias. 505. Matico, 506. Matiere de Derosne, 535. vomitive, 309. Matter of Derosne. 535. Meadow saffron, 223. Melambo, 505. Melini sulphas, 705. Mercure, cvanure de, 413. deuto-iodure de, 421. deuto-nitrate de. 427. dipemitrate de, 427. hydrocyanate de. 413. nitrate acide de, 428. nitrate de, 426. Mercure, periodure de, 421. preparations de, 412. protoiodure de, 418. protonitrate de, 426. prussiate de, 413. Mercurii deuto-ioduretum, 421. protobromuretum, 412. protoioduretum, 418. Mercurius hydrocyanicus, 413. nitrosus calide paratus, 427. nitrosus frigore paratus, 426. Mercury and arsenic, hydriodate of, 429. iodide of, 429. " and morphia, iodide of, double, 432. bicyanide of, 413. biniodide of, 421. bromide of, 412. cyanide of, 413. deutoiodide of, 42!. deutonitrate of, 428. dipemitrate of, 428. hydrocyanate of, 413. iodide of, 418. iodide of, red, 421. iodide of chloride of, 491. iodoarsenite of, 429. nitrate of, acid, 428. nitrate of suboxide of, 426. periodide of, 421. preparations of, 412. protoiodide of, 418. proto-ioduret of, 418. protonitrate of, 426. prussiate of, 413. subiodide of, 418. supemitrate of, 428. solution of, 428. Mere de Seisfle, 312. Mesitalkohol, 645. Mesitylene, bihydrate of, 645. Mesmerism, 398. Milchsaure, 36. Mixture, Scudamore's, 231. Mohnstoff, 516. Moleplant, 334. Monesia, 512. Monesin, 512. Moosbitter, 177. Moos, carragaheen, 210. Moos, Irlandisch, 210. Morphei acetas, 523. Morpheum. 516. Morphia, 516. acetate of, 523. ALPHABETICAL CONTENTS. XXV Morphia and codeia, muriate of, 531. bimeconate of, 530. citrate of, 529. hydriodate of, 527. hydrochlorate of, 527. iodhydrate of, 527. iodide of iodhydrate of, 527. ioduret of, 529. muriate of, 527. salts of, 516. sulphate of, 528. tartrate of, 530. MorphisB acetas, 523. hydriodas, 527- hydrochloras, 527. Morphii murias, 527. sulphas, 528. Morphin, 516. essigsaures, 523. iodwasserstoffsaures, 527. salzsaures, 527. schwefelsaures, 528. Morphina, 516. Morphinae acetas, 523. bimeconas, 530. hydrochloras, 527. murias, 527. sulphas, 528. tartras, 530. Morphine, 516. acetate of, 523. and zinc, double iodide of, 666. bimeconate of, 530. citrate of, 529. et codeine, double muriate de,531. hydriodate de, 527. hydrochlorate de, 527. iodhydrate de, 527. muriate of, 527. sels de, 516. sulphate of, 528. tartrate of, 530. Morphinsalze, 516. Morphinum, 516. Morphium, 516. acetat, 523. aceticum, 523. essigsaures, 523. hydrochlorsaures, 527. muriaticum, 527. salzsaures, 527. schwefelsaures, 528. sulphat, 528. sulphuricum, 528. Mort aux chiens, 223. Moss, carageen, 210. Ceylon, 383. Moss, corrigeen, 210. edible, 383. Irish, 210. Jaffna, 383. marine, 383. Mousse d'Irlande, 210. perlee, 210. Moxa, 531. Moxiburium, 531. Moxibustion, 531. Mugwort, 108. Murias aurico-nitricum, 127. morphicus, 527. zincicus, 688. Muriate d'or, 120. Murid, 141. Muride, 141. Murigene, 182. Murin, 141. Murine, 141. Mustardseed oil, 559. Mutterkorn, 312. Nadelstich, 51. Naphtha, 645. phosphorata, 544. sulphurica, 61. vitriol, 61. wood, 645. Naphthalin, 720. Naphthaline, 720. Narcotina, 535. muriate of, 535. Narda celtica altera, 103. Narkotin, 535. Natrium-gold-chlorid, 122. Natriumplatinchlorid, 578. Natron phosphorsaures, 728. Natronwasser, oxydirt salzsaures, 643. Nattum chloratum, 643. chloricum, 643. chlorsaures, 643. oxydirt oder hyperoxygenirt salz- saures, 643. oxymuriaticum, 643. Navelwort, 707. Nephrine, 675. Nephrodium filix mas, 381. Neurogamia, 398. Nierenfarrn, mannlicher } 381. Niesswurzstoff, 678. Nitras ferricus, 361. hydrargyricus, 427. hydrargyricus acido nitrico solu- tus, 428. hydrargyrosus, 426. plumbicus, 723. XXVI ALPHABETICAL CONTENTS. Nitre, 724. Nitro-muriatic mixture, 187. Nitrum satuminum, 723. Noix vomique, 538. extrait alcoolique de, 538. Nombril de Venus, 707. Noyer, 493. Nussbaum, 493. Nux vomica, 538. alcoholic extract of, 538. Ochsengalle, 708. Oelsiiss, 400. Ofenruss, 385. Oil of bitter almonds, 81. cod. 545. codliver, 545. croton, 561. of mustard seed, 559. Oleum aethereum riorum arnicae, 103. aethereum seminum sinapis, 559. cadinum, 721. crotonis, 561. euphorbias lathyridis, 334. jecoris aselli, 545. juniperi empyreumaticum, 721. morrhuas, 545. ricini officinale, 566. seminis crotonis, 561. sinapis. 559. tiglii, 561. vitrioli dulce, 61. volatile seminum sinapis, 559. Opiane, 585. Opiumalkaloid, 516. lettuce, 496. Opiumsalz, Derosne'sches, 535. Or, chlorure d' 120. cyanure d', 125. divise, 129. oxide de, 127. et de sodium chlorure d', 122. I et soude, hydrochlorate d ? , 122. et soude, muriate d', 122. metallique, 129. muriate d', 122. nitromuriate d', 127. oxide d', 129. preparations d', 116. protoiodure d', 126. Oxide d'argent, 99. Oxidum ferricum hydratum, 364. Oxydirtes silber, 99. Oxydirt-salzsaures natronwasser, 643. Oxydum argenti, 99. Oxyhydrocarburetum exoleo pyrox- ilico paratum, 255. Panacea lapsorum, 103. Papaverinum, 218. Pariser blau. 345. Passerage, 716. Pasta seminum paulliniae, 569. Pate de guarana, 569. Paullinia, 569. Perlmoos Irlandisch, 210. PfefferstofT, 572. Pferdekastanie, 410. Pferdekeste, 410. Phloiorrhizina, 571. Phloridzin, 571. Pierre d'aimant, 498. Pigmentum indicurn, 432. Pills, Blaud's, 373. ferruginous, of Vallet, 372. Piper angustifolium, 506. caudatum, 281. cubeba, 281. elongatum, 506. Piperin, 281, 572. Piperina, 572. Pipsissewa, 179. Piscidia erythrina. 722. Platina, bichloride of, 577. muriatica, 577. muriatica natronata, 578. perchloride of, 577. preparations of, 575. Platinae chloridum, 577. Platinchlorid, 577. Platine, bichlorure de, 577. et sodium, chlorure double de, 578. perchlorure de, 577. preparations de, 575. Platini bichloridum, 577. perchloridum, 577. preeparata, 575. Platinoxyd, salzsaures, 577. Platinpraparate, 575. Platinum, 575. bichloratum, 577. bichloride of, 577. chloride of, 577. perchloride of, 577. and sodium, double chloride of, 578. Plocaria Candida, 383. Plomb, chlorure de ; 722. iodure de, 578. nitrate de, 723. tannate de, 580. Plombagine, 339. Plumbago, 339. Plumbi chloridum, 722. hydriodas, 578. ALPHABETICAL CONTENTS. XXV11 Plumbi iodhydras, 578. iodidum, 578. ioduretura, 578. nitras ; 723. tannas, 580. Plumbum iodatum, 578. hydroiodicum, 578. nigrum, 339. nitricum, 723. scytodepsicum, 580. tannicum, 580. Poison nut, 538. Poivre a queue, 281. Polypodium fllix mas, 381. Polyporus officinalis, 138. Polystichum filix mas, 381. Pomegranate, 402. Potassa, arsenite of, 105. chlorate of, 581. hydrocyanate of, 588. hydriodate of, 595. ioduretted, 598. hydrobromate of, 585. hyperoxymuriate of, 581. nitrate of, 724. oxymuriate of, 581. Potassae bromhydras, 585. chloras, 581. cyanhydras, 588. euchloras, 581. hydriodas, 595. hydrobromas, 585. hydrocyanas, 588. murias hyperoxygenatum, 581. murias oxygenatum, 581. nitras, 724. Potasse, bromure de, 585. chlorate de, 581. hydriodate de, 595. iodure de, 595. nitrate de, 724. Potassii bromidum, 585. cyanidum, 588. cyanuretum, 588. hydrargyro-ioditfum, 592. iodidum, 595. iodohydrargyras, 592. ioduretum, 595. oxygeno-chloruretum, 581. proto-hydriodas, 595. protoxidi hydriodas, 595. Potassium, bromide of, 585. cyanide of, 588. cyanuret of, 588. dihydrargyro-biniodide of, 592. hydrargyro-iodide of, 592. iodide of, 595. Potassium, iodohydrargyrate of, 592. ioduret of iodohydrargyrate of,592. ioduret of, 595. protoxide of, chlorate of, 581. Potio picea, 89. Poudre de blanchement, 153. de Tennant, 153. Powder, bleaching, Tennant's, 153. Preta, raiz, 147. Principium adstringens, 33. scytodephicum, 38. Prussiate de potasse et de fer, 345. Pseudoangusturinum, 145. Ptarmica montana, 103. Pulvis ad fumigationes muriaticas, 182. Punica granatum, 402. Purgirkorner-Euphorbie, 334. Pyrola umbellata, 179. Pyrola corymbosa, 179. Pyrole en ombelle, 179, Quecksilber, blausaures, 413. bromid. 412. bromiir, 412. cyanid, 413. deuto-bromur, 412. deuto-iodiir, 421. deuto-iodiir des, 421. iodid, 418, 421. iodid. gelbes, 418. iodidul, 418. iodiir, 418. oxyd, blausaures, 413. oxydul, salpetersaures, 426. praparate, 412. proto-iodiir des, 418. proto-bromure des, 412. Quecksilberiodidkalium, 592. salpetersaures, kaltbereitetes,426. heissbereitetes,427. Quillaia, 512. Quina, 603, see Quiniae. acetica, 605. citrica, 607. Quinia, 603, (for its salts see Qui- nine.) Quiniae acetas, 605. arsenias, 606. arsenis, 607. citras, 607. et cinchoniae tannas, 635. ferrocyanas, 608. hydriodas, 610. iodidum, 610. lactas, 611. murias, 612. nitras, 613. XXV111 ALPHABETICAL CONTENTS. Quiniae phosphas, 613. sulphas, 614. impurus, 636. valerianas, 633. Quinin, 603. Quinina, see Quinine. Quinine, 603. acetate of, 605. amorphous, 637. arseniate of, 606. arsenite of, 607. brute, 604. citrate of, 607. disulphate of, 614. extract of, 636. ferrocyanuret of, 608. hydriodate of, 610. iodide of, 610. iodide of iodhydrate of, 611. lactate of, 611. muriate of, 612. nitrate of, 613. phosphate of, 613. sulphate of, 614. valerianate of, 633. and cinchonine, tannate of, 635. and iron, hydriodate of, 611. Quininum, 603. Quiniodine, 636. Quinium, 603. aiz crusadin preta, 147. Reissblei, 339. Resina chinae praeparata, 636. Rindsgalle, 703. Ringelblume, 150. Rochenleberthran, 546. Rosscastanien, 410. Rosskeste, 410. Russ, 385. Russkali, 389. Rye, corned, 312. spurred, 312. Sabadillina, 678. Saccharum mannae, 503. Safran batard, 212. de mars aperitif, 376. des pres, 223. wilder, 223. Saffron, meadow, 223. Saint Christophe, herbe, 212. Sal essentiale corticis Peruviani,603, Salicina, 637. Salicinum, 637. Salpetersaure, 701. Salt of Derosne, 531. Salzsaure, dephlogistisirte oder oxy- dirte, 189. Salzaure ubersaure, 189. Salzsaures silberammonium, 95. Sanicula Manlandica, 726. Sanicle, 726. Sanicle, Maryland, 726. Sapo domesticus mollis, 641. ex oleo et potassa confectus, 641. elainicus, 641. kalicus, 641. mollis, 641. niger, 641. viridis, 641. Satzmehliodur, 490. Sauerdornbitter, 136. Savon a base de potasse, 641. mou, 641. noir, 641. ScheePsches suss, 400. Schmierseife, 641. griine, 641. Schwanzpfeffer, 281. Schwarzkorn, 312. Schwefelather, 61. Schwefelalcohol, 668. Schwefeliodiir, 673. Schwefelkohlenstoff, 668. Schwererde, iodwasserstoffsaure, 132. Schwindelkorner, 281. Scorodite, 336. Scudamore's mixture, 231. Secale clavatum, 312. cornutum, 312. luxurians, 312. Secalis cerealis, semina monstrosa, 312. mater, 312. Seemoos, Irlandisch, 210. geperltes, 210. Seetang, 210. Seife, kali, 641. schwarz, 641. Seigle cornu ou corrompu, 212. a eperon, 312. ivre, 312. noir, 312. ergote, 312. faux, 312. Sel de Derosne, 531. de Gregory, 531. essentiel d'opium, 531. Senlol atherisches. 559. Serpentaria, cimicifuga, 212. Serpentaria? Braziliensis radix, 147. Sidhee, 166. Silberammonium, salzsaures, 95. chloriir, 94. iodiir, 98. ALPHABETICAL CONTENTS. XXIX Silberammoniumoxyd, 99. oxyd, cyansaures, 97. oxydirtes, 99. praparate, 92. salraiak, 95. salzsaures, 94. zertheiltes, 101. Silver, ammonio-chloride of, 95. chloride of, 94. ckloruret of, 94. cyanide of, 97. cyanuret of, 97. iodide of, 98. ioduret of, 98. metallic, 101. muriate of, 94. and ammonia, chloride of, 95. chloruret of, 95. preparations of, 92. Sinapis oleum, 559. Sipeerine, 133. Snake root, black, 212, 726. Soap, soft, 641. Soda, arseniate of, 105. chlorinata, 643. chloruret of, 643. chlorite of, 643. hypochlorite of, 643. hyposulphite of, 727. phosphate of, 728. Sodae chloridum, 643. chloruretum. 643. hyposulphis, 727. oxymurias, 643. phosphas, 728. Sodii auri-terchloridum, 122. chloroplatinas, 578. Sodium, auro-terchloride of, 122. chloroplatinate of, 578. chlorure d'oxide de, 643. Soldier's weed, 506. Solutio alexiteria oxygenata, 189. chlorinii, 189. ferri nitratis, 361. Solution of chlorine, 189. Goindet's, 597. de Pearson, 105. Donovan's, 429. Fowler's, 105. Lugol's, 489, 598. of nitrate of iron, 361. of persesquinitrate of iron, 361. Soot, 385. Souci, 150. ordinaire, 150. Soude, chlorure de, 643. hyposulfite de, 727. Soude, phosphate de, 728. sulfite sulfure de, 727. Soufre carbure, 668. iodure, 673- Species pro vaporibus superoxydi muriatici, 182. Sphserococcus crispus, 210. lichenoides, 383. Spicanard, 729. Spiegelruss, 385. Spinnblume, 223. Spirit, pyro-acetic, 645. Spiritus pyro-aceticus, 645. salis marini dephlogisticatus, 182, Sponsa solis, 150. Springkraut, kleines, 334. Spur, the, 312. Spurge, caper, 334. garden, 334. Starch, iodide of, 490. Starkmehliodiir, 490. Steinkohlenkali, 82. Stephensia elongata, 506. Stinkstoff, 141. Stockflschleberthran, 545. Stockung des Blutes in der Gefas- sen, 713. Strychna, 649. Strychnia, 649. acetate of, 664. hydriodate of, 665. iodate of, 665. iodide of iodhydrate of, 666. nitrate of, 667. sulphate of, 668. Strychnia and zink, double iodide of, 666. Strychnin, 645. acetat, 664. essigsaures, 664. iodsaures, 665. iodwasserstoffsaures, 665. nitrat, 667. salpetersaures, 667. schwefelsaures, 668. sulphat, 668. Strychnine, see Strychnia, Strychninum, 645. aceticum, 664. iodicum, 665. ' nitricum, 667. sulphuricum, 668. Strychnium, 645. Subjee, 166. Succus limonis, 728. Suffitus chlorini, 182. oxymuriaticus, 182. XXX ALPHABETICAL CONTENTS. Sugar of manna, 503. Suie, 3^5. Sulfure de carbon, 668. Sulphas cadmicus, 705. manganosus, 718. morphicus, 528. quinicus, 614. Sulphur, iodide of, 673. Sulphuret of carbon, 668. Sulphuretum carbonii, 668. Sulphuris carburetum, 668. iodidum, 673. iodu return, 673. Sumbuli radix, 729. Sumbul root, 729. Sumbulwurzel, 729. Superchloridum formylicum, 196. Suppository, galvanic, 399. Swertia chirayita, 399. Tabac de Montagne, 103. des Savoyards, 103. des Vosges, 103. Tang, krauser, 210. Tannas chinii seu cinchonicus seu quinicus, 635. plumbi, 580. Tannic acid, 38. Tannicum, 38. Tannin, 38. Tanninum, 38. Tar water, 89. Tellurismus, 398. Terra aluminis, 101. aluminosa pura, 101. argillacea pura, 101. bolaris, 101. sigillata, 101. The de seigle noirci des sages-fem- mes Americaines, 312. Theervvasser, 89. Thierkohle, 173. Thonerde, gereinigte, 101. reine, 101. Thonerdensalze, 74. Thridace, 496. Tithymalus latifolius, 334. Todtenblume, 150. Tue-chien, 223. Ulva crispa, 210. Urea, 675. nitrica, 677. Ureag nitras, 677. Uree, 675. nitrate de, 677. Uricum, 675. Ussacu, 715. Ustilago, 312. Vallet's ferruginous pills, 372. Vauquelin, 645. Veratria, 678. sulphate of, 687. Veratrin, 678. Veratrina, 678. Veratrium, 678. Verrucaria, 150. Vieillotte, 223. Vinaigre de bois, 13. Violine, 309. Volta ; sche E Voltaism, 392. Vomicina, 145. Vomic nut, 538. Wachholder-oel, brenzliches, 721. Wallnussbaum, 493. Walnut tree, 493. Walschennuss, 493. Wasser, Bineliisch.es, 82. Brocchierisches, 84. oxydirt, salzsaures, 189. Wasserstoffblausaure, 23. Water, Binelii, 82. of bitter almonds, 80. Brocchieri, 84. tar, 89. Weed, soldier's, 506. Weidenbitter, 637. WeidenstofF, 637. "Weisensafran, 223. Winter green, 179. Wintergrun, 179. holdenbluthigen, 179. Wismuth, valeriansaures, 704. Wohlverlei, 103. blumenol, 104. Wohlverleiol, 104. Wolfstrapp, wolliger, 130. Woodsoot, 385. Yerba del Soldada, 506. Zeitlose, 223. Zinc and morphia, double iodide of, 698. and strychnia, double iodide of, 666, butter of, 688. chloride of, 688. cyanuret of, 694. ferrocyanuret of, 695. ferrohydrocyanate of, 695. hydrochlorate of, 688. hydrocyanate of, 694. iodide of, 698. muriate of, 688. prussiate of, 694. Zinci butyrum, 688. ALPHABETICAL CONTENTS. XXXI Zinci chloridum, 688. chloruretum, 688. cyanhydras, 694. cyanidum, 694. cyanuretum, 694. ferrocyanuretum, 695. ferrohydrocyanas, 695. iodidum, 698. ioduretum, 698. valerianas, 699. Zincum borussicum, 694. chloratum, 688. cyanogenatum, 694. ferrohydrocyanicum, 695. hydrocyanicum, 694. iodatum, 698. muriaticum oxydatum, 688. salitum, 688. Zincum valerianicum, 698. zooticum, 699. Zink, baldriansaures, 699. Zinkbutter, 688. Zinkchlorid, 688. Zinkchloriir, 688. Zink, chlorwasserstoffsaures, 688. Zinkcyaniir, 695. Zinkeisenblausaures, 695. Zinkeisencyaniir ; 694. Zinkiodur, 698. Zinkoxyd, eisenoxydul, blausaures, 695. salzsaures, 688. valeriansaures, 699. Zinkoxydul ; blausaures, 695. Zink, salzsaures, 688. Zoomagnetismus, 398. NEW REMEDIES. I. AC'IDUM ACE'TICUM EMPYREUMAT'ICUM. Synonymes. Acidum pyro-aceticum seu Ligni pyro-oleosum seu pyrolig- nosum seu pyroxylicum, Acetum ligneum seu pyrolignosum seu lignorum empyreumaticum, Pyroligneous, and Pyrolignic acid. French. Acide pyro-acetique, A. pyrolignique, A. pyroligneux, Vinaigre de bois. German. Bjrenzliche oder brand ige H ol zsau re ; Holzsaure; Holzessig; Holzessigsaure. Pyroligneous acid, although brought much into notice — revived as it were — in recent times, is by no means the product of those times exclusively. The cedria, with which the Egyptians em- balmed the bodies of the dead, it is presumed, was identical with it. Pliny recommends cedria, or the oil of tar, got from the cedar, in toothach, 1 and Galen unites with him. 3 The virtues of pyroligneous acid are often also referred to by Boerhaave. 3 METHOD OF PREPARING. Pyroligneous acid is prepared in chemical laboratories by the dry distillation of wood, especially of hard wood, which is placed in an iron retort heated to redness. First of all, there passes over a light brown or greenish fluid, which contains some empy- reumatic oil; to this succeeds the pyroligneous acid, which is formed during distillation. If the distillation be continued, more empyreumatic oil passes over, and lastly tar. The chief constituent of pyroligneous acid is vinegar, which can be deprived of its empyreumatic constituents by rectification with fine porous animal charcoal. Besides vinegar, it contains empyreumatic oil (pyrelain ;) empyreumatic resin (jpyrretin,) a peculiar matter containing nitrogen, and similar to an extract (em- pyreumatic extract,) and spirit of tar (spiritus pyrolignicus.) Reichenbach discovered in it the new substance, creasote, 4 which seems to be the most important ingredient, — its medicinal efficacy appearing to be dependent upon that substance. Impure pyroligneous acid is of a brownish colour, and of an acid smoky smell and taste. This is the preparation which is gene- 1 Hist. Nat. xxxiv. 11. 4 De Simpl. Medic. Facult. lib. vii. See Cormack on Creasote, p. 59. Edinburgh, 1836. »P ■ 8 3 Riecke, Die neuern Arzneimittel. u. s. w. S. 6, Stuttgart, 1837. * See the article Creasote. 2 14 ACIDUM ACETICUM EMPYREUMATICUM. rally used externally ; but, by chemical means, the acid may be purified so as to furnish the acidum aceticum empyreumaticum rectiftcatum. This differs from impure pyroligneous acid in con- taining less empyreumatic resin and extract, and creasote. The London College, again, prepare from it a stronger acid, — the acidum aceticum fortius, — which is extremely volatile and pun- gent, and is used as a revellent. EFFECTS ON THE ECONOMY IN HEALTH. From experiments instituted on animals, it would appear, that the administration of pyroligneous acid in large doses occasions vomiting of a considerable quantity of frothy fluid, having a strong odour of the acid; tremors of the limbs; convulsions; tetanus; pro- trusion of the eyes; insensibility; paralysis of the limbs; dyspnoea; croupy cough; hoarseness, &c. The death of the animal super- venes with symptoms of suffocation, and the fatal termination is often rapidly induced. Inspection after death exhibits manifest venous congestion in the brain, spinal marrow, lungs, liver, and spleen, and in the right side of the heart, — with, at times, in- flammation of the stomach. According to Berres, it occasions marked narcotic effects. In by no means considerable doses, he found it to cause violent pain in the stomach and bowels, nausea and vomiting, general weakness, heaviness, vertigo, convulsions, and even death, without exhibiting any decided effect upon the vascular system. In smaller doses, it is said to produce a sensa- tion of burning in the stomach, and after a time to quicken the pulse, and augment the cutaneous and renal depurations. Others — and the best observers, we think — deny it any narcotic pro- perties. 1 As an antiseptic, its efficacy is undoubted, and this has been long known. Creasote is, doubtless, a main agent in producing this result; and wherever the administration of creasote is indicated, the use of pyroligneous acid may be proper. EFFECTS ON THE ECONOMY IN DISEASE. Possessed of the properties described above, pyroligneous acid was at once suggested in cases of gangrene and sphacelus, in which it was successfully used, as well as in cachectic conditions brought on by the misuse of mercury, and in herpetic, flabby, fungous, and sloughing ulcers, in porrigo, and in toothach pro- duced by caries — the acid being dropped upon cotton and applied to the hollow^ tooth. In most of these cases, it was generally ex- hibited both internally and externally. Numerous experiments have been made with it in various affections by different observers; but its use has been more especially extolled in cases of gangrene. in which it corrects fcetor, and promotes the separation of the dead 1 Richter's Specielie Therapie, S. 25p. Berlin, 1 828. ACIDUM ACETICUM EMPYREQMATICUM. 15 parts. 1 The physicians of the Berlin Charite experimented with it in cases of sloughing gangrenous sores, with such success, that they pronounced it an antiseptic of the highest order. 2 Besides the cases mentioned, it has been advised, mixed with white of egg, in excoriated nipples, 3 in cancerous and scrofulous affections, in cancrum oris, by Berres, Klaatsch, Heim and Romberg: in mercurial salivation by Schneider; in caries of the bones, and as a gargle in scarlet fever by Barth. It has, moreover, been re- commended by Buchanan 4 in deafness caused by deficient secre- tion of the cerumen of the ear, and in discharges of an offensive character from the meatus auditorius, as well as from other outlets ; in chronic inflammation of the tarsal edges of the eyelids; in scabies; mfavus by Berres and Wigan ; in toot bach by Berres. In gastromalacia it has been. recommended by Pitschaft 5 and Teufel; 6 in phthisis by Harless, and in dropsy, diarrhoea, putrid nervous fevers, &c, by Ampach ; 7 and in scorbutus by Berres, 8 yet, as was before remarked, it is rarely employed in- ternally: indeed both externally and internally, it has been greatly supplanted by creasote. MODE OF ADMINISTRATION. The inequality in the strength of the preparation renders it diffi- cult to fix upon any precise dose. Of the impure pyroligneous acid, Sachs administered from five to thirty drops, three or four times a day, in simple or aromatic water. Externally, it is applied both in a pure and dilute state; in the former case to ulcers, by means of a pencil, several times in the day. It is generally diluted with simple water: but in cases of cancrum oris, sugared water has commonly formed the diluent. It is also applied at times in the way of cataplasm. As a ivash in porrigo, and as an injection, it may be diluted with six or eight parts of water; as a collyrium, the proportion may be one part of the acid to twelve of water, and it may be employed, of about the same strength, as a gargle. Heim has recommended the following application in cancrum oris. 1 T. Y. Simons, in American Journal of the Medical Sciences, vol. v. 3 Riecke, Op. cit. S. 9. 3 Bursharat, in Gazette Medicale, cited in Amer. Journ. of the Medical Sciences. Feb. 1833, p. 503. 4 Illustrations of Acoustic Surgery, Lond. 1825. 5 Med. Chirurg. Zeitung, iNo. 7, 1825. 6 Annal. fur die gesammte Helkund. unter der Redact, d. Mitglied. der Badensch. S'anitatsk. 2ter Jahrg. 1825. 7 Rust's Magazin, B.xvi. H. 2. S.353, and Richter,Op.cit. B.x. S. 257, Berlin. 1828. 8 Aschenbreuner, Die neueren Arzneimittel und Arzneibereitungsformen u.s. w. S. 7. Erlargen, 1848. 16 ACIDUM ACETICUM EMPYREUMATICUM. Mel acidi acetici empyreumatiei. Honey of pyroligneous acid. R. Acid. acet. empyreum. crud. f giss. Mellis rosas ^j. M. To be applied by means of a pencil. Buchanan advises the following form of injection in cases of purulent discharges from the meatus auditorius. Injectio acidi acetici empyreumatiei. Injection of pyroligneous acid. R. Acid, acetic, empyreum. f gij. Aquae destillatse f £vj. M. Fiat injectio bis die utenda. The following drops he recommends in cases where the ceru- men is deficient in quantity. Guttffi acidi acetici empyrcumatici. Drops of pyroligneous acid. R. Acidi acet. empyreum. crud. Olei. terebinth, rectif. Sp. aetheris sulphur, comp. aa. partes sequales. M. Two drops of this compound are to be dropped every night into the meatus auditorius. Cataplasma acidi acetici empyreumatiei. Cataplasm of pyroligneous acid. R. Furfur, ftss. Lin. pulv. j§j. M. bene et adde Acid, acetic, empyreum. crud. q. s. ut fiat cataplasma. To be applied to foul ulcers. Linimentum acidi acetici empyreumatiei. Liniment of pyroligneous acid. R. Acid. acet. empyreum. ^ss. Myroxyl. gij. Viteli. ovi q. s. ut flat linimentum. To be applied on lint three times a day to sloughs and ulcers. Collutorium acidi acetici empyreumatiei. Mouth-ivash of pyroligneous acid. R. Acid. acet. empyreum. rectif. f ^ss. Aquae cinnamomi f ?iv. Syrup, mori f ^ij. M. Phobus advises this as a wash for the mouth in cases of cancrum oris. It should be kept in a glass vessel covered with black paper to prevent decomposition. ACIDUM BENZOICUM. 17 II. ACIDUM BENZOICUM. Synonymes. Acidum Benzoicum per sublimationem, Flores Benzoes seu Benzoini, Benzoic Acid, Flowers of Benjamin. French. Acide Benzoique. German. Benzoesaure. Benzoic acid exists in the various balsamic substances, as ben- zoin, storax, tolu balsam, &c. METHOD OF PREPARING. In pharmacy it is obtained from benzoin by sublimation. The following process is given in the last edition of the Pharmacopoeia of the United States (1842.) Take of benzoin, in coarse powder, a pound. Put the benzoin, previously thoroughly mixed with an equal weight of fine sand, into a suitable vessel, and, by means of a sand bath, with a gradually increasing heat, sublime until vapours cease to rise. Deprive the sublimed matter of oil, by pressure on bibulous paper, and again sublime. A superior method, according to Messrs. Ballard and Garrod,' is to boil the benzoin in powder with hydrate of lime, so as to form a benzoate of lime, which is dissolved in the water, while the resin remains combined with the lime in the form of an insoluble compound. Muriatic acid being added to the filtered liquid, the benzoic acid is set free, and crystallizes on cooling. Benzoic acid, obtained by the process of the Pharmacopoeia of the United States, is in white feathery crystals, of an agreeable odour, fusible, wholly volatilizable if cautiously heated, and sparingly soluble in cold water, more so in boiling water, which deposits it on cooling; very soluble in alcohol, and readily dissolved by solu- tion of potassa, from which it is precipitated by chlorohydric acid. EFFECTS ON THE ECONOMY. In another work 2 the author has remarked': — "The therapeuti- cal action of benzoic acid is doubtless excitant, and it has been imagined by Dr. Pereira 3 and others, that its influence is princi- pally directed to the mucous surfaces, and especially to the aerian membrane. " The author has no reason for believing in this affi- nity, and such would appear to be the general feeling of the pro- fession, as it is now scarcely used except in one or two prepa- rations, in which it seems to be retained only from old prepossessions and associations. Of late years, however, it has been introduced for a special purpose, and on this account is noticed here. In a paper communicated by Mr. A. Ure to the Medico-chirurgical So- ciety, January 7th, 1841, 4 he stated, that when a certain portion 1 Elements of Mat. Med. and Therap. p. 275, Loud. 1845. 3 General Therapeutics and Materia Medica, 4th edit. 1, 236. Philad. 1850. 3 Elements of Mat. Med. and Therap. 2d Amer. edit. 1, 373. Phila. 1846. 4 Provincial Medical and Surgical Journal, July 17, 1841. 18 ACIDUM BENZOICUM. of benzoic acid or of a soluble benzoic salt is introduced into the stomach, the urine, in the course of a couple of hours, is found, upon adding a portion of muriatic acid, to yield a copious precipi- tate of beautiful rose pink acicular crystals of hippuric acid. In pursuing his investigations farther, he ascertained, that no trace whatever of uric acid or of any of its salts could be discovered in the urine in question. It had been wholly superseded by the hip- puric; and as the salts, which this acid forms with the ordinary bases occurring in the animal fluids, as soda, ammonia and potassa, are all of easy solubility, Mr. Ure inferred, that in benzoic acid we have an agent of great value in the uric acid diathesis : and he affirmed, that " the application of the above principle had proved of material benefit in the treatment of certain unhealthy conditions of the urine occurring in subjects of a calculous or gouty diathesis ; since it enabled the practitioner to obviate entirely the various de- positions resulting from excess of uric acid, the fruitful source of that most distressing malady, stone in the bladder ; as also to con- trol and prevent the formation of the so called tophaceous concre- tions or chalkstones, which occasion so much inconvenience, defor- mity and pain to individuals labouring under gout." The statement of Mr. Ure attracted the attention of chemists, whose observations did not however confirm the inference, that the hippuric acid was formed at the expense of the uric acid in the urine, 1 although they established, that the benzoic acid was con- verted into the hippuric. 3 Neither, therefore, in the uric acid diathesis, nor in cases of the formation of gouty or tophaceous de- posits, the chief constituent of which is generally urate of soda, can the administration of benzoic acid be of service, and its ineffi- ciency in these diseases is now admitted ; 3 but from its power of causing increased acidity of the urine, it has been considered to slightly stimulate the mucous membrane of the urinary organs, and has been found useful in catarrh of the bladder, and in cases where there exists a secretion of granular mucus mixed with phosphates.* The suggestions of Mr. Ure, in regard to the action of ben- zoic acid on the urates, induced Dr. Walker of Huddersfield, 5 to administer it in chronic dysuria incidental chiefly to persons in the decline of life, or in what he terms dysuria senilis, — an affec- tion, which is, of course, dependent upon various pathological con- ditions, — and he asserts, that he was disposed to augur favourably of its utility. " In some instances," he says, " we may account for the benefit resulting from its use by its chemical action on the 1 Keller, in appendix to Liebiofs Animal Chemistry, p. 315, Cambridge, 1842. 3 Garrod, Lond. Edinb. and Dubl. Phil. Mag. June 1842, Lond. Lancet, vol. 2, 1S44, p. 239, and Profs. Booth and Boye, Transactions of the Amer. Philos. Soc, vol. ix. pt. 2, p. 185. Phila. 1845. 3 Ballard and Garrod, op. cit. p. 408. Lond. 1845. 4 Ballard and Garrod, p. 409, and Mr. Ure, Provincial Med. and Sur. Journ. Feb. 11, 1843, and Lond. Lancet, Nov. 16, 1844. 4 Ibid. Feb. 26, 1842. ACIDUM BENZOICUM. 19 urates, which if in excess may add to the acrimony of the urine, and thus prove a source of irritation to the mucous membrane of the bladder. But it is often of service where the gravel in the urine is inconsiderable, and where the irritation and pain w T ould seem to have arisen from some other cause." Dr. Walker, however, used it in association with copaiba; and his remarks induced Mr. Soden 1 to employ the combination in some urinary affections, ac- companied with vesical irritation and increased secretion from the mucous membrane. The most remarkable result appeared to Mr. Soden to be its decided efficacy in diminishing, and in some in- stances of completely suppressing, the muco-purulent deposition in the urine, which is so prominent a symptom in most cases of affection of the bladder. He properly remarks, however, that a doubt may be very fairly entertained, whether this effect be attributable to the benzoic acid or to the copaiba, or to their combination ; and in the doubt Mr. Ure deduces no positive inference in regard to the precise agency of the benzoic acid. 3 It may be concluded, then, that benzoic acid has been introduced as a remedy in lithuria on erroneous chemical deductions : and hence that the favourable results recorded have been fallacious, or depending on other causes. Dr. Seymour 3 states, that he has frequently used the benzoate of ammonia in gout, in cases in which the small joints were red and swollen, or w 7 here fluid was deposited in the joint of the great toe : and also in cases where the urate of soda existed in the joints of the fingers ; and that it was decidedly useful. He thinks, that early depositions were arrested, and large depositions diminished, under its use. He esteems it a good diuretic, and especially adapted for those cases of dropsy, in which an irritable stomach renders the employment of ordinary diuretics impracticable. He has also seen the albumen in renal dropsy diminish under its use. MODE OF ADMINISTRATION. The dose of benzoic acid may be from five grains to half a drachm. Mistura Acidi Benzoici et Copaibse. Mixture of Benzoic acid and Copaiba. R. Acid. Benzoic, gj. Copaib. f gss. Vitel!. ovi q. s. Aq. Camphor, f §vij. M. Dose. Two table-spoonfuls three times a day. 1 Ibid. July 29, 1842. a Ibid. Feb. 11, 1843. 3 Thoughts on the Nature and Treatment of several severe Diseases of the Human Body, vol. i. p. 123, Lond. 1847. 20 ACIDUM GALLICUM. ACIDUM GALLICUM. Synonymes. Gallic acid. French. Acicle Gallique. German. Gallussaure. Gallic acid is by no means so abundant as tannic acid. A so- lution of the latter in water, exposed to the air, gradually absorbs oxygen, and deposits crystals of gallic acid, formed by the de- struction of tannic acid. METHOD OF PREPARING. A strong extract of gall-nuts in cold water may be precipitated in the cold by sulphuric acid : the thick mass must be mixed with dilute sulphuric acid ; be expressed whilst still humid, and be in- troduced, in this state, into a mixture of sulphuric acid with two parts of water at the boiling temperature. The liquid is boiled for some minutes, and then allowed to cool. Crystals of gallic acid are deposited, which may be purified by crystallizing again from water ; — converting the new product — which is still coloured — by means of acetate of lead — into an insoluble gallate of lead, which is washed, then diffused through water, and decomposed by a stream of sulphuretted hydrogen gas. The sulphuret of lead, thus formed, assists in carrying down the colouring matter. 1 It may also be produced by adding sulphuric acid to a solution of tannic acid, which causes a precipitation of the tannic acid in combination with the sulphuric : the precipitate is dissolved in di- lute sulphuric acid by the aid of heat, and the solution is boiled for a few minutes; the tannic acid is all decomposed; and, on cool- ing, crystals of gallic acid, coloured, are obtained. 2 Gallic acid is in thin silky needles. It requires one hundred parts of cold water, and three of hot water, to dissolve it. It is very soluble in alcohol, and slightly so in ether. The solution in water has an acid and astringent taste, and is gradually decom- posed by keeping. EFFECTS ON THE ECONOMY. Gallic acid has long been esteemed a valuable astringent ; yet doubts appear to have been entertained in regard to its being pos- sessed of such property; and until its use was revived of late it had fallen into disrepute. Sir Benjamin Brodie, according to Dr. A. T. Thomson, 3 gave a patient, who had a frightful hemorrhage from the prostate gland, and in whose case all other remedies had 1 Graham's Elements of Chemistry, American edit., p. 637, Phila. 1843. 5 Ballard and Garrod, Elements of Materia Medica and Therapeutics, p. 415, London, lS4r,. 3 Elements of Mat. Med. and Therap. 3d edit., and Watson, in Lond. Med. Gaz. July 8, 1842, p. 547. or in his Lectures on the Principles and Practice of Physic. Amer. edit. p. 921, Phila. 1845. ACIDUM GALLICUM. 21 failed, a dose of" Ruspini's styptic," and repeated the dose twice in the course of twelve hours. About half an hour after the first dose was taken, the bleeding ceased, and it never recurred. This styptic is said to consist of gallic acid, a small quantity of sulphate of zinc, and opium, dissolved in a mixture of alcohol and rose water ; but as the quantity of sulphate of zinc and of opium appears to be too small to influence the medicine, a simple solution of gallic acid in diluted alcohol, it has been conceived, may answer all the purposes of the expensive nostrum. Hence gallic acid has been used in cases in which the styptic has been found efficacious. In a paper read before the medico-chirurgical society of Edin- burgh, Professor Simpson 1 stated, that in the previous year he had employed gallic acid in menorrhagia with the most success- ful results. Some of the cases, which had yielded under its use, were of old standing, and of an aggravated description. He gave it during the interval, as well as during the discharge; and he was first induced to prescribe it from finding that a case of very obsti- nate menorrhagia got well under the use of Ruspini's styptic, after many other remedies had failed. Professor Simpson suggests, whether the anti-hemorrhagic properties of some of our common astringent drugs may not depend upon the gallic acid, as much as, or more than, upon the tannic acid which they contain, or upon the tannic acid becoming converted into gallic acid within the body. Dr. Stevenson 2 has published several cases to show the value of this acid in uterine hemorrhage and hematuria ; and Mr. James S. Hughes 3 has recorded a case of profuse hematuria, the result of injury on the lumbar region, which was treated successfully by it in the form of pill with extract of gentian — two grains and a half of the acid to each pill, — one of these being given at inter- vals of three hours ; and Homburger 4 administered it successfully in hematuria renalis; in bloody diarrhoea accompanying the mor- bus maculosus; and in the hcemoptysis of phthisis. Dr. Christi- son 5 has seen several cases of menorrhagia recover promptly un- der its use. He has likewise seen hematuria repeatedly yield to it, and in two instances of hcemoptysis the hemorrhage rapidly ceased after the third dose of six grains given every hour. Messrs. Ballard and Garrod 6 declare it to be one of the most powerful as- tringents that chemical art has derived from the vegetable king- dom ; and that a tolerably extensive experience by them of its use 1 Lond. and Edinb. Monthly Journal of Med. Science, July, 1843, p. 661. 2 Edinb. Med. and Surg. Journal, July, 1843. 3 Dublin Quarterly Journal of Med. Science, cited in Med. Examiner, July, 1847, p. 447. g 4 Canstatt and Eisanmann's Jahresbericht iiber die Fortschritte in der Heilkunde im Jahre, 1848, S. 149. 5 Dispensatory, American edit, by R. E. Griffith, p. 967. Philad. 1848. 6 Op. cit. p. 415. Lond. 1845. 22 ACIDUM GALLICUM. enables them to declare it to be an invaluable remedy in most forms of passive hemorrhages and fluxes. The chief of the cases in which they have employed it, and where they have found it of the greatest service, are menorrhagia and leucorrhcea, as well as for checking the distressing night-sweats of phthisis. In the first two of these especially, no astringent that they had employed would bear a comparison with this, either for the rapidity with which the cure was effected, or the permanency of the result. Their eulogy, however, of its action in the night-sweats of phthisis is calculated to throw some doubts on the accuracy of their expe- rience in other cases. No medicine can be expected to exert much efficacy on them, any more than on the hectic, inasmuch as they are mere morbid expressions of the condition of the lungs and ge- neral system. Messrs. Ballard and Garrod state, that if the use of the acid be continued beyond two or three days, it manifests some constipating tendency, whilst Professor Simpson affirms that it has the advantage over most other anti-hemorrhagic medicines, that it has no constipating effect. The observations of Messrs. Ballard and Garrod are probably the most accurate. They affirm, also, that the excessive expectorations of chronic bronchitis and phthisis are much influenced by its administration. In leucorrhcea they have found it highly useful as an injection, and Mr. Sampson 1 gave it with good effect in gonorrhoea in the quantity of a drachm in the twenty-four hours, taken in twelve grain closes ; and he places great confidence in its use in cases of albuminuria. Dr. Christison, 3 too, had his attention turned to its apparent power of arresting the excretion of albumen in the urine in Bright 9 s Dis- ease of the Kidney, and in a few instances it appeared to him to have that effect. MODE OF ADMINISTRATION. Gallic acid may be given in doses of from two grains to five or more, in the form of pill, repeated every tw 7 o or three hours. Pilnlre acidi gallic i. Pills of gallic acid. R. Acid, gallic, gr. ij. — v. Confect. rosae q. s. ut fiat pilula. In j ectio acidi gallici. Injection of gallic acid. R. Acid, gallic. >)j. ad JJj. Aquae Oij. M. 1 London Lancet, Dec. 1st, 1849. 2 Qp. cit. ACIDUM HYDROCYANICUM. 23 IV. ACIDUM HYDROCYANICUM. Syhonymes. Acidum Prussicum sen Borussicura seu Zooticum seu Zoo- tinicum, Hydrocyanic, Prussic, Cyanohydric or Cyanhydric Acid. French. Acide Hydrocyanique, Acide Prussique. German. Blausaure,\VasserstofTblausaure, Hydrocyansaure, Cyanwasserstoffsaure. 'This acid can scarcely be looked upon as new ; yet it is only in recent times that its application to pathological conditions has been well appreciated. It was discovered by Scheele in 1780 ; but its preparation in a state of purity, and its exact chemical constitu- tion, were not understood until Gay-Lussac published the results of his investigations on the subject in the year 1815. 1 METHOD OF PREPARING. The three chief modes for preparing hydrocyanic acid at one time received into the pharmacopoeias were those of Scheele, Gay- Lussac, and Yauquelin ; the first of which was adopted by the framers of the United States Pharmacopoeia of 1820, and by those of Belgium, Paris, and Ferrara; the second, by the pharmacopoeias of Paris and Ferrara; and the third by those of Belgium, Paris, and the United States. (Edition of 1830.) 1. Scheele 's Method .— Take of Prussian blue, 128 parts; Red oxide of mercury, 64 parts ; Distilled water, 105 parts. Boil for a quarter of an hour, constantly shaking ; strain, filter, and wash the residuum with Boiling water, 128 parts. Mix the two liquids together ; introduce them into a flask, and add For- phyrized iron filings, 96 parts ; Sulphuric acid (66°,) 24 parts : diluted with Distilled ivater, 24 parts. Shake the mixture, and keep the flask for an hour in cold water ; pour the decanted liquor into a tubulated retort placed in a sand bath, to the neck of which is attached an adapter that passes into a tubulated receiver, whence a curved tube issues that passes into a flask filled with water ; lute the apparatus ; cover the receiver with wet rags ; raise the heat until the liquid boils, and until there have passed into the receiver 192 parts. Add to this liquid, 8 parts of Carbonate of lime. Distil again, and draw off 128 parts, which must be kept iu a bot- tle covered with black paper. The process of Scheele always affords an acid mixed with a va- riable quantity of water. 2. Gay-Lussac 's Method.— Take Cyanuret of mercury, at pleasure. Introduce it into a tubulated retort, the neck of which is furnished with a wide tube of glass filled with broken marble and chloride of calcium, which tube communicates, through a smaller one, with a bell glass surrounded by a freezing mixture. 1 Annates de Chimie, torn, lxvii. p. 128, and torn, xcv. p. 136. 24 ACIDUM HYDROCYANICUM. Pour on muriatic acid sufficient to rise above the cyanuret to the height of a finger; heat gradually and moderately, and receive the condensed product into the bell glass. The acid obtained in this way is anhydrous, and of the specific gravity .700. t Vanquelin's Method. — Take of Cyanuret of mercury, 1 part; Distilled water, 8 parts. Pass a current ofsulphohydric acid gas into the solution, until the gas is in excess ; pour into the liquid pulverized subcarbonate of lead in sufficient quantity to remove the excess of sulphohydric acid ; shake the mixture constantly, and when it has no longer the smell of putrid eggs, and ceases to blacken paper impregnated with acetate of lead, filter and preserve it carefully. The product of this operation has been considered to approxi- mate the average density of the acid of Scheele. 1 The variable density of the acid prepared after Scheele's me- thod has prevented it from being generally used in medicine. The acid of Gay-Lussac is most commonly employed ; but as its de- gree of concentration renders it dangerous, it is diluted with dis- tilled water. Robiquet has proposed to bring its density to .900, by adding two parts of water to it. Thus reduced, it resembles the acid of Scheele, with the advantage, that there is a constant and known ratio between the pure or anhydrous acid and the quantity of water united with it. Magendie adds to it six times its bulk, or eight and a half times its weight, of distilled water, and calls the mixture Acide prussique medicinal, 2 Medicinal jjrussic or Medicinal hydrocyanic acid. Others have advised the employment of a mixture of three parts of water, and one part of acid, under the name of Acide hydrocyanique au quart or "Hydrocyanic acid of quarter strength." 3 Dr. Bache asserts, that he had the process (Proust's or Vau- quelin's) of the United States' Pharmacopoeia (1830) repeated, when he found the acid obtained to have the specific gravity .998. In the last edition of the Pharmacopoeia of the United States, (1842,) the following form was introduced. It is essentially that of the London Pharmacopoeia. Take of Ferrocyanuret of Po- tassium, gij.; Sulphuric acid, giss,; Distilled water, a sufficient quantity. Mix the acid with four fluidounces of distilled water, and pour the mixture, when cool, into a glass retort. To this add the ferrocyanuret of potassium, previously dissolved in ten 1 See Notes on Hydrocyanic acid, by R. E. Griffith, in Philad. Journ. of Pharmacy, iv. 17. Philad. 1833; also, Pereira, Elements of Materia Medica, 2d edit. i. 429. Lond. 1842. The Dispensatory of the United States of America, by Wood and Bache, 6th edit. p. 786, Philad. 1845, and Mr. David Stewart, Maryland Medical and Surgical Jour- nal, April, 1840, p. 264. 2 Formulaire pour la preparation etc. de plusieurs nouveaux medicamens. 3 Pharmacopee Universelle, par Jourdan, i. 31. Paris, 1828. ACIDUM HYDROCYANICUM. 25 fluidounces of distilled water. Pour eight fluidounces of distilled water into a cooled receiver, and having attached this to the re- tort, distil, by means of a sand bath, with a moderate heat, six fluidounces. Lastly, add to the product five fluidounces of dis- tilled water, or as much as may be sufficient to render the hydro- cyanic acid of such a strength, that 12.7 grains of nitrate of sil- ver, dissolved in distilled water, may be accurately saturated by 100 grains of the acid. When hydrocyanic acid is wanted for immediate use, the follow- ing formula is recommended. — Take of Cyanuret of silver, fifty grains and a half; Muriatic acid, forty-one grains; Distilled wa- ter, a fluidounce. Mix the muriatic acid with the distilled water, add the cyanuret of silver, and shake the whole in a well-stopped vial. When the insoluble matter has subsided, pour off the clear liquor and keep it for use. The characters that hydrocyanic acid should possess, according to the forms last given, are as follows : — It is colourless, of a pe- culiar odour, and wholly volatilizable by heat. One hundred grains of it produce, with solution of nitrate of silver, a white precipitate, which, when washed and dried, weighs ten grains, and is readily dissolved by boiling nitric acid. The acid of the Pharmacopoeia of the United States contains two per cent, of pure anhydrous acid. 1 No matter how prepared, hydrocyanic acid should be kept in well-stopped bottles from which the light is excluded. EFFECTS ON THE ECONOMY IN HEALTH. Hydrocyanic acid is usually classed amongst the narcotic poi- sons, 2 yet there is reason for believing, that its ordinary effects are purely sedative. Whilst the agents belonging to the class of nar- cotics produce, first of all, excitation in the organic actions, fol- lowed, sooner or later, when the agent is in sufficient dose, by signs of sedation, this acid would seem to occasion the latter results only. It is the most powerful of our poisons, at times producing, in an adequate dose, the fatal result so suddenly, that the animal ex- perimented upon can scarcely be removed from the lap of the ex- perimenter before all signs of life are extinct. This rapidity of action has seemed to be unfavourable to the idea, that it acts through the mass of blood, and to favour the view of those who believe, that the impression is made immediately on the nerves of the part with which it is placed in contact, or on the nerves that are distributed to the lining membrane of the blood-vessels, as sug- gested by Messrs. Addison and Morgan. 3 The same objection, however, applies to the explanation of these gentlemen as to that 1 Pharmacopoeia of the United States, p. 59. Philadelphia, 1342. 9 Christison, Treatise on Poisons, 1st Amer. from 4th Edin. ed. p. 582. Phila. 1845. 8 An Essay on the Operation of Poisonous Agents upon the Living Body. London. 26 ACIDUM HYDROCYANICUM. which ascribes the effects to the poison being taken into the blood — that the fatal result is often too sudden for us to presume, that it has entered the blood-vessels ; unless we esteem it an agent pos- sessed of powerfully penetrating properties. A female, who was deceived by the odour of a solution of hy- drocyanic acid in alcohol, drank a small vialful, and died in two minutes as if struck with apoplexy. A strong healthy man, thirty-six years of age, being detected in thieving, swallowed a small vialful of the acid, staggered a few steps, and fell dead. Four or five minutes afterwards, the physician who was called found him lifeless, without the slightest trace of pulse or respiration. In a few minutes, convulsive expirations were observed, but no indica- tions of returning life : the face was sunken and livid ; the hands and feet deadly cold ; the forehead and face cold and dry ; and the eyes half open and glassy. 1 M. Damason 2 relates the case of a druggist, who had some hy- drocyanic acid in a vial with a ground stopper, and, as it had been prepared almost three months, thinking that it was decomposed, he opened the vial, and applied it to his nose to ascertain whether the acid retained any smell ; he instantly fell down, and remained for half an hour without giving the slightest signs of life ; but finally recovered after an illness of several days. Many experiments have been made on animals with this acid. A drop, introduced into the bill or anus of a sparrow, induced death in from one to two minutes, preceded by convulsions. Even holding the bill over a vial filled with the acid proved fatal. A duck was destroyed by fourteen drops. Twenty drops introduced into the stomach of a rabbit killed it in three minutes. When a few drops were injected into the jugular vein, death supervened still sooner. A small dog, to which two drops had been given, experienced shortness of breath, staggered, fell, passed its urine re- peatedly, vomited twice, and afterwards seemed quite well. The same animal took, five hours later, eight drops, and fell into a te- tanic, comatose condition, but recovered in half an hour. More severe but not fatal effects resulted from sixteen drops. Thirty to forty drops administered to dogs and cats produced violent con- vulsions and death, in from six to fifteen minutes. The experiments of Emmert and Coullon seem to have shown that the action of hydrocyanic acid is more violent when it is in- jected into the jugular vein, or inhaled in a concentrated form; less so when injected into the rectum. In the case of a horse, into whose jugular it was injected, death occurred in twenty-one mi- nutes. When placed in contact with the dura mater, or with 1 Hufeland. Journal der Practisch. Heilkund. Band. xl. St. 1. S. So— 02. and Osann, in Art. Blausaure, in Encyc. YVorterb. der YIedicinischen "VYissenschaft. Band. t. S. 528, Berlin, I 1 Journal de Chiraie Medicale. Juin, 1531. ACIDUM HYDRO CYANICUM. 27 nerves, no striking phenomena were perceptible. This fact was confirmed by Viborg. 1 On the other hand, when received into a wound in its concentrated state, it acts most violently. Scharring, w T ho broke a class containing the acid, and received some of it into the wound produced thereby, died in an hour after the accident. It is not easy to deduce comparative results from the discordant statements of different experimenters, inasmuch as we are ignorant of the precise strength of the acid employed. A French physician made some experiments on the uncertainty of the strength of the medicinal acid ; and found, that he could swallow a whole ounce of one sample, and a drachm of a stronger sample, without sus- taining any injury: but on trying some, which had been recently prepared by Vauquelin, he was immediately taken ill, and nar- rowly escaped with life. 3 Dr. Pereira 3 caused the instantaneous death of a rabbit by applying its nose to a receiver filled with the vapour of the pure acid: the animal died without a struggle. A drop of the pure acid of Gay-Lussac, placed in the throat of the most vigorous dog, caused it to fall dead after two or three hur- ried respirations. 4 We have already alluded to the effect of the acid when dropped upon the conjunctiva — a mucous surface, and therefore possessed of highly absorbing powers; but it cannot even be placed w T ith im- punity in contact with surfaces, which, owing to their being co- vered with cuticle, do not readily absorb. Orfila 5 states, that a professor of Vienna having prepared a pure and concentrated acid, spread a certain quantity of it on his naked arm, and died a short time afterwards. Dr. Christison, 6 however, says this was proba- bly a mistake. On repeating some of the experiments, he found y that a single drop, weighing scarcely a third of a grain, dropped into the mouth of a rabbit, killed it in eighty-three seconds, and began to act in sixty-three ; that three drops, weighing four-fifths of a grain, in like manner, killed a strong cat in thirty seconds, and began to act in ten ; that another was affected by the same dose in five, and died in forty seconds; that four drops, weighing a grain and a fifth, did not affect a rabbit for twenty se- conds, but killed it in ten seconds more ; and that twenty-five grains, corresponding with an ounce and a half of medicinal acid, began to act on a rabbit, as soon as it was poured into its mouth, and killed it outright in ten seconds at farthest. Three drops, projected into the eye, acted on a cat in twenty seconds, and killed it in twenty more; and the same quantity, dropped on a fresh 1 Osann, loc. cit. S. 580. 2 Revue Medicale, xvii. 265, and Christison on Poisons, 1st American Edit. p. 582. Fhila. 1845. 8 Elements of Mat. Med. &c, 2d edit. i. 437, Lond. 1842, * Magendie. in Annales de Chimie et de Physique, vi. 347, and Formulaire, &c. 5 Toxicologic 6 Op. cit. p. 592. 28 ACIDUM HYDROCYANICUM. wound in the loins, acted in forty-five, and proved fatal in one hundred and five, seconds. 1 As before remarked, from the rapidity with which the toxical effects are observed after hydrocyanic acid has been taken, it has seemed to be almost impossible for the poison to have entered the blood-vessels, and have passed with the current of the circulation to the great vital organ on which its deleterious agency is exerted. The well devised and carefully conducted experiments of Professor Blake, 3 of St. Louis, show, however, that in the case of this poison, as of every other, the velocity of the circulatory current is so great, as to enable us to understand that the deadly influence may be exerted in all cases by the reception of the poison into the blood. He found, that sufficient time always elapses between the applica- tion of the poison and the first evidences of its action to admit of such contact. In an experiment on a rabbit with hydrocyanic acid, 3 the animal, immediately after the contact of the acid with the lining membrane of the mouth, jumped from the table, and when on the floor was perfectly able to stand on its feet. At two seconds and a half after the application of the poison it fell on its side, and in five seconds was dead. " This," says Dr. Blake, " is but one of many experiments which have been performed on cats and rabbits, and in no instance have I observed instantaneous death, or even the instantaneous action of the poison." 4 If given in rather too strong a dose, or — if in proper doses — at too short intervals, it produces headach, and vertigo, which go off, however, in a few minutes. When inhaled, even if diluted with atmospheric air, it causes vomiting, prostration, pains in the back part of the head, and great diminution of the arterial pulsations. In a more concentrated state, the effects are more rapidly fatal than in any other form of administration. M. Robert found, that when a bird, a rabbit, a cat, and two dogs, were made to breathe air saturated with its vapour, the first and second died in one se- cond ; the cat in two seconds, one dog in five, the other in ten se- conds. 5 With regard to the parts of the economy that are primarily acted upon by the hydrocyanic acid after it has entered the blood, most observers have designated the nervous system. 6 In no other way, it has been conceived, is it as easy to account for the extreme 1 See, also, Geoghegan, in Dublin Medical Journal, for 1835, and Pereira, Op. cit p. 24-2. 2 Edinb. Med. and Surgical Journal, April, 1839, p. 339, and St. Louis Med. and Surg. Journal. Nov. and Dec., 1848. 3 American Journal of the Medical Sciences, July, 1849, p. 106. * See the Author's General Therapeutics and Materia Medica, 4th edit., 8vo., Phila. 1840. 5 Annales de Chimie, xcii. 59. 6 Lonsdale, Edinb. Medical and Surgical Journal, January, 1839. and Lond. Lancet, June 15th, 1839, p. 440. ACIDUM HYDROCYANICUM. 29 rapidity of its action in fatal cases. When mixed with the blood, however, out of the body, it altogether changes the character of tkat fluid, and opposes its coagulation; 1 and a recent writer, M. Coze, 2 of Strasburg, is of opinion, that it affects more especially the circulatory apparatus; death resulting from the suspension of the movements of the heart, and the constriction of the ultimate arterial divisions, whence follow repletion of the larger arterial trunks and stasis of the blood— the convulsions being owing to a defective supply of blood to the spinal marrow. Some of the Ger- man writers 3 have endeavoured to indicate three grades of its ac- tion on the economy. First. In moderate doses, long continued, it occasions a marked diminution in the action of the nervous and vascular systems; vertigo; disposition to syncope; epistaxis as a consequence of thinness of the blood; and a disposition to putrid diseases.* Secondly. In larger doses, the sedative effect of the acid on the spinal marrow, and the abdominal ganglia, is indicated by feelings of weakness, numbness, tremors, and other involuntary motions of the extremities; involuntary discharge of the urine and faeces; augmentation of the cutaneous and urinary depurations; palpitations; anxiety at the prsecordia ; weak pulse; and, accord- ing to some, headach, especially in the back part of the head; ex- coriation of the tongue and inner parts of the cheeks, 5 and saliva- tion. This last symptom is given by Dr. Christison 6 on the au- thority of Drs. Macleod and Granville. 7 It has been suspected, however, that salivation, in these cases, was brought about by the use of an impure acid, containing probably a small quantity of the corrosive chloride of mercury, particularly if the acid had been pre- pared — according to the process of the Dublin College — with bi- cyanuret of mercury, muriatic acid and water. Mercury is, indeed, asserted to have been actually discovered in the acid by Sylvester's test. Thirdly. In still larger doses, it induces violent affections of the spinal marrow, convulsions, trismus, opisthotonos, emprosthoto- nos, fainting, &c. From the results of all his observations, Osann 8 infers, that hy- drocyanic acid acts dynamically on the nervous system, by di- minishing, depressing, and annihilating its life; and, through the nervous system, affecting the organs of vegetation or nutrition, and of hsematosis; — that it incontestably has a specific relation to the spinal marrow, the ganglions of the abdomen, and the dependent 1 Magendie, Lectures on the Blood. Lect. xvii. in Lancet, for Jan. 26, 1839, p. 636. and Blake, Op. cit. 2 Bouchardat, Annuaire de Therapeutique pour 1850, p. 20. Paris. 1850. 8 Richter, Specielle Therapie, Band. x. S. 280. Berlin, 1828; and Osann, loc. ck. S. 527. 4 Encyc. Worterb. B. ii. S. 315. Berlin, 1828. * Born, in Rust's Magazin, B. xiii. S. 282. 6 Op. citaf. ' Lond. Med. and Phys. Journ. xlvi. 359 and 363. 3 Loc. citat. S. 526. 30 AC1DUM HYDROCYANICUM. organs; and hence it is, that, in comparison with other narcotic agents, it is less stupefying, whilst it influences more deeply the phenomena of vegetative or organic life. He properly remark^ however, that the inferences of Jorg, 1 from his experiments, are apparently opposed to this view. Jorg considered its effects upon the brain to be excitant, and that it occasioned turgescence of that organ. There would seem to be no distinct evidence of hydrocyanic acid being a cumulative poison, although this has been at times sus- pected. Its operation must be diligently watched at first, until the proper dose is ascertained. This, says Dr. Christison, 2 is the only secret for using it with safety and confidence. EFFECTS ON THE ECONOMY IN DISEASE. From the effects produced by the hydrocyanic acid on the healthy body, we may infer the cases of disease in which it may be indicated. It is decidedly sedative, allaying nervous irritability and vascular action, and therefore adapted for all cases in which these are inordinately excited. Yet its power, as a medicinal agent, is not as great as was at one time presumed, and as is still presumed, by many. In some countries, too. it has found more favour than in others. In Italy, France and England, it has been more extensively used than in Germany ; yet in many of the Phar- macopoeias of the last country it has been admitted into the list of officinal agents. The great objections that have been urged against it are — its danger, even in a small dose, if not carefully adminis- tered; the difficulty of having it always of the same strength; the impossibility of administering it undiluted, and the danger of giving too strong a dose in consequence of its rising to the surface of water. More than once the difference in the strength of the acid prepared by different methods would seem to have occasioned un- fortunate results. Orfila, 3 mentions the case of a sick person, who had used it for a length of time in increasing doses, with advan- tage; when, being compelled to send her prescription to another apothecary, the acid he employed was so strong as to produce death, w T ith all the symptoms of poisoning by hydrocyanic acid. For these and other reasons, Riecke, L. W. Sachs, and Osann greatly prefer the Aqua laurocerasi and the Aqua amygdalarum amararam, which, although in other respects not less objection- able, are less dangerous. 4 Sir George Lefevre 5 affirms that cherry-laurel water is a more effective preparation than hydro- 1 Materialien zu einer kunftigen Heilmittellehre, B. i. S. 53, 117. J On Poisons, edit. cit. p. 588. 3 Toxicologic * Die neuern Arzneimittel, u. s. w. von V. A. Riecke, S. 5. Stuttgart, 1837; Osann, loc chat, and Enoyclopad. Worterb. ii. 315. 5 An Apology for the Nerves, &c. p. 291. Lond. 1S44. ACIDUM HVDROCYANICUM. 31 cyanic acid. In many nervous affections, as palpitation, hysteria, &c, he generally prescribes the following draught: R. Aq. lauro-cerasi wj/ xx. flor. aurant. f §i. Syrup tolut. f^j. M. The draught to be taken pro re nata. Possessed of the powerful sedative agency which has been de- scribed, it is not to be wondered at, that hydrocyanic acid should have been given in a multitude of cases; and, as constantly hap- pens, that unsuccessful trials, suggested by the merest empiricism, should have been made with it. It is rarely employed \w fevers, — intermittent, remittent, or con- tinued. By many, it has been esteemed beneficial in hectic; but here its agency must be doubtful. 1 In inflammations, especially when accompanied with marked erethism of the nervous system, it has been greatly extolled, and, next to blood-letting, has been regarded by many as one of our most valuable antiphlogistics. The followers of the contra-stimu- lant school esteem it as one of their most efficacious contra-stimu- lants. In the acute inflammations of internal organs, it has been highly recommended by the Italian physicians, Borda and Brera ; in thoracic inflammation, after blood-letting, in conjunction with tartrate of antimony and potassa, and similar sedative agents; and by others in enteritis, metritis, and nephritis, and in active he- morrhages. In chronic inflammations it has been advised by Granville, Magendie, Heller, Elwert, Behr, Roch, &c., and espe- cially in chronic catarrh, bronchitis, and hoopi7ig cough. In the last affection it is conceived by Dr. A. T. Thomson 2 to be " the sheet anchor of the practitioner;" and by Dr. Roe 3 to pos- sess a " specific" (?) power. In warm weather, he thinks, it will cure almost any case of simple hooping cough in a short time ; in all seasons it will abridge its duration, and in almost every instance, where it does not cure, it will, at least, materially relieve the se- verity of the cough. In pulmonary consumption it has been recommended by Gran- ville, Magendie, S. G. Morton, 4 Fantonetti, 5 and others, parti- cularly where there is any inflammatory or spasmodic complication ; but others as Neumann, Weitsch, Sir James Clark, Andral, 6 For- get, 7 and, we may add, ourselves, have given it in these very cases without any success. By some, indeed, it has been affirmed, that 1 See the author's General Therapeutics and Mat. Med., 4th edit. ii. 183, Phila. 1850. 3 Elements of Mat. Med. and Therapeutics, i. 435. Lond. 1 832. 3 A Treatise on the Nature and Treatment of Hooping Cough, &c, p. 10. Lond. 1838. 4 Illustrations of Pulmonary Consumption, p. 131. Philad. 1834. 8 Gazette des Hopitaux, 19 Fev., 1839. 6 Bulletin General de Therapeutique, Mars, 1840. 1 L'Experience, 14 Nov., 1839; and Amer. Med. Intel., Sept. I, 1840, p. 170. 32 ACIDUM HYDROCYANICUM. its administration in phthisis is to be adopted with caution, as in many cases, instead of allaying, it appears to increase, the cough and fever, diminish the expectoration, and occasion a sense of suf- focation. 1 It has been, moreover, asserted, that its depressing and destructive agency has acted injuriously on the organism of the consumptive. 3 In chronic nervous diseases, especially when of a spasmodic character — as in spasmodic affections of the heart — even when organic, hydrocyanic acid has been advised as a soothing agent, as well as in spasmodic asthma; in the sense of suffocation that accompanies hydrothorax and other affections; and in spas- modic dysphagia. Its efficacy, too, has been marked, according to Dr. Elliotson, 3 in various neuropathic disorders of the sto- ?nach, especially in those in which pain at the epigastrium was the leading symptom, — in every form, indeed, of gastrodynia; and in painful affections of the bowels, of a similar character — enteralgia — it has been found useful by Dr. Pereira. 4 In enlargement of the heart it was found by Heller to dimi- nish the force and frequency of the pulsations, and in this way to afford essential relief. In an old person, labouring under anasarca accompanied by great pain in the breast, Dr. Rees observed, after the administration of Vauquelin's acid, great diuresis, with the removal of the dropsy and its concomitant symptoms. 5 In the asthma pulverulent urn of the Germans, (Staubasth- ma,) that is, in the variety to which millers, bakers, grinders and others are liable, Creutswicher is said to have found it highly serviceable. 6 Its efficacy has not been so marked in epilepsy, chorea, and kindred affections; yet it has been strongly recom- mended in tetanus. Trevezant ordered it in a case of trauv/atic tetanus, after opium had been given in vain, in the dose of from two to twelve drops with favourable results. 7 On the other hand, Klein gave it in a similar case, with no other apparent effect than that of rendering death more easy. 8 It has likewise been advised in spasmodic pains of the uterus. Yet, although it would seem to be soothing and antispasmodic in many cases of erethism, Grin- del and Osann 9 consider it by no means adapted for the radical cure of spasmodic diseases. In violent neuralgia, especially in an impressible condition of 1 Schneider, Med. prakt. Adversarien am Krankenbette, Erste Liefer. S. C2, referred to by Osann. a Siebergundi, in Hufeland's Journal der pract. Heilkund. B. liii.. St. 6, S. 15. ' On the Efficacy of Hydrocyanic or Frussic Acid in Affections of the Stomach, &c. Lond 1820. 4 Op. citat., p. 443. s Osann. Op. cit.. and Harle?s, Uhein-Westphal. Jahrbuch. Bd. x. St 1, S. 82. • Kust's Masazin, Bd. xxii. S. 33n. • Frnriep's Notizen, Bd. xiv. No. 15, S.324. 8 Heidelberger Klinische Annalen, Bd. ii. S. 112. 9 Loc. citat., S. 535. ACIDUM HYDROCYANICUM. 33 the vascular system in nervous cephalalgia, hemicrania, tic douloureux, and in gouty rheumatic sciatica, it has been ex- tolled. Dr. E. S. Bonnet, 1 of Charleston, treated successfully some cases of facial neuralgia of great severity, by applying it externally in the form of the distilled water of prunus lauro-cera- sus. It is proper, however, to remark, that in two of the three cases described, belladonna was employed in combination. The mode of applying it was by lotion, composed of four ounces of the laurel water, one ounce of sulphuric ether, alone, or with half a drachm or a drachm of extract of belladonna. With this lotion the affected parts, previously covered with carded cotton or cotton wadding, were kept constantly wet. It has likewise been recom- mended by Dr. Elliotson 2 in the cure of vomiting not dependent upon inflammation. These are the chief cases in which its internal use has been prescribed. It has been employed externally in the following. As a soothing agent in severe pain; — for example, in toothach from caries; one to two drops, according to Ehvert, being put into the hollow tooth. Krimer applied it in a dilute state to painful wounds; and it has been injected with advantage into fi sluice. In neuralgia, the application of a cataplasm of belladonna and hydrocyanic acid has been advised by some. In cutaneous affections, of an itching, painful or inflammatory nature, it has been used with much success. In five cases of ob- stinate herpes, Schneider used a solution of the acid in alcohol: in similar cases Dr. A. T. Thomson, besides „the use of a purgative of calomel and colocynth, applied compresses to the parts wetted with the dilute acid. In two cases of impetigo, the local applica- tion completely allayed the distressing and intolerable itching and tingling, after other external applications, and the internal use of anodynes, had been of no avail. The discharge was diminished and rendered milder: alterative doses of mercury, combined with sarsaparilla, formed the internal treatment. 3 Dr. Thomson found the lotion useful, in combination with small doses of corrosive chlo- ride of mercury, in acne rosacea, and in several other cutaneous affections. In herpes, Magendie advises a lotion of hydrocyanic acid and lettuce water in the proportions mentioned hereafter. The acid has likewise been used, in the form of glyster, in scir- rhus of the pylorus, in the strength of six drops of Vauquelin's acid to eight ounces of water; 4 and uterine pain from scirrhus, injections of the acid, combined with infusion of belladonna, have been employed with advantage. 1 North American Archives of Medical and Surgical Science, April, 1835. 3 Lond. Med. Gazette. 1831, and Amer. Journ. of Med. Sciences, May, 1831, p. 242. 3 London Medical and Physical Journal, Feb. 1822; and the author's edit, of Magen- die's Formulary, p. 112. Lond. 1824. Philad. 1825. * Bernd, in Rust's Magazin. Bd. xiii., S. 273. 04 ACIDUM HYDROCYANICUM. In ophthalmia, especially of the scrofulous kind, with engorge- ment of the conjunctiva, it has been advised by Elwert 1 — two drops of the acid being mixed with a drachm of water, and a little dropped frequently into the eye ; and it has been given in the ac- tive inflammatory stage of blennorrhcea. 2 Its vapour has been advised in amaurosis, and in opacity of the cornea; 3 but it does not seem to be entitled to much credit in those affections. Lastly, when a portion of tcenia has protruded from the rectum, it has been advised by Cagnola, Golnecke,and others, that hydro- cyanic acid should be applied to it with the view of destroying it. 4 Such are the principal affections in which the hydrocyanic acid has been used. The author has often employed it internally in many of the cases recommended, especially in painful affections accompanied by great nervous impressibility, and in consumption, but he has not had sufficient reason to place it high in rank amongst medicinal agents. 5 He has certainly had no evidence, that it can cure consumption when not beyond its first stage, as remarked by Magendie. 6 If the practitioner will bear in mind the effects which the acid is capable of inducing upon healthy man, when the dose is carried to the requisite extent, he will have no difficulty in deciding upon the cases in which its agency may be appropriate. If not a true sedative, it is the nearest approach to one in the catalogue of the materia medica ; and therefore its employment is clearly indicated in all.diseases in which there is much erethism, — administered alone or along with other appropriate agents. MODE OF ADMINISTRATION. After the remarks that have been made on the varying strength of the hydrocyanic acid, according to the particular form by which it may have been prepared, it is hardly necessary to say, that the physician must be acquainted with the character of the acid he prescribes. The ordinary dose of that of the Pharmacopoeia of the United States is a drop, given three times a day in a little sugared water: it must be borne in mind, however, that the spe- cific gravity of the acid is less than that of water, and hence the necessity of dropping the quantity of acid at the time of using it, rather than forming a mixture with a larger quantity of the acid, which will certainly rise to the surface, if the mixture be put to 1 Rust's Magazin, B. xiii., S. 182. 1 Ibid. B. xiii., S. 228. 3 Paterson in Lond. iMed. Oaz. May 15, 1844, p. 808. 4 Osann. Op. cit. and Gerson and Julius, Magaz. d. ausliindischen Litteratur der gesammt. Heilkund. B. ii. 177. Also, Hufetand und Osann's Journal der prakt. Heil- kund. 13d. lviii , St. 6. S. 122, and Richter, Op. cit, S. HIS. 1 See, also, Becquerel, Gazette Medicale de Paris, 13 Jan., 1840. s The author's edit, of his Formulary, p. 108. ACIDUM HVDROCYANICUM. 35 one side : and unless the vial is shaken, a much larger dose may- be administered than was intended. It must also be recollected, that the acid loses its strength by keeping. Magendie remarks, 1 that when left to itself in a close vessel, it sometimes becomes de- composed in less than an hour, and that it rarely preserves its in- tegrity for more than a fortnight. The substances that are incompatible with it in the same pre- scription, are most metallic oxides, particularly those of mercury and antimony, nitrate of silver, salts of iron, sulphurets, mineral acids and chlorine. The proper plan is to begin with a small dose and to augment it carefully until some effect is induced, but if any of the signs — mentioned above as indicating the supervention of the sedative effects of the acid — should supervene, it ought to be discontinued. Magendie, it has been seen, uses the hydrocyanic acid of Gay- Lussac, diluted with 8.5 times its weight of water; and this mix- ture he denominates medicinal prussic acid. The following are forms in which the acid may be administered. Mistura acidi hydro eyanici. Mixture of hydrocyanic acid. (Melange pectoral.) R. Acidi hydrocyanici medicinalis f gj. Aquae destillatas Oj. Sacchari albi Jiss. M. A dessert-spoonful of this is directed to be taken every morn- ing and evening at bed time — the dose being gradually increased to six or eight spoonfuls in the 24 hours. Magendie. R. Acidi hydrocyanici (Scheele's) ttLxij. Vin. antimon. f gj. Tinct. opii camphoratae f giiss. Aquae camphorae f ^vijss. Fiat mistura. Dose. — In hooping cough, a table-spoonful every four hours for a delicate boy four years old, to be given in some warm drink. The child to remain in a warm room, and to live upon light pudding and broth. Roe. R. Acidi hydrocyanici (Scheele's,) Ttl xx. Vin. antimon. f giss. ipecacuanhae f giss. Aquae f gxiij. Fiat mistura. Dose. — A tea-spoonful every two hours for a healthy-looking female child, five years of age. Roe. Syrupus acidi hydrocyanici. Syrup of hydrocyanic acid. R. Syrupi purificat. Oj. Acidi hydrocyanici medicinalis f 3j. M. 1 Op.citat. p. 104. 36 ACIDUM LACTIS. This syrup may be added to common pectoral mixtures, and used as other syrups are, Magendie. Lotio acidi hydrocyanici. Lotion of hydrocyanic acid. R. Acidi hydrocyanici f ^ss. Alcohol, f 3j. Aquae destillat. f ^xss. This was the lotion employed by Professor Thomson in cases of impetigo. The following was used by Schneider in herpes. R. Acidi hydrocyanici f ^iss. Alcohol, f£vi. M. And in the same cases Magendie employed the subjoined for- mula. R. Acidi hydrocyanici f.^ij. Aqua? lactucae Oij. M. The distilled water of the garden lettuce probably contains no- thing to recommend it over common distilled water. Dr. Joy 1 advises the following lotion in acne and impetigo to correct itching; and in ulcerated cancer to diminish pain. R. Acid, hydrocyan. dil. f 3i— 31V. Decoct, malvse Oj. M. The bottle should be shaken before each application. All these formulae are objectionable for the reasons before as- signed; and it is consequently better to drop the acid at the time of using it, taking care that it has not lost its properties. V. ACIDUM LACTIS. Synonymes. Acidum Lacteum seu Lactis seu Lacticum, Lactic Acid ; Acid of milk. French. Acide Lactique. German. Milchsaure. This acid has been recommended as a therapeutical agent by Magendie. 3 METHOD OF PREPARING. Lactic acid maybe obtained either from milk or from the ju ice of the red beet. In the latter case, the juice is put in a situation the temperature of which is between 77° and 86° Fah. After the lapse of a few days, a commotion is observed in the mass, which 1 Tweedie's Libr. of Med., v. 288, Lond 1840, or Araer. edit 2 Forraulaire pour la preparation et l'emploi de plusieurs nouveaux medicamens, &c, Edit. Oerne. Paris, 1836. ACIDUM LACTIS. 37 is known under the name " viscous fermentation," {fermentation visqueuse,) and hydrogen and carburetted hydrogen are evolved in considerable quantity. When the mass has become fluid again, and the fermentation has ended, which generally requires about two months, it is evaporated to the consistence of syrup, the whole then becomes traversed by a multitude of mannitic crys- tals, which — when washed with a small quantity of water, and dried — are entirely pure. The mass, moreover, contains a saccha- rine matter, which affords all the signs of the sugar of the grape. The product of the evaporation is next treated with alcohol; this dissolves the lactic acid, and precipitates several substances that have not yet been examined. The alcoholic extract is then dis- solved in water, which occasions a fresh precipitation. The li- quid is now saturated with carbonate of zinc, and by this means a fresh precipitation is effected, more copious than the preceding. By concentration, the lactate of zinc snoots into crystals, which are collected and heated in water, to which animal charcoal, previously washed in muriatic acid, has been added : the fluid is then filtered, and the lactate of zinc is deposited in perfectly white crystals : these are washed in boiling alcohol, in which they are insoluble; afterwards they are treated with baryta, and then with sulphuric acid, which separates the lactic acid. This is finally concentrated in vacuo. 1 Mitscherlich 2 gives the following process for preparing it pure. Lactate of lead, formed in the usual way, is decomposed by sul- phate of zinc; the sulphate of lead is separated, and the lactate of zinc crystallized by evaporation; this is at first yellow, but by repeated crystallizations it is obtained of a pure white. This so- lution of the lactate is decomposed by pure baryta; the oxide of zinc separated, and the lactate of baryta, which is in solution, is decomposed by sulphuric acid, and the fluid evaporated; this yields a clear, colourless, syrupy, not volatile acid, which is de- composed, and leaves a residue of charcoal when heated at a suffi- ciently high temperature. Milk, which has been suffered to ferment for a long while, and is treated in the same way, affords lactic acid. Corriol has like- wise detected it in an aqueous infusion of the nux vomica. When concentrated in vacuo until it parts with no more water, lactic acid is a colourless liquor, of syrupy consistence; its specific gravity being about 1.215. It is inodorous, but of a very sour taste, similar to that of the strongest vegetable acids. When ex- posed to the air, it attracts moisture. Water and alcohol dissolve it in all proportions. One of its most striking properties, which 1 Gay-Lussac and Pelouze, Annates de Chimie et de Physique, Avril, 1833. (Tom. KL 410.) 2 Report to British Association, 2d meeting, and Phila. Journal of Pharmacy, vi. 83. Philadelphia, 1834-5. 38 ACIDUM LACTIS. is of especial interest to the physician, is, that it quickly dissolves phosphate of lime, especially that which is contained in bones. EFFECTS ON THE ECONOMY. As lactic acid was conceived to play a part amongst the juices which effect the solution of the food in the stomach, Magendie thought it might be given with advantage in cases of dyspepsia produced by simple debility of the digestive apparatus ; and his experiments afforded him very encouraging results. In consequence of the facility with which lactic acid dissolves phosphate of lime, it has been suggested, whether it might not be administered with advantage in cases of white gravel, or, in other words, of phosphalic depositions from the urine. Magen- die has not yet been able to institute experiments on this matter. At the time when the edition of his Formulary, to which we have referred, was published, he had commenced some clinical experi- ments with lactate of potassa, and lactate of soda, but without any results worthy of being communicated to the profession. He re- commends these salts, however, to the attention of physicians. MODE OF ADMINISTRATION. Magendie gives lactic acid either in the form of lemonade or of lozenges. Potus acidi lactis. Lemonade of lactic acid. R. Acid. lact. liquid, f 3j. ad giv. Aquae Oij. Syrupifgij. M. Pastil li acidi lactis. Lozenges of lactic acid. R. Acid. lact. pur. gij. Sacch. pulv. ^j. Gum. tragac. q. s. 01. aether, vamgl. gtt. iv. M. Make into lozenges weighing half a dram each. Let them be kept in a well closed vessel. Of these, from two to six may be taken in the 24 hours without any evil consequences. VI. AC'TDUM TAN'NICUM. Synonymes. Acidum Quercitannicum, Tanninum Puram, Tannicum, Prin- cipium Adstringens seu Scytodephicum, Tannin, Tannic acid. French. Acide Tannique. German. Tannin, Gerberstoff, Gerbsaure. This article, in its pure state, has been subjected to experiment of late years only. ACIDUM TANNICUM. 39 METHOD OF PREPARING. According to Buchner, 1 tannic acid should be prepared for me- dical use in the following manner. From eight to twelve parts of hot water must be poured on one part of powdered galls, and the mixture be allowed to digest for an hour, frequently agitating it. It must then be filtered, and the residue be again treated in the same manner with a little hot water. The different infusions, which generally pass through the filter turbid, must be mixed to- gether, and a little dilute sulphuric acid be added by drops, con- stantly shaking the mixture so long as any precipitate of tannic acid follows. The acid is deposited very soon in this way, in a collected yellowish white, gelatiniform mass, which by the influ- ence of air gradually assumes a brown colour. After the fluid is poured off, the residue is washed twice with cold water acidulated with sulphuric acid : carbonate of bary- ta, or carbonate of potassa, is then added to it in small portions, carefully shaking the mixture, until there is no farther efferves- cence, and until a portion of the mass dissolved in water and test- ed by chloride of barium affords no more evidence of the presence of sulphuric acid. The yet moist mass is then put into a retort with alcohol of about ninety per cent., which is added repeatedly in small portions; the alcohol is made to boil, to dissolve the tan- nic acid, and separate it from the sulphate of baryta or sulphate of lime; the alcoholic solution is then poured off clear, and by a gen- tle heat evaporated to dryness. The following form for its preparation is given in the last edi- tion of the Pharmacopoeia of the United States (1842.) Take of Galls, in powder; Sulphuric ether, each a sufficient quantity. Put into a glass adapter, loosely closed at its lower end with card- ed cotton, sufficient powdered galls to fill about one half of it ; and press the powder slightly. Then fit the adapter accurately to the mouth of a receiving vessel ; fill it with the sulphuric ether, and close the upper orifice so as to prevent the escape of the ether by evaporation. The liquid which passes separates into two unequal portions, of which the lower is much smaller in quantity and much denser than the upper. When the ether ceases to pass, pour fresh portions upon the galls, until the lower stratum of liquid in the receiver no longer increases. Then separate this from the upper, put it into a cap- sule, and evaporate with a moderate heat to dryness. Lastly, rub what remains into powder. The upper portion of liquid will yield by distillation a quantity of ether, which, when washed with water, may be employed in a subsequent operation. 1 Repertorium, B. xxxiv. H. 3; also, A. W. Buchner, Neueste Entdeckung. fiber die Gerbs'aure, u.s. w. Frankf. 1833, and Dierbach, in Heidelberger Klinische Annalen, B. x. H. 3, S. 339, Heidelb. 1834. For the process of M . Duval, see Annal.de Chimie et de Physique, and Amer. Journal of Pharm. July. 1841, p. 171. 40 ACIDUM TANNICUM. Tannic acid, thus preparer!, is of a yellowish-white colour; of a strongly astringent taste ; very soluble in water, and less so in al- cohol and in ether. It reddens litmus paper. 1 EFFECTS ON THE ECONOMY. Tannic acid is a strong astringent, 2 which has hitherto been mainly used in uterine hemorrhage, and especially by the Italian physicians. Porta 3 was, perhaps, the first who tried it. He found it very efficacious in cases not dependent upon any or- ganic mischief in the uterus. It exhibits its powers, according to him, even in small doses — as of two grains, and is well borne by the stomach. Ferrario 4 likewise administered it with advantage in the same affection, but he does not consider it adapted for cases in which either partial or general plethora, or local excitement of the uterus, or any organic disease, exists: it is indicated only where mere atony is present. He gives it in the form of powder or pill, in two grain doses, six times a day. The effect is gene- rally good: the hemorrhage diminishes and soon ceases, and, at the same time, the strength augments, and recovery succeeds with- out any disturbance of the functions. Giadorow 5 details two cases of diabetes cured by it, when given in combination with opium, as in the prescription at the end of this article. The first patient was cured in ten, the second in twelve days. M. Dumars 6 ex- tols it in the same disease, administered by the mouth as well as by the rectum. According to Ricci, 7 tannic acid has frequently been employed in Italy both in internal and external hemorrhages. G. A. Richter, 8 however, affirms, that he has given it in habitual me- trorrhagia without any advantage whatever. Within the last few years, M. Cavarra 9 has instituted many experiments on animals, as well as on himself, from which he concludes, that when tannic acid is placed in contact with certain parts of the living economy, it exerts upon them the same chemico-vital action which it does on an inert organic tissue, or, in other words, it tans them as it tans lea- ther. " These parts," he says, " are the mucous membranes of the urethra, vagina, intestines, and lungs. The action of tannic acid appears to be, to cause such a condensation or contraction in them, that the glands with which they are studded no longer afford pas- sage for the mucus which they secrete." 1 Pharm. of the United States, p. 63, Fhilad. 1842. 3 See. on the action of this agent, Mitscherlich, Medicinische Zeitunff, No. 43, 1838, and Bullet General de Therap. 30 Mars, 1837. 1 Delpech, Memorial des Hopitaux du Midi, Sic. Fevrier, 1829, p. 51. * Annali universali di Medicina, Geniiajo, 1^29. * Annali universali di Medicina, and Gazette Medical, Sep. 15, 1832. 8 Cited in the Provincial Medical and Surgical Journal, Nov 18, 1842. 1 Bulletin des Sciences Medicales, Sept. 1H28. 8 Arzneimittellehre, Supplement, s. GO ; also, Cavalier, in Archiv. Generates, xix. 5^9. * Bulletin del'Aeademie Royale de Medecine, Janvier, 1837; also, American Medical Intelligencer, Oct. 16, 1837, p. 258. ACIDUM TANNICUM. 41 M. Cavarra asserts, that he has proved these positions by nu- merous experiments and demonstrations. When tannic acid is taken internally, its immediate effect is constipation, by arresting the secretion from the mucous membrane. When it has reached the stomach, it is absorbed, and carried into the current of the cir- culation. There exists between this organ and the vagina, the urethra, and the lungs, no communication except through the cir- culatory system, and, consequently, the tannic acid — it is fair to presume — must be absorbed to cure leiicorrhoea,gonorrhcea,&x\<\ the most obstinate chronic catarrhs . M. Cavarra concludes, that of all the effects of tannic acid, two of the most surprising are, the cures operated by it in cases of obstinate nervous coughs, and the excellent action it exerts in phthisis. Farther experiments are, however, demanded before this last point can be admitted. From our knowledge of the properties of tannic acid, it is not easy to see how it — or any astringent — can be of much service in the latter malady. Mixed with powdered sugar, in the proportion of from two to ten parts of the acid to ten parts of sugar, it has been blown, with advantage, by M. P. de Mignot, 1 into the fauces to facilitate the expulsion of false membranes. Dr. S. S. Allison, 2 who has for six years constantly prescribed tannic acid internally with much success in various diseases, speaks highly of it in chronic bronchial catarrh, chronic diarrhoea, leu- corrhoea, menorrhagia, the hemorrhagic diathesis, and albuminu- ria. As a local application, he extols it in sponginess and hemor- rhage of the gams, relaxation of the throat, prolapsus ani, he- morrhoidal tumours, gonorrhcea ; and as an external application to the skin where astringents are indicated. He has found it like- wise of service in dyspepsia ; and as a nervine in several cases of nervous debility, languor and excitability. In these last cases, he generally combines it with camphor, hops, or hyoscyamus. M. Subregondi 3 strongly recommends it in hooping-cough, when the period of excitement has passed away. His practice is to give from a quarter to half a grain every two hours along w T ith some soothing agent, as the extractum conii, and Durr 4 speaks highly of a combination of it with benzoin in the latter stages of the same malady. He prepares powders, each containing from two to five centigrammes, — gr. J to £ — with 50 centigrammes — gr. 8 of sugar ; one to be given every two hours. 1 Bouchardat, Annuaire de Therapeutique pour 1848, p. 138. 4 London Journal of Medicine, Jan. 1850. cited in Ranking's Half yearly Abstract, &€., Amer. edit., xi. 77. Phila. 1850; and in Amer. Jour, of the Med. Sciences, Oct 1850. p. 507. * Cited in Northern Journal of Medicine, Dec. 1844, and in Braithwaite's Retrospect, Amer. edit. viii. 54. New York, 1845. * Cited in Provincial Med. and Surg. Journal, April 3, 1850. 42 ACIDUM TANNICUM. M. Amedee Latour 1 has highly extolled it for its efficacy in hcemoptysis. In one case, it completely succeeded when other re- medies had failed; and in three cases of hemorrhage to a slighter degree, it was wholly successful. M. Charvet* has also recom- mended it in the sweats of phthisis. He gives it in the dose of from half a grain to a grain and a half, alone or associated with opium, and generally at bed-time. Hiiter affirms, that tannic acid, prepared from dried galls, in the form of ointment, or diluted with distilled water, is very serviceable in most cases of Egyptian ophthalmia. It has likewise been ad- vised in hemorrhoids and fissures of the anus? In the hyperemesis induced by ipecacuanha or emetia, it may be administered as an antidote. M. Druitt 4 thinks, that in any case in which a vegetable astrin- gent is indicated, tannic acid should have the preference. A simple solution in distilled water, he says, is much more easily and quickly prepared, as well as much more elegant, than the ordinary decoc- tions or injections' of oak bark, catechu, &c. It can be made, moreover, of uniform strength, and free from foreign inert matter, and is not liable to decompose quickly. In sore nipples, he found it to be invaluable. He employs it in solution — five grains to the fluidounce of distilled water — on lint covered with oiled silk. He has also found it of great service in toot hack. The gum around the tooth is first scarified with a fine lancet, and then a little cot- ton wool, imbued with a solution of a scruple of tannic acid, and five grains of mastich in tw r o fluidrachms of ether, must be put into the cavity; and, "if the ache is to be cured at all, this plan will put an end to it in nine cases out of ten." In a case of open, almost incurable, cancerous ulceration, in which it was applied by Dr. Michaelsen, 5 to arrest the bleeding, it excited a wonderful effect on the ulcer and the carcinoma itself. According to the experiments of Magendie, 6 tannic acid is one of the substances that oppose the coagulation of the blood. MODE OF ADMINISTRATION. It may be given in the form of pill, or draught, or as a lave- ment. In the dose of from a quarter of a grain to two grains, it does not produce any unpleasant constipation, but its effects must be observed with care. 7 1 Journal de Medecine et de Chirurg. Pratiq. Nov. 1S39. See, also, Bouchardat, Annuaire, &c, pour 1849, p. 203, " Bulletin General de Therapeutique, Mai, 1840. 3 Didav, in Bouchardat, Annuaire de Therapeutique pour 1S47, p. 170. Paris, 1847, 4 Provincial Med. Journ. Oct. 9, 1844. * Med. Chir. Zeitung, xviii. 24. cited in Schmidt's Jahrbucher, u. s. w. No. G, S. 287. Jahrgang 1849. 6 Lond. Lancet. Jan. 20, 1829, p. 636. 7 Cavarra,in Bulletin General de Therapeutique, 30 Mars, 1837. ACIDUM TANNICUM. 43 V i n u m aromatic u m cum acido tannico. Aromatic wine ivith tannic acid. R. Vini aromat. f 5 viij. Acid, tannic, ^ij. M. R. Vini aromat. f 3 viij. Acid, tannic. £ij. Ext. opii purif. gss. M. Used as local dressings to chancres. Ricord. The vinum aromaticum of the French Codex, used by Ricord, is composed of four ounces of aromatic herbs, (rosemary, rue, sage, hyssop, lavender, absinthium, origanum, thyme, laurel leaves, red rose leaves, chamomile, melilotum, and elder,) digested in two pints of red wine for eight days. Injectio acidi tannici. Injection of tannic acid. R. Acid, tannic. £)iv. Infunde per minut. x. in Aquse bullientis Oj. To be injected slowly into the rectum in cases of uterine he- morrhage. Dumars, c R. Vin. rubr. f gvj. Acid, tannic, gr. xviij. M. Used in chronic blennorrhcea, or what is called an old gleet. 1 Ricord. In the case of the female, the quantity of tannic acid may be doubled, or still farther increased. Pilulse acidi tannici. Pills of tannic acid. R. Acid, tannic, pulv. gr. vj. Acac. pulv. gr. xij. Sacchar. pulv. gr. lxxij. Syrup, q. s. ut fiat massa in pilulas pond. gr. iv. sing, dividend. Dose. — One to four, morning and evening, where an astringent is needed. . . Cavarra, Pilular acidi tannici composite. Compound pills of tannic acid. (Pilules de tannin composees.) R. Acidi tannic. gv. xvss. } (1 gramme.) Morphia acetat. Antimon. et potassse tartrat. aa gr. iss. Confect. q. s. ut fiant pilulse xx. x La Lancette Francaise, No. 33, Paris, 1838, and Parker, Modern Treatment of Sy- philitic Diseases, American Med. Library edit. p. 44. Philad. 1840. 44 ACIDUM TANNICUM. Dose. — One or two in the day in hemorrhage, diarrhoea, &c. Jourdain. Pilulae acidi tannici cum opio. Pills of tannic acid with opium. (Pilules narcotiques astringentes.) R. Acid, tannic. £ss. Extract, opii gi. J. Confect. rosse q. s. M. et divide in pilulas xx. One every hour in uterine hemorrhage. Dumars. Pulveres acidi tannici et opii. Powders of tannic acid and opium. R. Acid tannic. J}ij. Opii pulv. gr. ss. Misce et divide in pulveres tres. Dose. — One, morning, noon, and night ; gradually increasing the quantity of tannic acid to four scruples daily. Giadorow. Syrnpus acidi tannici. Syrup of tannic acid. R. Acid, tannic, p. v. Syrup, p. 500. — Mix and filter. Bouchardat. 1 Ungnentnm acidi tannici. Ointment of tannic acid. R. Acidi tannici gr. xvss. Adipis ^ss. M. This is the Pommade contre les ger cures de Vanus, of M. Diday, applied, in fissure of the anus, on the extremity of the little finger. Diday. Dentif ricium acidi tannici compositum. Compound dentifrice of tannic acid. R. Acid, tannic, ^ss. Sacchar. lact. lb. iiss. Carmin. giiss. Essent. Menth. Anis. aa gtt. xx, Flor. aurant. gtt. x. M. To prevent accumulation of tartar, and give tone to the gums. Mialhe* Pomatum acidi tannici- Pomatum of tannic acid. (Liparole de tannin.') R. Adipis suill. gxij. Acid, tannic, gij. Aquae pur. f ^ij. 1 Annuaire de Thferapeutique pour 1848, p. 138, Paris, 1848. * L'Abeille Medicale, Mai, 1848, p. 116. ACONITIA. 45 Dissolve the tannic acid in the water, by triturating in a glass mortar; add the fat and mix. 1 B&ral. Lotio acidi tannici. Lotion of tannic acid. Hydrolotif de tannin, pour Vurathre. R. Aquae destillat. f ^viij. Acid, tannic, gr. xxxij. Solve. Employed in obstinate blennorrhea. Beral. VII. ACONITIA. Synontmes. Aconitina, Aconita ? Aconitium, Xconitinumj Aconitine. German. Akonitin, Aconitin. This active principle, which was discovered by Peschier,* and by Brandes, has been recommended by Dr. Turnbull, 3 whose eulo- gies on the medical virtues of the natural order Ranunculaceae are evidently, however, overstrained. METHOD OF PREPARING. Turnbull gives two processes ; the former being the more easy of manipulation; the latter yielding a purer result, and on the whole being preferable. A quantity of the fresh root of Jlconitum napellus being very carefully and cautiously dried, and reduced to powder, — one part of it by weight, and two parts by measure of strong alcohol, are to be digested together at a gentle heat for seven days, and the tincture, whilst warm, is to be filtered. It must then be reduced to the consistence of an extract, by careful evaporation, at a low and well regulated temperature; the object of this being to prevent the destruction or expulsion of the active principle, which would very probably ensue, if the temperature employed were higher than barely sufficient to carry off the alco- hol. To the extract, thus prepared, liquid ammonia is to be added, drop by drop, and mixed well with it, to precipitate the al- kaloid: in this part of the process care must be taken that too much be not added, as in some instances the product appears to have been decomposed by inattention to this circumstance. It is not easy to give a precise rule as to the quantity ; but enough will have been added, if the extract exhales the odour of ammonia when 1 Bulletin General de Therapeutique, Janvier, 1838. 9 Trommsdorff's Journal der Pharmacie, v. 84. * On the medical properties of the natural order Ranunculaceae, and more particularly on the uses of sabadilla seeds, delphinium staphysagria and aconitum napellus, and their alcaloids, veratria, sabadilline, delphinia and aconitine. Chap. iii. Lond. 1 835. 46 ACONITIA. stirred. The mass now consists of impure aeonitia, mixed with a quantity of extractive, and other matters soluble in water, and it may be taken up either by boiling alcohol or by sulphuric ether; or the soluble matter may be removed by repeated washings with small quantities of cold water, which will leave the aconilia. This latter process, Turnbull says, is the one he has generally employed, and it is performed by pouring a little water on the extract, and mixing them carefully together; then allowing the undissolved part to subside, pouring off the fluid, and repeating the operation as long as any soluble matter is taken up: a quantity of light brown or gray powder is left, which may be purified by subse- quent solution in alcohol. This powder contains the active pro- perties of the aconite, in a high degree of concentration. The second process consists in dissolving the alcoholic extract, prepared as above, without the addition of the ammonia, in as much cold water as will take it up, carefully decanting the solu- tion from the insoluble part, and filtering it. To the filtered solu- tion liquid ammonia is to be added, drop by drop, as long as any precipitation is occasioned. When the precipitate has sub- sided, the supernatant fluid must be carefully poured, or drawn off by means of a syphon; and after the precipitate has been deprived of as much of the fluid as possible, it should be purified by a suffi- cient number of washings with small quantities of cold water, or. what is better, it may be dissolved in as much alcohol as will take it up, and the solution be thrown into cold water: the precipitate thus formed is to be earefully dried. The product obtained by this process is white. The London College, in their Pharmacopoeia of 1836, give the following form : — Take of aconite root, dried and bruised, two pounds; rectified spirit, three gallons; diluted sulphuric acid, solution of ammonia and purified animal charcoal, of each a sufficient quantity. Boil the aconite with a gallon of the spirit for an hour, in a retort with a receiver fitted to it. Pour off the liquor, and again boil the residue with another gallon of the spirit, and with the spirit recently distilled, and pour off the liquor also. Let the same be done a third time. Then press the aconite, and having mixed all the liquors and filtered them, distil the spirit. Evaporate the remainder to the proper consistence of an extract. Dissolve this in water and filter. Evaporate the solution with a gentle heat, so that it may thicken like syrup. To this add diluted sulphuric acid, mixed with distilled water sufficient to dis- solve the aeonitia. Next drop in solution of ammonia, and dissolve the aeonitia which is thrown down in dilute sulphuric acid, mixed as before with water; then mix in the animal charcoal, occasion- ally shaking for a quarter of an hour. Lastly, filter; and having again dropped in solution of ammonia so as to precipitate the aeonitia, wash and dry it. This process, however, according to ACONITIA. 47 Messrs. Ballard and Garrod, 1 mostly fails in procuring the alka- loid. Aconitia occurs in the form of an amorphous powder, having an intensely acrid and bitter taste. It is not volatile, and should leave no ash when heated to destruction. When well prepared, accord- ing to Geiger, it is a firm, colourless, and translucent mass; of a shining appearance, friable and inodorous : the taste is disagreeably bitter, leaving behind it an acrid sensation in the throat, but not corrosive or burning. It does not dissolve readily in water : at the ordinary temperature requiring one hundred and fifty parts thereof, but only fifty parts of boiling water. It is soluble in al- cohol and in ether. Tincture of iodine occasions in the solution a reddish-brown precipitate ; tincture of galls a white one. It forms, with the acids, for the most part, salts that are not crystal- lizable, which readily dissolve both in water and alcohol. EFFECTS ON THE ECONOMY. The effects of aconitia appear to be essentially analogous to those of delphinia. A grain of the first of the two preparations described by Turnbull was dissolved in a dram of alcohol; twenty drops of the solution put into the mouth of a guinea-pig occasioned death in a few minutes. Other experiments, too, have been performed, all of which demonstrate the extreme activity of the substance. If a grain or two of aconitia or veratria or delphi- nia be mixed with a little lard, or dissolved in a dram of alcohol, and a small quantity be rubbed on the skin, a sensation of heat and tingling is experienced after the friction has been persevered in for a minute or two. There is a slight difference, however, in the effects produced, and the resemblance is greatest between those of delphinia and aconitia. When a small quantity of aconitia, says Dr. Turnbull, either made into an ointment, or dissolved in alcohol, is rubbed for a mi- nute or two upon the skin, a sensation of heat and prickling is ex- perienced; to this succeeds a feeling of numbness and constriction in the part, as if a heavy weight were laid upon it, or as if the skin were drawn together by the powerful and involuntary con- traction of the muscles beneath. This effect lasts from two or three to twelve or more hours, according to the quantity rubbed in. So small a portion as the one hundredth part of a grain has produced a sensation that has continued a whole day. A minute portion of it mixed with lard, and applied to the eye, occasions contraction of the pupil according to Dr. Pereira, whilst Geiger and Hesse affirm that the aconitia which they obtained produced dilatation of the pupil. Dr. Pereira states, that the aconitia pre- pared by Mr. Morson of London is so powerful, that one-fiftieth 1 Elements of Mat. Med. and Therap. p. 164. Lond. 1845. 48 ACONITIA. of a grain has endangered the life of an individual. It is, he con- siders, the most virulent poison known, not excepting hydrocyanic acid. 1 Whilst employing aconite itself in his clinical practice, Dr. Lombard, 2 of Geneva, tried its effects on animals, and chiefly in reference to its action on the heart. The experiments were made on frogs, whose hearts beat with great regularity, and for a consi- derable time after the animal has been mutilated. The medicine was introduced into the stomach or applied locally to the heart, which was laid bare after the animal had been stupified by blows on the head. He found, that aconite employed internally rendered the pulsations less frequent, but not irregular, and consequently that it exerted a decidedly sedative effect on the heart; whence he infers, that it is a proper remedy in active diseases of that organ, and indeed in inflammatory affections in general, in which he ex- hibited it with success. In cases of poisoning by it, the contrac- tions of the heart have been found diminished and almost suspend- ed. 3 The homoeopathists regard it as an energetic antiphlogistic. Dr. Eades 4 concludes, from his own observations, that the most remarkable symptoms exhibited by animals from the use of aco- nite or its alkaloid, are — weakness; staggering; gradually in- creasing insensibility of the surface; slowly increasing weakness of the voluntary muscles, ending, perhaps, in paralysis; great lan- guor of the pulse ; more or less blindness, and convulsive twitch- inp-s before death. The ablest investigation yet undertaken into the actions of aco- nite, according to Dr. Christison, 5 is contained in the inaugural dis- sertation of Dr. Fleming 6 since published, and with a copy of which the author was favoured by Dr. Fleming. He found that the most remarkable symptoms are weakness and staggering, gra- dually increasing paralysis of the voluntary muscles, slowly in- creasing insensibility of the surface, and more or less blindness. He farther observed, that the pupil becomes much contracted; the irritability of the voluntary muscles is impaired ; the veins are con- gested after death, the blood unaltered, and the heart capable of contracting for some time after respiration has ceased. From its action on the cerebro-spinal and muscular systems, he deduces the following practical inferences. First, it is sedative, anodyne and antispasmodic. Secondly, it is an advisable antiphlogistic in apo- plexy, phrenitis, or any disease in which the circulation of the brain is excited. Thirdly, it is contra-indicated in head-ach arising 1 Elements of Mat. Med. &c, 2d edit. ii. 1811. Lond. 1842. 3 Gazette Medicale de Paris, Oct. 10, 1835. 3 Orfila, Toxicologic, it 221, 4 Dublin Journal of Med. Science, March, 1845, p. 55. 5 Treatise on Poisons. Amer. edit. p. (>65. Phila. 1S4-5. 8 An Inquiry into the Physiology and Medicinal Properties of the Aconitum Napellus, &c. Lond. 1845. ACONITIA. 49 from anaemia or chlorosis, and wherever there is a torpid or para- lytic condition of the muscular system, and, Fourthly, Its proper- ties suggest its employment in convulsive or spasmodic diseases. From its action on the circulation he infers, First, that it is a powerful antiphlogistic. Secondly, it is calculated to be of great value in all cases where there is inordinate activity of the circula- tion. Thirdly, it is contra-indicated when there is obvious me- chanical impediment to the passage of the blood, particularly through the heart or lungs: it is requisite, therefore, in every case before commencing its use, to ascertain that no such obstruction exists; and fourthly, it is contra-indicated whenever there is irri- tability of the circulation, with great diminution of power, such as occurs after severe hemorrhage. Its results on the respiratory system led him to the inference, First, that it will probably be found a highly advantageous anti- phlogistic in pneumonia, pleuritis, &c. Secondly, it seems calcu- lated to be serviceable in spasmodic asthma. Thirdly, it is con- tra-indicated in difficulty of breathing, arising from any other cause than inflammation or spasm; and fourthly, in cases of advanced bronchitis, with excess of secretion, it would prove highly injuri- ous by diminishing still farther the power of expectoration. Dr. Fleming has not met with any convincing evidence that it is a cumulative remedy; although in two cases he was induced to suspect it. The individuals were affected with general tremors, severe pain in the head and eye-balls, constant lachrymation, in- tense photophobia, heat of skin, quick pulse, and great restlessness. In many other instances, however, where the administration of the remedy was continued for weeks, and even months, no such effects were observed. The diseases in which Dr. Turnbull chiefly employed aconitia externally, were of the neuralgic kind ; but he used it as well in gouty and rheumatic cases; and its success, he remarks, fully an- swered his anticipations. He employs it either in the form of so- lution in alcohol, in the proportion of one or more grains to the drachm, — or of ointment, made according to the following for- mula: R. Aconitias gr. ij. Alcohol, gtt. vj. Tere optime et adde. Adipis 3J. ut fiat unguentum. The alcohol is added to prevent the aconitia from forming a thick compound with part of the lard, so as to render it difficult to make a proper ointment. In one case of tic douloureux, of ex- treme severity, as much as eight grains was prescribed in the oint- ment with the most marked benefit. The best mode of applying it is simply to rub a small portion of it over the whole seat of the affection, until the pain is either for the time removed, or until the full effect, described above, is induced on the cutaneous nerves ; 50 ACONITIA. and the friction should be repeated three or four times, or more frequently, during the day, according to the effect on the disease; the proportion of the aconitia being increased at every second or third rubbing. Dr. Turnbull found, in the case of aconitia — as well as in that of veratria and delphinia — that unless the friction occasioned a full development of the peculiar impressions caused by it when rubbed on the skin, no benefit whatever was to be looked for from its employment; and he observes, that if there be the slightest abrasion of the skin, an application of such activity should not be resorted to ; and that it should be carefully kept from coming in contact with any of the mucous membranes. Aconite and its alkaloid have been used internally and exter- nally in neuralgia, with marked advantage by Jahn, Tealier, Hufeland, Wildberg, Fleming 1 and others; but Drs. Copland, A. T. Thomson and others have prescribed it in several cases with- out success. By many, the external application of the remedy is considered to be more likely to be beneficial ; whilst others give a preference to its internal use. Mr. F. C. Skey 3 details two cases which were cured by it. It was rubbed down into an ointment with lard, in the proportion of one grain of the former to one dram of the latter, and applied in a small quantity by the forefinger over the track of the painful nerve, and was gently rubbed or rather smeared over the surface for half a minute or longer, once or twice a day, according to the degree of pain. The observations of Turnbull and Skey have been confirmed by Drs. Roots, Sigmond, Fleming and others. 3 In neuralgia of the heart, Dr. Copland 4 found it highly serviceable. Aconitia is not much used. The extravagance of its price, which is said to have been in England 3s. 6d. or upwards of three quarters of a dollar per grain, 5 would necessarily limit its use, had it proved to be more advantageous than it has. It woulo 1 appear, that all its powers are possessed by the tincture of aconite or by the alcoholic extract. Dr. Turnbull likewise advises the external application of an am- moniated extract of aconite, which is made by evaporating very carefully, and at a low temperature, the tincture of the dried root of the plant, prepared as directed in the process for obtaining aconitia, to the consistence of an extract. To every dram of this, eight or ten drops of liquor ammonise should be added, and after the mixture has stood a short time in a very gentle heat, to drive » Op. cit. p. 56. 2 London Med. Gaz. Nov. 5, 1836. 3 Dr Cowan, Provincial Med. and Surg. Journ. May, 1643; cited in Braithwaite's Retrospect, Amer. edit. vjii. 26. New York, 1844. 4 Dictionary of Practical Medicine, vi. 8H3. 5 Pereira, Elements of Mat Med and Therap. 2d Amer. edit, p, 757. Phila. 1846. ACONITIA. 51 off the excess of ammonia, it may be used in the form of an oint- ment, according to the following prescription : Unguentum extracti aconiti ammoniati, Ointment of ammoniated extract of aconite. R. Ext. aconit. ammon. gj. Adipis giij. Misce ut fiat unguentum. When this ointment is rubbed upon the skin, it occasions sen- sations in the part similar to those produced by the aconitia oint- ment : they are, however, rather more pungent. In less severe cases, Dr. Turnbull advises the simple saturated tincture of the dried root, with or without the addition of a little ammonia. The external use of this tincture of aconite has been recommended in neuralgia and chronic rheumatism by Dr. Pereira, 1 and Mr. Jos. Curtis; 2 and in hemicrania 3 by Dr. Fleming. The alcoholic extract of aconite — Extractum aconiti alco- holicum — which is officinal in the last edition of the Pharmaco- poeia of the United States, 1842 — has likewise been advised by Drs. Lombard of Geneva, 4 Busse, J. B. Watkins, 5 and others, in articular rheumatism. Dr. Lombard gives it in doses of half a grain every two hours, and gradually augments the dose to six or nine grains in the same period. A case of poisoning by five grains of this extract— from which, however, the patient recovered — has been published by M. E. L. Pereyra, of Bordeaux. 6 The applications of the different preparations of aconite to the- rapeutics have been given elsewhere. 7 VIII. ACUPUNCTU'RA. Synonymes. Acupuncture, Acupuncturation. German. Die Akupunktur; der Nadelstich. Although acupuncturation is really an ancient therapeutical agent, attention to it has been so much revived of late years, and its use has been so largely extended, that it may be looked upon as constituting one of the novelties of therapeutics. It consists in the introduction of needles into different parts of the body with a view of removing or mitigating disease ; and appears to have been entirely unknown to the Grecian, Roman, and Arabian physicians. 8 1 Elements of Materia Medica, 2d edit. ii. 1808. Lond. 1842. 2 Lond. Lancet, June 26, 1841. 3 Op. cit. p. 60. 4 Gazette Medicale, Juin 28, 1834. See, also, Sigmond, in Lancet for August 5, 1837. * Philad. Med. Examiner, No. 33. 6 La Lancetfe Francaise, No. 37, Mars 26, 1839. n General Therapeutics and Materia Medica, i. 374. 4 th edit. Philad. 1850. 8 V. A. Riecke, Die neuern Arzneimittel, u. s. w. S. 12, Stuttgart, 1837. 52 ACUPUNCTURA. From the most ancient times, however, it has been in use with the Chinese and Japanese, by whom it was regarded as one of the most important of remedial agencies. By these people it was sys- tematically taught on appropriate phantoms or mannekins, called Tsoe-Bosi, and the practice of the operation was permitted to those only who were able to pass a rigid examination thereon. In Europe, it was first known about 170 years ago, from the writings of a Dutch surgeon, Ten-Rhyne, who wrote in 1683 j 1 and attention was subsequently drawn to it by Kampfer; 3 but after this it was almost forgotten, until Berlioz, in 1816, drew attention to its em- ployment. His example was soon followed by Beclard, 3 Breton- neau, 4 Haime, 5 Demours, 6 Sarlandie, 7 Pelletan, Segalas, Dantu, Velpeau, Meyranx, 8 Dance, in France ; by Churchill, Scott, El- liotson, 9 and others in England ; by Friedrich, 10 Bernstein 11 L.W. Sachs, Heyfelder, Michaelis, 12 Grafe, 13 and others, in Germany ; by Carraro, 14 Bergamaschi,' 3 Bellini, and others, in Italy; and by Ewing, 16 E. J. Coxe, 17 F. Bache, 18 and others, in this country. M. Jules Cloquet had much to do in reviving its employment in his own country and elsewhere, by bis treatise on the subject pub- lished at Paris, in 1826, where it was for a long period a fashion- able article in the hospitals ; so much so, it is affirmed, that attempts were even made to heal a fractured bone by it without the appli- cation of any appropriate apparatus ; and, at one time, it is said, the patients in one hospital actually revolted against the piqueurs medecins! I9 . MODE OF ADMINISTRATION. In the operation of acupuncture, needles are employed, which are very fine, well polished and sharp pointed. They are usually from two to four inches long, the length being adapted to the depth it may be desired to make them penetrate. If steel needles are I Mantissa schematica de Acupunctura ad dissert, de Arthritide. London, 1683. ' Amcenitat exotic, politico-physico medic, p. 583. Lemgov. 1712 ; and History of Japan, vol. ii., Appendix, sect. 4, p. 34. 3 Mem. de la Societe Medic. d'Emulation, viii. 575. * Journal Universel des Sciences Med. xiii. 35. Paris, 1817. * Journal Gener. de Medec. torn, xiii., and Journal Univers. des Sciences Medic, torn. xiii. 1819. 6 Ibid. torn. xv. * Mem. sur l'Electropuncture. Paris, 1825. * Archives Generates de Med. torn. vii. Paris, 1825. 9 Med. Chir. Trans, xiii. 467. Lond. 1827; and art. Acupunture, in Cyclop. Pract. Med. Amer.edit. Philad. 1845. 10 Translation of Churchill's work in German, p. 40. II Hufeland's Journal, lxvii. Berlin, 1828. ,a Grafe und Walther's Journal. B. v. St. 3, S. 552. 13 E. Grafe, in art. Acupunctur, in Encyc. Worterb.der medicinisch. W issenschaft. B. i. S. 312. Berlin, 1828. l4 Annali Universali d'Omodei, 1825. 11 Ibid. 1826. > 6 N. Amer. Med. and Surg. Journal, ii. 77. Phila. 1826, 11 Ibid. ii. 276. Phila. 1826. " Ibid. i. 31 1. Phila. 1826; and art. Acupuncture, in Cyclop, of Pract. Med. i. 200, Phila. 1833. l9 Riecke, Op. cit. S. 13. ACUPUNCTURA. 53 selected, they are heated to redness, and allowed to cool slowly, in order that they may be less brittle. At the blunt extremity of the needle a head of lead, or sealing wax is attached — to prevent it from being forced entirely into the body. This is the simplest method of acupuncturation, and it is as effectual as any other. By various acupuncturists, needle-holders or handles of ivory have been devised, to some of which the needle is permanently attached. Perhaps the porte-aiguille or ' needle-holder ' recommended by Dr. F. Bache, 1 is as good as any that has been invented. The needle, with its poi^te-aiguille, consists of a handle with a steel socket to receive the end of the needle, which may be fixed se- curely, after having been inserted, by the pressure of a small la- teral screw. By this construction, the operator can at pleasure fix in the handle a needle of the length he may desire, and after inserting it he is enabled to detach the handle by relaxing the screw. After all, however, needles prepared in the simple manner mentioned above are adequate to every useful purpose. Besides common steel needles, those of gold, silver and plati- num have been used, but it does not appear that one metal is pre- ferable to another. To introduce the needles, the skin is stretched, and the needle inserted by a movement of rotation performed in opposite direc- tions, aided by gentle pressure. As a general rule, the seat of pain will indicate the place where the needle should be introduced ; but where the feelings of the patient do not point out the spot, it must be suggested by our knowledge of anatomy and physiology. From the experiments of Beclard, Bretonneau, Segalas, Dantu, Velpeau, and others, it would appear, that perforation of arteries, nerves, and even of important viscera with very fine needles, has not been followed by any injurious results; yet, at times, accidents have been produced thereby ; and, therefore, it may be laid down as a rule, that the greater nerves and arteries of a certain size, should be avoided. Prudence would likewise suggest, that important vis- cera, as the heart, stomach, intestines, &c, should not be pene- trated. The number of needles to be used varies according to the ex- tent of the parts affected. In the opinion of many experienced physicians, we ought not to be afraid of the number, but rather in- sert too many than too few, and not at too great a distance from each other. The length of time, during which they should be suf- fered to continue in the part, differs : no fixed rule can be laid down. Some suffer them to remain for an hour and a half, or two hours : at times, a period of five minutes is sufficient. In other cases, they have been kept in for two or three days. It ap- pears to be by no means settled what medicinal influence is exerted by their longer or shorter continuance in the parts. 1 Cyclop, p. 202. 54 ACUPUNCTURA. EFFECTS ON THF ECONOMY. Allusion has already been made to the impunity with which, in the generality of cases, acupuncturation may be practised even on important organs. As respects the nerves, Cloquet has seldom or never seen the puncture of them give rise to so much pain as to render it neces- sary to withdraw the needles: the pain was generally trifling and speedily passed away. He inserted needles into the brain and spinal marrow, and into the crural nerve of a cat, without any evi- dence of severe suffering or of change of function. Similar ex- periments were made by E. Grafe with the same results. 1 Nor was inconvenience found by Delaunay, Btclard and Cloquet to be sustained on puncturing the arteries and veins. A few drops of blood perhaps issued, but the flow was readily stopped by pressure with the finger. The slight ecchymosis which at times super- vened, disappeared rapidly of itself. In Grafe's experiments, he never found much bleeding ensue, although he properly esteemed it advisable to keep clear of the nerves and blood-vessels, in order to avoid any unnecessary pain or mischief. As regards the fasciae and periosteum, Grafe found, that the in- sertion of needles into them was always very painful, and he re- commends, therefore, that the operation should be performed with care on those parts. Should, however, the needles be introduced, and much pain be experienced, it rapidly ceases, when they are withdrawn. Lastly — MM. Haime,Bretonneau, Velpeau, and Meyranx insti- tuted several experiments on dogs by passing needles into the brain, heart, lungs, stomach, &c, and little or no inconvenience, as remarked above, was experienced, provided the needles were extremely fine. Cloquet passed his needles so deeply into the chest of an animal as to leave no doubt, that they had penetrated the lungs, and he subsequently pierced the liver, stomach, and tes- ticles without the supervention of any unpleasant result, and Bel- lini 2 affirms, that he has repeatedly passed them into the stomach, liver and intestines without injury. The pain occasioned by acupuncturation is generally easily tolerated ; but at times it is so violent, that the patients cry out; the violence, however, usually passes away either when the needle is drawn out or forced in deeper. It would seem, that the opera- tion is, as a general rule, most successful when it occasions the least pain. Cloquet asserts, that a kind of electric shock is some- times experienced in the surrounding parts at the moment of the introduction of the needle; in other cases, a tremulous motion is observable in the fibres of the muscles penetrated. Almost always, 1 Art. Acupunctur. in Encyc. Worterb. u. s. w. S. 317. Berlin, 1828. 9 Cited in Brit. & Foreign Medico-Chirurg. Review, for July, 1848, p. 232. ACUPUNCTURA. 55 some time after the entrance of the needles, a more or less regular aureola or halo of a red colour, and without tumefaction, is per- ceptible around them, which soon disappears after they are with- drawn; but when they are suffered to remain long in the part it may persist for hours. When the operation is productive of benefit, relief is speedily experienced. The extraction of the steel needles is ordinarily accompanied by more pain than their insertion, especially if they have penetrated deeply, and been retained in the flesh for a long time. The diffi- culty is owing to their having become oxidized, and consequently rough on the surface. In withdrawing them, it is advisable to give them a movement of rotation, and at the same time to press upon the skin surrounding them with the thumb and index finger. In the hospitals of St. Louis, La Pitie, and the Hotel Dieu of Paris, acupuncturation was practised some thousands of times, and in every case, according to Guersent, without the occurrence of any thing unpleasant. Pelletan, however, affirms, that he saw it on four occasions followed by slight faintness at the hospital St. Louis, but none of the cases assumed the characters of full syn- cope. Gaultier de Claubry has frequently seen faintness, febrile movements, spasm, and insupportable pain produced by it, and Heyfelder saw it followed by convulsions and fainting.- Beclard has related a case where the needle penetrated to the bone, and occasioned intense pain. The patient remained a long time faint, and afterwards violent delirium ensued, which gradually ceased in the course of the day, and was followed by great debility. Subsequently, an abscess formed in the part on which the opera- tion was practised. As to the modus operandi of acupuncturation, we cannot con- ceive its effects to be any thing more than a new T nervous im- pression produced by the needle on the parts which it penetrates. The needles having been found oxidized, especially at the point, it has been supposed by some, that the oxidation is connected with the remedial agency, and it has been even affirmed, that in some diseases they oxidize more readilv than in others. 1 It is a suffi- cient reply to this view, that beneficial results are obtained from the use of needles made of metals that do not become oxidized, and that the steel needles oxidize in the sound, as well as in the diseased body, and even in parts that have been removed from the body, and placed in warm water; for in the cold dead body, it is affirmed, the phenomenon is not observed. Cloquet and Pel- letan think, from their experiments, that the effects of acupunctu- ration are a consequence of the development of the nervous fluid 1 Grafe.loc.cit. S. 319. 56 ACUPUNCTURA. — which they liken to the galvanic — around the needles; a view which is denied by Pouillet and B^clard, but adopted in a modi- fied form by Dr. Bache, 1 who throws out the conjecture "that in many cases of local pain this accumulation of the nervous (elec- trical) fluid depends upon the altered state of the various fasciae or condensed sheets of tissue, giving them the power, to a certain extent, of insulating the parts which they serve to embrace." The explanation is ingenious, but we do not think it necessary, if adequate, to explain the phenomena. We have no doubt, that the effects are owing to a concentration of the nervous power towards the part transfixed by the needle, so that a derivation of the ner- vous influx is induced towards the seat of pain, or towards the nerves particularly concerned in the production of the pain; but farther than this we know not. There is one phenomenon which is dependent on the oxidation of the needle. When the free extremity of an inserted needle is con- nected with the ground by means of a conducting substance, or is put in connexion with a soft part of the patient's body, it becomes the seat of a galvanic current, which is exhibited by the multiplier of Schweiger. That this phenomenon is dependent upon the oxi- dation of the metal, is proved by the circumstance that it does not take place when an unoxidizable metal is employed. 2 Acupuncturation has been used by Berlioz in gouty and rheu- matic cases ; by Haime in rheumatic, spasmodic, and convulsive affections, and by Demours in amaurosis and ophthalmia, the needles being inserted into the temples ; Finch advised it in anasarca, practised on the feet; he also discharged, in this way, the fluid of ascites. 4 Pipelet 5 employed it advantageously in a violent convulsive affection. The needles did not remove or mark- edly diminish the symptoms, but they postponed their recurrence. Michaelis 6 cured a case of rheumatism by it, but he did not find it so serviceable in oedema of the feet, as the fluid would not flow readily through the minute apertures. Friedrich proposed, in cases of asphyxia, when every other remedy had been employed un- successfully, that the cavities of the heart should be penetrated by a needle to excite its contraction, and this plan was subsequently advised by Carraro, 7 who found, from his experiments on cats, that they could in this way be resuscitated after drowning, when every manifestation of vitality had ceased. His experiments, how- ever, w T hen repeated by Dr. E. J. Coxe, 8 of Philadelphia, were not found to succeed. J. Cloquet obtained the happiest results from acupuncturation in neuralgia, rheumatism, muscular contractions, ' Op. citat. p. 305. a Riecke, S. 1 6. 3 Op. citat. Paris, 1816. 4 Lond. Med. Repos.Mar. 1823. 8 Journal Complem. du Diet, des Sciences Medic, t. xvi. Paris, 1823. 6 Griife und Walther's Journal, B. v. St. 3. 1 Annal. univ. di Medicin, 1825. See, also, Provincial Med. and Surg. Journ., May 15, 1841. 8 North Amer. Med. and Surg. Journ. ii. Dec. 20, 1830. a Travers in Lond. Med. Gazette, Feb. 1837, p. 737. Lewis, Ibid. Feb. 1837, p. 788. Mr. Robert Keate, Ibid. p. 789. 3 British Annals of Medicine, No. 1 , p. 13. 4 Davidson, in Edinb. Med. and Sur?. Jonrn. for Jan. 1838. * Lancet, May 7, 1836, and Jan. 14, 1837. See a case of Ovarian Dropsy, in which ACUPUNCTURA. 59 Reference has already been made to the use of acupuncturation in anasarca. The author has used it advantageously to drain off the fluid from the areolar membrane. In such cases larger needles are needed; some prefer them to be of the size of an ordinary glover's needle, and of a triangular shape; a puncture of this kind being less likely to close. 1 In the mass of cases, it need scarcely be said, this course can act merely in a palliative manner, — the cause of the dropsical accu- mulation persisting. Still, as Dr. Graves has remarked, under fa- vourable circumstances, and in a good constitution, the simple operation of evacuating the fluid by punctures made through the skin, has been, of itself, sufficient to effect a cure. In a lady, under his care, general anasarca came on after fever, and resisted every form of treatment he could devise. Wheh he had made many fruitless attempts to produce absorption by means of internal remedies, another practitioner was called in, who practised acu- puncturation of the lower extremities, and succeeded completely. Mr. Vowell 2 has published a case in which acupuncturation was successfully employed for the removal of a ganglion. A young lady under his care had been affected with a ganglion of consi- derable size on the extensor tendons of the foot, which produced not only disfiguration, but some uneasiness. Mr. Vowell applied blisters, and afterwards iodine ointment and pressure, for above a month, without benefit. He then inserted the tambour porte- aiguille of his patient. Pressure was applied, and within a week the tumour had completely disappeared. M. Wiesel, 3 has narrated a qise of fracture of the two bones of the forearm, in which, reunion of the bones not having taken place at the end of nine weeks, he had recourse to acupuncture with full success. He introduced between the two moveable fragments of the ulna two needles, sufficiently long to traverse the false arti- culation from side to side, and kept them in that position for the six following days, after which he withdrew them, because they had excited by their presence considerable swelling of the part and severe pain. Fifteen days afterwards, he traversed in the same manner the false articulation of the radius, with two other needles, which, at the end of a few days, caused sharp pain and slight sup- puration. He then applied a simple bandage to the limbs, and in the space of six weeks complete consolidation had taken place. When acupuncturation is conjoined with electricity or galvanism, it constitutes electro-puncture, and galvano-puncture. it was employed by Robert D. Thompson, in Lancet, May 25, 1839, p. 344; and one of Ascites, by Mr. Campbell, Lond. Med. Gaz. Nov. 1838. 1 Graves, Lond. Med. Gaz. Oct. 1838. See, also, King, Ibid Oct. 7, 1837, and Nov. 25, 1837. a 2 Lancet, Aug. 25, 1838, p. 770. 3 Gazette des Hopitaux, Dec. 1843, cited in Braithwaite's Retrospect, Amer. edit. ix. 186. New York, 1844. 60 2ETHER HYDROCYANICUS. IX. .ETHER HYDROCYANICUS. Synonymes. iEther Prussicus, Hydrocyanic, or Prussic Ether, Hydrocya- nate of Etherine, Cyanuret of Ethyle. French. Ether Hydrocyanique. German. Cyan at her, Cyanwasserstoffather. Hydrocyanather. This preparation was discovered some years ago by Pelouze,' and, according to Magendie, 2 it resembles in its effects hydro- cyanic acid, without being so violent a poison, and, consequently, he esteems it w T orthy of regard as an addition to the materia medica. METHOD OF PREPARING. Equal parts of sulpho-vinate of baryta and cyanuret of 'potas- sium are mixed intimately together; put into a glass retort, to which a tubulated receiver is adapted, and exposed to a moderate temperature. By distillation, a colourless, or slightly yellowish fluid is obtained, which separates into two distinct strata. The lighter consists chiefly of hydrocyanic ether, which is not pure, however, but mixed with water, alcohol, sulphuric ether, and hy- drocyanic acid. In order to purify it, it must be strongly shaken, and, with four or five times its bulk of water, must be exposed for some time to a temperature of 60° or 70° centigrade; it must be again agitated with a little water, decanted, suffered to remain in contact with chlorinated lime for twenty-four hours, and then distilled. The ether thus obtained is pure. It is a colourless fluid, of a penetrating, disagreeable garlicky odour. Specific gravity 0.78. It boils at 82° centigrade; is very slightly soluble in water, but soluble in every proportion in alcohol and sulphuric ether. In its pure state, it does not disturb a solution of nitrate of silver. It inflames very readily, and burns with a blue light. Potassa decomposes it with difficulty, and only when highly con- centrated. EFFECTS ON THE ECONOMY. Six drops of this ether placed in the throat of a dog, occasioned, in a short time, deep respiratory efforts: the animal fell on its side, and convulsions succeeded, with considerable motion of the paws. This condition continued for four minutes, after which the effects gradually disappeared, and in the course of half an hour ceased. Six drops injected into the jugular vein rapidly caused death, with symptoms similar to those induced by hydrocyanic acid. Accord- ing to Magendie, these experiments were frequently repeated by him w T ith different modifications after which he ventured upon its administration in disease. He added six drops of the ether to a 1 Journal de Fharmacie, xx. 309. Paris, 1833. 3 Formulaire: — deiniere edition. -3ETHER SULPHURICUS. 61 mucilaginous linctus, and prescribed it to a patient labouring under hooping-cough, who, in the course of a few days, derived signal benefit from it, and without complaining of its penetrating, dis- agreeable odour. The same good effects happened to several patients to whom he gave it in the Hotel Dieu. But although the results were favourable in cases in which the hydrocyanic acid was indicated, he found it often necessary to discontinue it, on account of the invincible nausea which its smell induced. Magendie ad- vises it in those diseases in which mixture of hydrocyanic acid have been found of service. iETHER SULPHURICUS. Synonymes. iEther Vitriolicus, Naphtha Sulfurica, Oleum Vitrioli dulce, Vitriol Naphtha, Sulphuric Ether, Letheon. French. Ether Sulfurique. German. Schwefe lather. It is only within the last few years, that a class of agents has been introduced into the Materia Medica, which have received the name of Jin aesthetics, a term used by Dr. Pereira 1 synonymously with narcotics, anodynes and paregorics, as " agents w^hich dimi- nish sensibility or relieve pain;" but he adds, that the term is com- monly applied to agents which diminish common sensibility, or sensibility to pain. As remarked elsewhere, 2 however, it is most generally employed to designate such agents, when received into the lungs in the form of vapours or gases; and the vapours most used are those of ether and chloroform. It has been long known, that the vapour of ether would cause exhilaration and intoxication when breathed from a bladder, a practice which, as the author has been informed, was a popular diversion thirty or forty years ago in Philadelphia. As long ago as the year 1805, it was used to relieve the distress in the last stage of pulmonary inflammation in the case of a gentleman in Boston: in like cases it has been frequently prescribed since, and it was so prescribed in the year 1812, to a member of Dr. J. C. Warren's family, who experienced great relief from it. The mode of applying it was by moistening a handkerchief and placing it near the face of the patient. It was not, however, until October, 1846, that it was brought forward prominently as an anaesthetic in sur- gical operations. Dr. W. F. G. Morton, a dentist of Boston, about the middle of that month, informed Dr. Warren, that he had pos- session of a means for accomplishing the object; — that he had made trials of its efficacy in the extraction of teeth, and was desirous 1 The Elements of Materia Medica and Therapeutics, 3d edit, i. 203. Lond. 1849. 2 General Therapeutics and Mat. Med., 4th edit., i. 344. Philad., 1850. 5 62 2ETHER SULPHCJRICUS. that Dr. Warren should test its power in surgical operations. 1 Accordingly, at the Massachusetts General Hospital, its merits were tested by Drs. Warren and Hay ward, and the results being satisfactory, the trials were soon repeated there and elsewhere, in this country and abroad; and very speedily "etherization " — as it was termed — came to be regarded as one of the most important gifts presented by science to humanity. Although, however, it was first promulgated at the period above described, it is affirmed by Dr. C. W. Long, 2 of Jefferson, Jackson co., Georgia, that as early as the 30th of March, 1842, he removed a tumour from a patient who inhaled the vapour of ether from a towel, without any pain being experienced. 3 METHOD OF PREPARING. The officinal sulphuric ether of the pharmacopoeias is usually em- ployed for inhalation. The specific gravity of that of the Pharma- copoeias of the United States and London is .750; of the Dublin, .765 ; and of the Edinburgh, .735, or under. The last is the best for the purpose. The article employed by Dr. C. T. Jackson was prepared as follows. The strongest and purest rectified sulphuric ether, which can usually be obtained from the druggists, is agi- tated with water for the purpose of removing all acid. It is then freed from the water it may have taken up by chloride of calcium. The specific gravity of the product is about ,725. 4 EFFECTS ON THE ECONOMY IN HEALTH. The effects of all anaesthetics are essentially alike; and since their recent introduction numerous experiments have been made with them by distinguished physiologists and surgeons, — as by a commit- tee of the Surgical Society of Ireland, 5 by Flourens, 6 Longet, 7 Amussat, 8 Holmes Coote and Thomas Taylor, 9 Ville, 10 Gruby, 11 Thomas Wakley, 12 Gerardin and Verrier, 13 Snow, 14 Chambert, 15 Buchanan, 16 Black, 17 Schuh, Jorg, Von Bibra, Harless 18 and others, 1 Etherization, with Surgical Remarks, by John C. Warren. M. D., p. 4, Bost. 1849. See, on the orio-in of the inhalation of ether as a means of preventing pain in surgical operations, the Report of the Board of Trustees of the Massachusetts General Hospital, Boston. 1848. a Southern Medical and Surgical Journal, Dec. IS49. 3 On the history of ether inhalation, see Dr. Ranking, in Half-Yearly Abstract, Amer. edit. v. 328, Philad. 1647, and Report of the Committee on Surgery in Transactions f the Amer. Med. Association, i. 179. Philad. 1848. « Warren, Op. cit. p. 93. 5 Dublin Medical Press, Feb. 10, 1847. 6 Lancet, April 17, 1847. 1 Archives Generates de Medecine, Mars, 1847. » Comptes Rendus, 22 Fevr. 1847. s Lancet, June 19, 1847. i° Ibid. Julv 10, 1847. » Lond. Med. Gazette, Dec 24, 1847. 12 Lancet, Jan. 1, 1848. 13 Comptes Rendus, 27 Dec, 1847. " Lond. Med. Gazette. Jan. 1848. 15 Bouchardat, Annuaire de Therapeutique, pour 1848, p. 36. ■6 Lond. Med. Gaz. April, 1847. " Provincial Med. and Surg. Joum. May 5, 1847. i" Canstatt und Eisenmann, Jahresbericht, u. s.w.,im Jahre, 184T, iv. 159,Erlangen, 1848. ^THER SULPHURICUS. 63 and the results have been carefully noted. 1 All of them, when re- ceived into the lungs, readily enter the pulmonary blood vessels, and proceed to the great nervous centres, to exert on these their appro- priate agency. As a general rule, perhaps, the intellectual and mo- ral manifestations first exhibit their influence through the excitant action of the anaesthetic on the great cerebral and cerebellar gang- lia, so that a kind of intoxication supervenes, with imperfect power of regulating the movements. The sensory ganglia become subse- quently or simultaneously affected, and sensation and motion are suspended; and ultimately, if the quantity inhaled be sufficient, the medulla oblongata has its action suspended or destroyed ; respira- tion ceases, and death is the consequence. Yet great irregularity oc- curs in the supervention of these phenomena, as in the hysteroid condition induced by the animal magnetizer. At times, the in- tellect appears to be but little affected, whilst ordinary sensation is obtunded; and, at others, morbid sensation or pain is blunted, whilst ordinary feeling persists. The supervention of anesthetiza- tion is known by closure of the eyelids, if they have been pre- viously open; failure to respond to questions, and muscular relaxa- tion. Whilst the patient is under the influence, the pulse and the respiration must be carefully attended to. If they fail, or if the pupil, after having been contracted, becomes dilated, the inhala- tion must be immediately discontinued, and the face be sponged with cold water, ammonia be applied as an excitant to the nostrils and throat, and frictions to the extremities; and M. Ricord 3 recom- mends, in cases of threatened death from chloroform, the immediate inflation of the lungs, by applying the mouth to the patient's lips. It would appear from -the experiments of Mr. Nunneley, M.- Jules Roux 3 and others, that the local application of anaesthetics, as of narcotics in general, deadens the sensibility and power of motion of a part, whilst the nervous centres, and the nerves distri- buted to other parts of the body, may be unaffected. Mr. Nun- neley instituted an extensive series of experiments on animals, and found, that by immersing a limb in a small quantity of the fluid, or by applying the vapour topically for a limited period, it might be rendered perfectly incapable of motion and feeling, and be fixed in any desired position. It was but natural to suppose, that the indiscriminate employ- ment of so potent an agent, should, in some cases, give rise to un- pleasant, and even fatal results. Yet when we reflect on the im- mense number of persons who have been subjected to the inhala- tion of ether, the surprise is, that so few examples of injurious consequences should have been recorded. 1 See H. J. Bigelow, Anaesthetics, their mode of exhibition, and physiological effects, in Transactions of the Amer. Med. Association, ii. 197, Philad. 1848. * Rankings Half-Yearly Abstract, xi. 191. Amer. edit Philad. 1850. 8 Gazette des Hopitaux, 7 Nov. 1848. 64 iETHER SULPHURICUS. The most remarkable ill effects noticed by Dr. Warren, 1 were of two kinds; first, those caused by the exclusion of oxygen; and secondly, those from excessive etherization of the nervous centres, — the principal morbid effect from the latter cause being general convulsions — at times, so violent as to threaten life; but generally by suspending the inhalation, and employing the free affusion of cold water, the convulsions ceased. Cases in which distressing nervous and other phenomena supervened are related by Dr. War- ren, Mr. South, Professor Syme, 2 Professor Murphy, 3 Mr. Law- rence of Montrose, 4 Mr. Copeman, 5 Dr. Bennett, Mr. Eastman, 7 Dr. H. J. Bigelow, 8 Dr. N. R. Smith, 9 and others. Accidents have, however, been ascribed to it on no foundation. Thus, Dr. Pickford 10 states, that a medical friend in Dublin informed him, that of thirty fatal cases following operations in which ether had been employed in the various hospitals of that city, eight were found to be the subjects of recent tubercles of the lungs, — the un- doubted product, it was believed, of inhalation, — a statement which Mr. Macdonnell 11 denounces as altogether groundless. Professor Syme, Dr. Roberts 1 - and others, witnessed inconve- nient effects from the inhalation of ether, and the editor of the Monthly Journal of the Medical Sciences observed great excite- ment, cough, with expectoration of pus, haemoptysis, and convul- sions. In some cases, erotic feelings, and even nymphomania oc- curred in females: in others, hysterical symptoms, or those of de- pression, or intense headach, which continued several days; and similar phenomena have presented themselves to the author. Fa- tal cases, too, have occurred, which have been ascribed to the in- halation, by M. Jobert, M. Roux, Mr. Nunn,Dr. Maclagan, Mr. Robbs, M. Blandin, 13 M. Piedagnel, 14 Dr. Paul F. Eve, 15 Dr. J. W. B. M'Clellan, 16 and others. Fatal cases are, however, much more rare than they were some time ago ; and this is probably owing to more care being; taken in its administration, and in the discrimi- "... nation of cases for which it is adapted. It is proper to remark, that from tables published by Professors Simpson and Malgaigne, showing the mortality of surgical opera- tions in the British and French hospitals, where anaesthetics had I Op. cit. p. 24. - Monthly Journal of Med. Science, Aug. 1847. 3 Lancet, Nov. 27, 1847. "Monthly Journal, June, 1847. 5 Provincial Med. and Surg. Journal, Feb. 10, 1847. 6 Monthly Jour., June, 1847. " Lond. and Edinb. Monthly Journal, June. 1847. 8 Transactions of the American Medical x\ssociation, i. 209, Philad. 1848. 9 Ibid. ii. 214, Philad. 1849. 10 Edinb. Med. & Surg. Journ. July, 1847. II Provincial Med. and Surg. Journ., July 14, 1847. i a Monthly Journal of Medical Science, April, 1847. ■ 3 Gazette des Hopitaux, 23 Nov. 1847. See, also, the details of a case at the Hotel Dieu, of Paris, in Journ. des Connois Medico -Chirurg., cited in Ranking's Half-Yearly Abstract, Amer. edit. vii. 191. Philad. 1848. i 4 Cited in the Amer. Jour, of the Med. Sciences, April, 1848, p. 558. 15 Southern Med. and Surg. Journ. June, 1849. i 6 Transactions of the Amer. Med. Association, i. 192, Philad. 1848. .ETHER SULPHURICUS. 65 been used, and where they had not, it would appear that the mor- tality was decidedly greater where they were not employed; and hence it has been inferred, that where the employment of chloro- form has sacrificed one life, it may have preserved a hundred. 1 During the inhalation of ether, the blood has been observed to lose its florid colour by Mr. Pring, 2 M. i\.mussat, Dr. Ranking, 3 and numerous others. M. Lassaigne, 4 however, states that such was not the result of his observations. The morbid appearances presented by animals killed by the in- halation of ether have been similar to those observed in asphyxia; fluidity of the blood ; accumulation of that fluid on the right side of the heart and large veins, with engorgement of the internal viscera. In a fatal case, seen in the Royal Infirmary of Edin- burgh, there were found double pneumonia, bronchitis, and secon- dary purulent deposits in the joints. In a case recorded by Mr. Nunn, cerebral congestion, engorgement of the lungs posteriorly, and uniform fluidity of the blood, were found. In another case there was no great congestion ; but the blood was fluid throughout. The observations of MM. Amussat and Lassaigne showed, that in every case it loses its power of coagulation, although, with the exception of the presence of a minute quantity of ether, its chemical charac- ters are unchanged. 5 From a careful comparison of the effects produced on the eco- nomy by different anaesthetics, Dr. Hayward fi decidedly prefers sulphuric ether to either chloric ether or chloroform, — its great advantages being, in his opinion, "its entire safety, the ease with w T hich it is administered, and the slight inconveniences which fol- low its administration." EFFECTS ON THE ECONOMY IN DISEASE. It was in severe surgical operations that anaesthetics were first employed in the way of inhalation ; and until the discovery of chlo- roform, sulphuric ether was used almost solely, and generally with the most gratifying results. As soon as the intelligence reached Europe it was at once laid hold of by the most distinguished sur- geons, by Messrs. Liston, Key, Ferguson, Lawrence, Skey, 7 and others, in England; by MM. Malgaigne, Velpeau, Roux, Robert, Paul Guersant, Leroy d'Etoilles, and others, 8 in France; and by Blumhardt, Dieffenbach, Schuh, Heyfelder, and others, in Ger- many. 1 Report of the Committee on Surgery. Dr. N. R. Smith, Chairman, in Transact, of the A men Med. Association, ii. 215. Philad. 1849. - Lancet, May 1, 1847. 3 Half- Yearly Abstract, Amer. edit. v. 335. Philad. 1847. 4 Cited in Provincial Med. and Surg. Journ., May 5, 1847. s Monthly Journal of Medical Science, April, 1847. 6 Remarks on the Comparative Value of the Different Anaesthetic Agents. Boston, 1850- 1 Amer. Journal of the Med. Sciences, April, 1847, p. 50C. 8 Bouchardat, Annuaire, 1848; p. 35. bb .ETHER SULPHURICUS. Not long after its introduction in this country, nineteen cases of surgical operations performed on patients rendered insensible by it were recorded by Dr. J. Mason Warren, 1 of Boston; and since then the testimony in its favour has been so overwhelming and numerous, that it is impracticable even to enumerate the different authorities. Mr. Wells, of the English navy, soon reported the favourable results of one hundred and six cases. 3 Fractures and dislocations were happily arranged under its influence, by Dr. Warren, Dr. Parkman, 5 Mr. Dehane, 4 J. Caunt, 5 and others. Mr. Lawrence (i reported that it had been used in St. Bartholomew's Hospital in all descriptions of operative procedures between two and three thousand times without a single unpleasant result. Dr. Snow, 7 too, appears to have been most fortunate in his cases; for with the exception of headache on one or two occasions, the only unpleasant effects he had witnessed were sickness and vomiting, and these only occasionally. Mr. Humphrey, 8 in several hundred cases in which ether or chloroform had been inhaled, saw serious neuropathic phenomena in only four or five cases; and beyond these never witnessed more than headache, sickness, and giddiness, last- ing for a few hours; and these symptoms supervened but occasion- ally; whilst in one hundred and six cases Mr. Wells 9 saw no serious ill effects in any. There is scarcely a painful operation practised by the surgeon, oculist, or dentist, in which ether inhalation has not been employed. Among the earlier recorded cases were an amputation of the thigh by Dr. J. M. Warren ; extirpation of a tumour of the mamma by Dr. J. C. Warren; an operation for necrosis of the tibia by Dr. Townshend ; reduction of strangulated hernia by Dr. J. M. War- ren, 11 and Dr. Hosack; 11 sounding for stone, and lithotrify, by Dr. J. C. Warren ; stricture of the urethra, ivith fistulous openings, by Mr. Liston ; lithotomy, by Mr. Tatum ; an operation for fistulous sinuses by the side of the rectum, by Mr. Keate; 13 the removal of tumours in various parts, by Mr. Syme ; 13 extirpation of the mam- ma, by Dr. Jas. Bryan ; u amputation of the thigh, by Dr. Mutter ; 15 extirpation of the eye, by Mr. Lawrence and M. Velpeau; 18 and it has been inhaled in all cases of removal of tumours and plastic operations on the eyelids; but in operations, such as strabismus, 1 Boston Med. and Surg. Journal, March 24, 1847. 2 Lond. Med. Gazette, Sept., 1847. 3 Warren, Op. cit, pp. 44 and 46. 4 Provincial Med. and Surg. Journal, Sept., 1847. * Lond. Med/Gaz., June 4, 1847. 6 Amer. Journ. of the Medical Sciences. April, 1848, p. 551. 1 On the Inhalation of the Vapour of Ether in Surgical Operations, &.c. Lond., 1847. 8 Provincial Med. and Surg. Journ., Aug. 9, 1848. s Lond. Med. Gaz., Sept., 1847. 10 J. 0. Warren, Etherization, with Surgical Remarks, p. 53. Boston, 1848. " Boston Med. and Surg. Journ., Aug. 11, 1847. 12 Snow. Op cit, and Ranking's Half-yearly Ahstract, Am.Ed., vi.97, Philad., 1848. 13 Monthly Journal of Medical Sciences, Aug. 18, 1847. M Med. Exam.. June, 1 847, p. 332. ,s Ibid., Jan., 1 848, p. 14. ,6 Ranking, vii. 248. JSTHER SULPHURICUS. 67 which require, at times, the exercise of volition, anaesthetics are not indicated ; and in those for cataract, artificial pupil, &c, Mr. Wilde' considers the amount of pain does not demand their use. The following list, drawn up by Klencke, 2 will give a view of many of the operations in which it is recorded to have been used in the year 1847: 1. Extirpations: — Of encysted tumours, by Schuh, Strode 1 and Hornig. Of cancer and similar tumours, by Schuh, Pitha, Heyfelder, Opitz, Haller, Hayward, Pereshaw, Clement, Velpeau, Malgaigne, Landouzy, Ricord, Roux, Sedillot. Of cancer of the lip, by Pitha, Heyfelder, Maison-neuve. Of ranula, Heyfelder. Of condylomata, by Thomson, Fergusson, Bruns, Mikschik, Flor, Schubert and Kraus, and Von Brunner. Of telangiectasis, by Schuh and Pitha. Of nasal polypus, Schulz. Of glands. — Mammary gland, by Liston, Leblanc, Brookes, Bouchacourt, Goyrand. Parotid gland, Heyfelder. Tonsils, Roux. 2. Herniotomy. — Key, Partridge, Schuh, Pitha, Von RifFel, Heyfelder. Radical operation (after Gerdy), Kraus, of Prague. 3. Lithotomy.— -Morgan, Guersant, Balassa, Lithotrity, Leroy d'Etiolles. 4. Strictures. — Fergusson. Operations for fistulce, Pitha, Heyfelder. 5. Urethrotomy. — Petrequin. 6. Phimosis. — Fergusson, Thomson, Schuh, Sigmund, Opitz, Reisinger, Balassa, Von RifTel. 7. Castration. — Sigmund and Bonnet. 8. Hydrocele. — Ricord, Jobert, Opitz, Schuh, and Balassa. 9. Harelip. — Heyfelder, Pitha. 10. Ligature of the Crural Artery, by Von RifTel. 11. Amputations. — Of the thigh, Hayward, Lansdown, Cole- man, Liston, Malgaigne, Jobert, Th. Bell, Chiari, Raymonet, Duncan, Schuh, Pitha. Of the leg. Hawkins, Leblanc, Sedillot, Haller, Pitha, Dum- reicher, Opitz, Reisinger. Of the arm. Velpeau, Schuh, Sigmund. Of the forearm. Liston. Of the hand. Velpeau, Goyot, and Duval. Of the finger. Petrequin, Kraus, Martin, Heyfelder, Pitha, Sigmund. Of the teeth. Fairbrother, Tracy. 12. Exarticulations. — Of the foot-joint, Pitha. Of the teeth, Pitha, Sigmund, Opitz. Of the finger, Guersant, Voille- 1 Dublin Quart. Journ. of Med. Science, May, 1848. 3 Canstatt und Eisenmann, Jahresbericht, u. s. w., im Jahre, 1847, iv. 163. 68 AETHER SULPHURICUS. mier, Macmurdo, Von RifFel, Liston, Cooper, Velpeau, Maison- neuve, Pitha, Opitz, Kraus of Prague, Sigmund, Kahler. 13. Resections. — Removal of sequestra, Miller, Pitha, Sig- mund, Dumreicher, Sedillot. Of the shoulder, Nelaton. Head of the humerus, Pitha, Heyfelder. Of the ulna, Pitha. Of the head of the osfemoris, Sigmund. Of the tibia, Sedillot. Of the ankle-bone, Pitha. Of the lower jaw, Wattmann, Pitha, Tracy. 14. Cartilaginous Concretions in the Joints. — Sigmund. 15- Myotomy and Tenotomy. — Dumreicher, Schuh, Sigmund, Pitha, Behrend, Heyfelder. 16. Rhinoplasty. — DiefFenbach. Stomatoplasty, Liston. 17. Operations on the Eye. — Blepharoplasty, Sedillot, Brett. Extirpation of a tumour, Bigelow, Jiingken, Hammer. Cyst in the Orbit, Monod. Strabotomy, Brett, Malgaigne, Lorinser, Heyfelder, Hammer. Cataract, Brett, Cotton. Extirpation of the bulb, Lawrence. Staphyloma, Arlt. Arlt also operated for Trichiasis, Blepharo- phimosis, and Fistula lachrymalis. Of the bloodless operations — unblutige Operationen — the following were performed under the narcosis induced by ether: 1. Reduction of incarcerated hernia, by Pitha, Opitz, and Hornig. 2. Reduction of Luxations, by Velpeau and Dumreicher. 3. Introduction of the Catheter and Bougies, Fergusson. The list of patients who inhaled ether or chloroform for surgical operations in the Massachusetts General Hospital to April 1st, 1848, as reported by Dr. H. J. Bigelow, 1 numbered 154; and in- cluded 9 amputations of the thigh, 11 of the leg, 4 of the arm, and 12 of the breast. Thirty-seven cases are reported by Dr. Watson, 2 as having been treated in the First and Second Surgical Divisions of the New York Hospital ; 13 cases at the Clinic of the University of Pennsylvania are reported by Dr. H. H. Smith; 3 and 45 at the Clinic of the Jefferson Medical College by Dr. Mutter. 4 In 32 of these ether was employed ; in the remainder chloro- form. When the practice had been followed less than a year, Mr. Lawrence reported, that the trials with ether in a single London hospital amounted to between two and three thousand cases. One dentist in that city, up to the middle of July, 1848, had adminis- tered anaesthetics more than three thousand times. The physician has recourse to etherization in all cases which require the employment of other powerful narcotics and antispas- modics. It was found especially valuable in all the JVeuroses, by Kalinsky. 5 1 Transactions of the American Medical Association, i., 215. Philad., 1848. 2 Ibid., p. 218. 3 Ibid., p. 220. 4 Ibid., p. 221. 5 Canstatt und Eisenmann, Jahresbericht, u. s. w., iv. 1G7. Erlang, 1849. JETHER SULPHURICUS. 69 Tetanus. — It has been employed successfully for the relief of tetanic spasm; but, as properly remarked by Dr. Warren, 1 whilst it may mitigate the distress of the muscular contractions, it cannot be expected to overcome the morbid condition of the spinal membranes, or the medulla they envelop, which he — in the absence of adequate evidence and of probability — considers to be inflamma- tory. In cases related by Dr. W. H. Ranking 2 and M. Roux, 3 of Cherburg, it appeared to act injuriously ; and in another in which it was tried in France, death — it was conceived — was unques- tionably hastened by it ; whilst in others, reported by Dr. Brady 4 and Mr. Broughton, 5 it did not avert the fatal result. Cases are, however, recorded of its successful administration in tetanus, by Dr. Pertusio and Mr. Hawkesworth; 6 but they are regarded by Dr. Ranking 7 as by no means satisfactory. In cases related by Mr. Bransby Cooper, 8 Dr. Crawford, 9 and Dr. T. L. Ogier, 10 al- though it afforded temporary relief, it did not arrest the progress of the disease towards a fatal termination. A case, however, is related by Mr. Hopgood, 11 in a boy nine years of age, which was successfully treated by it; another by Mr. Chalmers; 12 another by Dr. Theobald, 13 of Baltimore; and another by Dr. Isaac Parrish; 14 and one of Tetanus rheumaticus, by Reichert. 15 Hydrophobia. — A case is recorded by Mr. Allen, 16 in which the spasms were temporarily relieved by ether inhalation, without, however, the fatal event being averted. Convulsions in a boy eleven years of age, w T ere much relieved by it under the direction of Dr. Wyatt; 17 and a case in a child, five months' old, w 7 as completely cured by Dr. Sabin. 18 Delirium tremens. A case is related by Dr. Upham, 19 in which sleep and quiet were induced by it ; and similar cases are recorded by Dr. Anderson.^ Dr. Stedman, too, used it with good effect. 21 Insanity. Ether has been inhaled under the direction of M. Cazenave, of Pau, and of M. Jobert 2a and Dr. Boyd; and it ap- 1 Etherization, with Surgical Remarks, p. 54. Boston, 1 848. a Provincial Medical and Surgical Journal, April 21 , 1847. 3 London Medical Gazette, Sept., 1848. 4 Dublin Med. Press, cited in Ranking's Half-yearly Abstract, v. 340. Philad., 1847. s Provincial Medical and Surgical Journal, May 5, 1847. 6 Ibid , May 19, 1847. 7 Half-yearly Abstract. Amer. Edit, v. 341. Philad., 1847. 3 Lond. Med. Gaz., Aug. 6, 1847. 9 British American Journal of Medical and Physical Science, Dec, 1847. 10 South. Journ. of Med. and Pharm., Nov., 1847. " Med. Times, Jan. 15, 1848. ia Provincial Medical and Surgical Journal, June 30, 1847. 13 Amer. Journ. of the Med. Sciences, Jan., 1848. 14 Transactions of the College of Physicians of Philad., vol. ii., No. 4. 15 Canstatt und Eisenmann, Jahresbericht, u. s. w., im Jahre 1848, iv. 177. Er- lang, 1849. 16 Lancet, Oct. 15, 1847. « West. Journ. Med. and Surg., A p., 1848. 18 Boston Medical and Surgical Journal, April, 1848. ,9 Prov. Med. and Surg. Journ., Dec. 15, 1847. 20 New York Annalist. 2i J. C. Warren, Etherization, with Surgical Remarks, p. 83. Boston, 1848. 22 Cited in Med. Gaz., May, 1847, and Brit, and For. Med. Rev., April, 1847. 70 J2THER SULPHURICUS. pears to have occasionally tranquillized, without any evil conse- quences. 1 Neuralgia. Its good effects in this disease have been deposed to by Kalinsky, 2 especially in hemicrania ; and by Morris, 5 Sem- ple/ Honore, Christison, 5 and others. Hysteria. A case in which the inhalation of ether proved suc- cessful in subduing hysteric symptoms after every kind of treatment had been used for four days without effect, is related by Mr. Wil- kinson ; and another fortunate case by Ducros. 6 Asthma. Dr. Willis" and Mr. Cantrell 3 have employed it suc- cessfully. The latter states that he had long used it prior to its recent introduction as an anaesthetic. In Obstinate Hiccough, it w 7 as prescribed with advantage by Dr. Christison; 9 and in Hooping-cough, it is spoken favourably of by Dr. Willis 10 and Max. Simon. 11 Laryngismus stridulus. A very severe case was materially benefited by the use of a sponge saturated with ether. Dr. Ran- king 12 saw the case with Mr. Image, who reports it. It has also been used successfully in Colica Pictonum, by M. Bouvier ; 13 and in flatulent colic by Horing. Renal Calculi. In the intense suffering attending the passage of a renal calculus — nephritic colic — inhalation of ether has been prescribed with signal advantage by Dr. Ware 14 and Dr. Griesin- ger; and in Dysmenorrhcea, by Dr. Griscom. 15 Ophthalmia. In violent cases, M. Guersant 13 has employed at the Hopital des Enfans Malades, of Paris, a collyrium composed of one part of nitrate of silver, and four parts of water, with great advantage. The pain is often, however, so great, that he has had recourse to the inhalation of ether with marked success to enable him to make the application. Dr. Mackenzie 17 advises the inhala- tion in many forms of ophthalmia, especially where there is much photophobia ; but the duration of the ophthalmia did not seem to be curtailed; and Dr. Smith, 13 of Cheltenham, by its agency, was 1 Drs. Ray and Bell, cited in Trans, of the Amer. Med. Assoc, iii. 79. Philad., 1850. 2 Canstatt und Eisenmann, Jahresbericht, u. s.w.,iv 167. Erlang., 1849. * Medical Times, cited in Ranking' s Half yearly Abstract. Amer. Edit., v. 341. Philad., 1847. 4 Lancet, March 27, 1847. 5 Dispensatory, Amer. Edit., by R. E. Griffith, p. 152. Philad , 1848. 6 Lancet. July 3, 1847. ' Ibid., March 20. 1847. a Prov. Med. and Surg. Joum., May 19, 1847. ■ Op. cit ,0 Op. Cit. 11 Canstatt und Eisenmann, Jahresbericht. u. s. w. , im Jahre, 1848, iv. 177. Er- langen, 1849. 12 Half-yearly Abstract, &c, Amer. Edit, v. 342. Philad., 1847. 13 Canstatt und Eisenmann, Op. cit. iv. 177. M Boston Med. and Surg. Joum.. May 1, 1847. 11 Transactions of the College of Physicians of Philadelphia, April. 1849. ,s London Medical Gazette, June, 1847. " Ibid. 18 Wilde, Report on Ophthalmic Surgery, in Dublin Quarterly Journal of Medical Science, May, 1848. .ETHER SULPHURICUS. 71 enabled to examine and manipulate on the eyes of young children affected with strumous ulcerations of the eye. Intermittent Fever. It is affirmed that Mr. J. W. Freer, 1 a pupil in the Chicago Hospital, employed ether in this malady with the most delightful results. Two or three inhalations invariably arrested the paroxysm instantaneously during the cold stage; brought on diaphoresis; and in cases where there was no unusual exertion, the paroxysms did not recur. Phthisis. In the last stage of this fatal malady the inhalation of ether has been prescribed by Dunker, 3 and it has exerted a mani- festly soothing influence : it has been ably and forcibly urged, too, by one 5 who has had much to do with the introduction and pro- mulgation of anaesthetics in the treatment of disease, that in in- curable affections, when the melancholy termination approaches, it may be highly desirable to administer them with the view of ren- dering death easy, — of inducing euthanasia.* Feigned diseases. Ether inhalation has been employed to de- tect them. M. Baudens 5 records two cases— one of simulated, the other of real infirmity — in which it detected the fraud. If volition be overpowered by it, the deception can no longer be main- tained. M. Bayard, 6 however — and the Editor of the Medico- Chirurgical Review for October, 1849, accords with him — is of opinion, that owing to the occasional results which follow the use of anaesthetics, especially of chloroform, and the uncertainty of the revelations obtained through their aid, they ought not — and the remark applies especially to chloroform — to be employed for the detection of simulated disease. The obstetrician has largely employed the inhalation of ether and other anaesthetics to relieve the intense suffering that accom- panies severe labour ; and experience seems to have shown, that whilst it effects this, and aids in the relaxation of the parts, it does not materially — or at all — diminish the parturient efforts. Professor Simpson, 7 of Edinburgh, was, perhaps, the first to em- ploy the inhalation of ether in this relation, and was a strong advo- cate for its use until he had tested the virtues of chloroform, which he now employs exclusively. His opinion of the value of ether is supported by the testimony of Paul Dubois, 8 Professor Siebold, 9 M. Roux, 10 of Toulon, Dr. Channing, 11 Dr. Parkman, 12 M. Chailly, 13 * Illinois and Indiana Med. and Surg. Journ. for Oct. and Nov., 1847. 2 Canstatt und Eisenmann, Jahresbericht, u. s w., im Jahre, 1848, iv. 177. Er- langen, 1849. 3 J. C. Warren. . 4 Etherization, with Surgical Remarks, p. 69. Boston, 1848. I Comptes rendus, 8 Mars, 1847. 6 Annales d'Hygiene, xlii. 165 — 201. T Monthly Journal of Medical Science. March, 1847; and Notes on the Inhalation of Sulphuric Ether in the Practice of Midwifery. 8 Lancet, March 6, 1847. 9 Lond. Med. Gaz., June 11, 1847. 10 Gazette Medicale de Paris, 9 Octobre, 1847. II A Treatise on Etherization in Child-birth. Boston, 1848. 12 American Journal of the Medical Sciences, April, 1849, p. 343. 13 Archives Generates de Medecine, Avril, 1847. 72 AETHER SULPHURICUS. Dr. Lloyd,' Mr. Lansdown, 2 Dr. Protheroe Smith, 5 Dr. Jonathan Clark, 4 Dr. Lindsly,' Dr. Trask, 6 and numerous others. Objec- tions have been brought against its use, many of which do not merit much notice. The strongest, perhaps, is the one urged by Drs. Radford," Meigs, and others, that in instrumental deliveries more especially, "as in lithotomy and lithotrity," the sensibility of the patient is a safeguard against injury of the soft parts; but the argument is more specious, perhaps, than solid, as a careful opera- tor could scarcely perpetrate such a blunder. 3 It has been very largely and successfully employed in instrumental and complicated labours. Two cases of placenta prcevia were treated under its agency by Dr. Protheroe Smith; 9 and examples of its value where turning was required, are recorded by him as well as by Mr. Gor- don, 10 Mr. Pickens, 11 and others. In numerous cases of puerperal convulsions, and in forceps and craniotomy cases, its value has been manifested. 12 MODE OF ADMINISTRATION. Various forms of inhaling apparatus have been devised. Many- are referred to by Dr. Ranking ;' 5 and some of them by the author 14 in another work, with figures representing them. The vapour is most conveniently inhaled from a soft sponge, hollowed out on one side, to receive the projection of the nose, and saturated with the purest ether. The sponge, thus prepared, is applied over the nos- trils, through which the inhalation must be made, leaving the mouth free to receive atmospheric air, and thus prevent the dan- ger of asphyxia. The time required to produce etherization is usually from three to five minutes, and the quantity generally found necessary, is about tw T o fluidounces; but the effects must be carefully watched. Dr. Warren 15 remarks, that after careful inspection of two hundred cases of both sexes, of all ages, in a great variety of conditions of health and disease, etherized through a sponge, without reference to quantity, he has seen no immediate or consequent symptoms, 1 Medical Times, March 27, 1847. 2 Lancet, June 5, 1847. 3 Lancet, May 1, and July 31, 1847. * Medical Examiner, October, 1847, p. 489, and March, 1S48, p. 153. '- Transactions of the American Medical Association, vol. L, Philad., 1848; and Medical Examiner. June, 1848, p. 339. 6 American Journal of the Medical Sciences, October, 1850, p. 341. 1 Lancet, April 7, 1847. * Answer to the Religious Objections advanced against the Employment of Anaes- thetic Agents in Midwifery and Surgery, Edinburgh. 1848; and Anaesthesia, or the Employment of Chloroform and Ether in Surgery, Midwifery, &c, by J. Y. Simpson, M. D., &c., Fhilad., 1848; and a Correspondence between Professors Simpson and Meigs, in Medical Examiner, March. 1848. p. 145 — April, 1848. p 205 — and May, 1848, p. 269. 9 Lancet, July 31, 1817. ,0 Ibid., July 14, 1847. " Provincial Med. and Surg. Journ., Sept. 21, 1847. ,a Channing, Op. cit. 13 Half-yearly Abstract of the Medical Sciences, v. 330, Amer edit Fhilada. 1S47. M General Therapeutics and Materia Medica, 4th edit i. 383. Philad. 1850. " Etherization, &c p. 77. Boston, 1848. iETHER SULPHURICUS. 73 which would lead him to embarrass the patient and the surgeon with a complex apparatus; and similar views are entertained by Dr. Hay ward. 1 The irritability of the parts," the latter remarks, "with which the ether comes in contact, is by degrees overcome; then the sponge may be applied directly to the face, and, if neces- sary, compressed in some measure so as to exclude to a greater de- gree the atmospheric air. When the desired effect is produced, which is usually in from three to five minutes, the patient has no control over the voluntary muscles ; he cannot speak ; he cannot open his eyes, w T hen directed to do so; his muscles become completely relaxed, and the pulse, w^hich, at the beginning of the inhalation, is frequent, and often rises during the process to one hundred and forty beats in a minute or more, becomes slower, and 1 have very often known it fall to sixty. The patient is then insensible, and unconscious; and the surgeon may begin his operation with great confidence that he will inflict no suffering. The sponge should then be removed, and reapplied, from time to time, as circum- stances may require. If the ether is not pure, longer time is ne- cessary to produce the desired effect: the brain and nervous sys- tem are more excited, and the patient is occasionally violent for a time, and with difficulty controlled. Before using the ether, the sponge should be dipped in warm w T ater, and then strongly com- pressed, leaving it slightly damp. The evaporation seems to go on better in this way, than when a sponge is used that has not been previously moistened. In the first instance, the ether should be poured over the inside of the sponge: about two ounces is enough. When more is required, it should be applied to the out- side, as it is best not to remove the sponge from the face." It has likewise been administered per anum, and M.Pirogoff, 2 of St. Petersburg, thought that the anaesthetic effects of the vapour were produced more speedily and with much less trouble to the patient. He found, that in from two to four minutes the odour of the vapour was perceptible in the breath, and the wonted effects supervened in from three to five minutes. The quantity of ether used varied from half an ounce to two ounces. Similar experi- ments were made by MM. Roux and Parchappe; and according to M.Velpeau, the former preceded M. Pirogoff. 1 Remarks on the Comparative Value of the Different Ansesthetic Agents, Boston, 1850. 2 Gazette Medicate de Paris, 8 Mai, 1847, 74 ALUMINJE SALES. XI. ALU'MINJE SALES. Synonym es. Salts of Alumina. French. Sels d'Alumine. German. Thonerdensalze. In making experiments on the agency of various substances as antiseptics, M. Gannal 1 discovered that the aluminous salts are alone possessed of the property of preserving animal matters, — "their bases combining with geline to form a special compound, the acid being set free." He found the aluminous deliquescent salts to be, of all saline substances, those that afford the most satis- factory results. The acetate of alumina and chloride of alu- minium succeeded perfectly. A mixture of equal parts of chloride of aluminium at 20° Beaume (s. g. 1.161,) and of the acetate of alumina at 10° (s. g. 1.075,) proved as good an injection as we possess for the preservation of dead bodies. The preservation of animal substances appears to depend upon the combination of geline with alumina : but the acid sulphate does not possess enough of the preservative element; and hence M. Gannal was driven to the employment of the salts of alumina that are richer in alumina, and more soluble in water. Of all these, the sulphate of alumina was found to merit the prefe- rence, ow T ing to its being of simple preparation and moderate price. 2 It may be made by the direct combination of alumina and sul- phuric acid ; and contains 30 per cent, of the former to 70 per cent, of the latter. A kilogramme — about two pounds, eight ounces, and a dram and a half troy— dissolved in two quarts of water, and costing twenty cents, M. Gannal found to be sufficient, in winter, to preserve a body fresh by injection for three months. To preserve it for a month or six w 7 eeks, it was not even neces- sary to inject the blood-vessels, — an enema of one quart, and the same quantity injected into the oesophagus being sufficient for the purpose. In hot weather, the solution must be stronger, or in greater quantity, and it should be injected into the carotids. The acetate of alumina, of which M. Gannal made use, was prepared by the addition of acetate of lead to sulphate of alu- mina and pot ass a. The acetate of alumina, thus prepared, at 18° of Beaumti's areometer, and in the quantity of five or six quarts, w 7 as sufficient to preserve a body for five or six months. This salt of alumina is, however, too costly ; and, therefore, can- not be employed in amphitheatres, where large quantities are re- quired. In the report on M. Gannal's memoir presented to the Insti- tute of France, the commission adduce, in favour of his plan, the 1 History of Embalming, &c. by J. N. Gannal, Paris, J 838, translated by R. Harlan M. D., p. 203. Philad. 1840. a Ibid. p. 233. ALUMINA SALES. 75 experience of MM. Serres, Dubreuil, Bourgery, Azous, Velpeau, and Amussat. " In the month of June, 1836," says M. Serres, "in the amphitheatre of the hospital, the body of a man, 22 years of age, was injected. Left to the open air, in a room exposed to the south, and upon a wooden table, it was preserved until the month of September, and was ultimately mummified. In the month of July, eight bodies were injected for dissection, and kept fifteen days. During the months of August and September, sixty subjects were injected. They were kept for twenty days." From these experiments, M. Serres concluded, that the liquid furnished by M. Gannal, permitted the dissection of bodies during summer, which had not been practicable in the anatomical schools of the hospitals of Paris ; and that it gave to the instruction in operative medicine a development which it had not previously enjoyed ; for, during the months of August and September, they were enabled to have thirty bodies at a time on the tables as in the middle of winter, so as to enable them to repeat before the students all the operations required in a regular course of operative surgery. For his discovery the Institute of France awarded M. Gannal the grand Monthyon prize of 1600 dollars, which was established for the discovery of any means calculated to remedy the unwholesome- ness of any art or profession. A useful application of M. GannaPs process is said to have been made by the police of Paris, in preserving bodies for many weeks in the Morgue or dead-house, where suspicions of murder required an unusual retention of the body above ground. 1 Specimens of pathological anatomy, preserved in the liquid of the injection, were not exempt, according to Dr. Harlan, from the usual inconvenience attached to similar preparations in a solu- tion of chloride of sodium and other salts, — being equally liable to incrustations, so as to require a change or renewal of the solution. The salts of alumina have been used in this city with the view of temporarily preserving the dead ; and a case has been published in which the acetate was employed ; but the corrosive chloride of mercury was used along with it, which was unnecessary. In the afternoon of the day on which the individual died, the abdominal aorta was injected upwards and downwards with a saturated so- lution of corrosive chloride in alcohol ; and on the following day, a saturated solution of acetate of alumina was thrown in, "which," says Dr. Sharpless, 3 "had the immediate effect of giving the whole body a manifest rose colour, making it resemble life in a re- markable degree." The salts of alumina have been chiefly employed to prevent pu- trefaction in the dead body; but they might be used with eminent advantage as external applications in cases that require the topi- 1 Harlan, Appendix to Gannal, Op. cit., p. 254. Q Medical Examiner, Aug. 13, 1842, p. 513. 76 AMMONIiE PHOSPHAS. cal use of antiseptics. At the author's suggestion, they were so used at the Philadelphia Hospital, and were found to have an ex- cellent effect in ulcers requiring antiseptic and detergent -applica- tions. 1 Two drams of the sulphate to half a pint of water is a good wash in such cases; but it may be made much stronger than this. Dr. George Johnson, of Georgia, used an injection of the sulphate with the happiest results in cases oi fetid discharges from the vagina. 2 After handling pathological specimens, the author has found a saturated solution of the salt remove the offensive odour from his hands more speedily and effectually than any other antiseptic. XII. AMMONIA PHOSPHAS. Synonymes. Ammonium phosphoricum, Phosphate of Ammonia. French. Phosphate d'Ammoniaque. German. Phosphorsaures Ammonium. Phosphate of ammonia has been recommended in some of the unofficial pharmacopoeias and formularies, as an excitant, dia- phoretic and discutient; 3 but it could scarcely be said to be em- ployed in medicine, when it w T as brought forward by Dr. Thomas Buckler, of Baltimore, on chemical considerations, as " a new re- medy for gout and rheumatism, as a solvent of uric acid calculus, and for diseases, acute and chronic, connected directly with the Hthic acid diathesis."* METHOD OF PREPARING. Neutral phosphate of ammonia may be made by saturating a somewhat concentrated solution of phosphoric acid with ammonia, applying heat, and setting the solution aside, that crystals may form. Or, it may be formed by saturating the excess of acid in superphosphate of lime by carbonate of ammonia. Phosphate of lime w T ill be precipitated, and phosphate of ammonia obtained in solution, which, being concentrated by a gentle heat, affords, on cooling, the salt in crystals. EFFECTS ON THE ECONOMY. From the facts of the frequent existence of lithuria in gout and rheumatism, and the sudden elimination of uric acid, — and that when chemists have examined the structural thickenings in those diseases, they have found a variable abnormous per centage of earthy matter, consisting for the most part of soda and lime, — and from other considerations, Dr. Buckler infers, that uric acid exists in the blood, — not in a free state, or it would be passed continu- 1 M. J. Pennypacker, Med. Ex., April 1 , 1843, p. 63. - Ibid. May 27, 1843, p. 112. 3 Merat and De Lens, Diet Univ.de Mat. Med. &c., edit, de Bruxelles, 1, 115. Bruxelles, 1838. * American Journal of Medical Sciences, Jan., 1846. p. 109. AMMONIA PHOSPHAS. 77 ously, but in a state of combination with soda or lime, or both. The predominance of lithic acid in the urine, he considers, gene- rally heralds recovery from an acute attack of gout or rheuma- tism. " Taking into account," he observes, " these two prominent facts, namely, the excess of lithic acid found in the urine at the period of convalescence from an attack of gout or rheumatism, and the subsequent deposit of soda and lime in the white tissues, it occurred to me, that during the existence of these diseases, the lithic acid might exist in the blood in a state- of combination with soda and lime, in the form of insoluble compounds, which the kid- neys and skin refuse to eliminate. If, then, any agent could be found capable of decomposing the lithates of soda and lime exist- ing in the blood, and of forming in their stead two soluble salts, which w 7 ould be voided by the kidneys and skin, we should there- by get rid of the excess of fibrin in the blood, the symptomatic fever and the gouty and rheumatic inflammation, wherever seated, which have been excited by the presence of these insoluble salts: it occurred to me that phosphate of ammonia might be the agent, provided it could be given in doses sufficient to answer the end, without producing any unpleasant physiological symptoms. If our theory were true, phosphate of ammonia seemed to be the proper reagent, for it would form, in place of the insoluble lithate of soda, two soluble salts, the phosphate of soda, which is remark- ably soluble, and the lithate of ammonia, which is also soluble, and both capable of being readily passed by the skin and kidneys. The excess of uric acid w T ould thus be got rid of in the form of lithate of ammonia, and the soda floating in the round of the cir- culation, instead of being deposited, as it were, like an alluvial formation in the substance of the fibrous and cartilaginous tissues, would be taken up by the phosphoric acid and eliminated from the circulation." With such views Dr. Buckler administered the phosphate of ammonia, and found that thickening, of the white tissues, of long standing, disappeared under its continued use; that it w T as de- cidedly serviceable in attacks of gout and acute rheumatism, and that in many old hospital cases of chronic rheumatism, the patients, without a single exception, declared themselves better, and begged for a continuance of the medicine. In every instance, in the cases reported, it was found that where lithic acid was pre- sent in the urine, it at once disappeared under the use of the phos- phate of ammonia. From this rapid disappearance of the acid from the urine, in every case, he was led irresistibly to the con- clusion, that the phosphate of ammonia must prove the best agent for dissolving uric acid calculus ; but he had had no opportunity for testing its efficacy in this respect. The cases adduced by Dr. Buckler do not demonstrate to us, so strongly as they do to him, the marked efficacy of phosphate of 6 78 AMMONIJE PHOSPHAS. ammonia in the cases in question. It is proper also to remark that, according to the analysis of Berzelius, this salt exists in the urine in health, and we have no reason to believe that it is not pre- sent in gouty and rheumatic diseases also. Moreover, although there may be generally a predominance of uric acid in the urine, in gout and rheumatism, it is by no means clear that these diseases are dependent on contamination of the blood with undischarged urea and uric acid, as has been maintained by many. 1 "Several considerations," say Messrs. Ballard and Garrod- — able chemists — "prevent our subscribing fully to this doctrine, which we are not aware to be established upon aught but hypothetical grounds." Phosphatic deposits are frequently, indeed, observed in conjunc- tion with gouty affections, and in many instances, it would seem, that tophaceous concretions contain no urate of soda, but in its stead phosphate of lime. In numerous cases of gout, the phospha- tic predominance is indeed marked. 3 Keller, 1 again, in animad- verting on the views of Mr. A. Ure, referred to under Acidum Benzoicum, remarks, that Mr. Ure "is certainly too hasty in re- commending benzoic acid as a remedy for the gouty and calculous concretions of uric acid. He seems to suppose that the uric acid has been employed in the conversion of benzoic acid into hippuric acid ; but as his observations were made on a gouty patient, it may be supposed that the urine, even without the internal use of ben- zoic acid, would have been found to contain no uric acid." M. Matter 5 of Bastia, has published some cases which appeared to him to exhibit the valuable agency of the phosphate in gout and rheumatism in the dose of about 30 grains ; and Dr. S. Edwards, 6 confirms its advantages in diseases which appear to depend upon the presence of an excess of lit hie acid or lithates in the blood. In chronic articular rheumatism, it appeared to be especially be- neficial. As a solvent of lithic calculi his experience does not en- able him to pronounce upon it, but his observations lead him to depose positively as to its powers to arrest the increase and per- haps the formation of them. In lithic acid gravel, he has fre- quently used it; and experience has taught him, that it creates a very rapid decrease and disappearance of the red crystalline sedi- ment. Sufficient time has not elapsed for experiments to have been made on a great scale, to test the qualities of the phosphatic salt in the cases described by Dr. Buckler. It has been already seen, that 1 Williams, Principles of Medicine, Amer. edit, by Clymer, p. 131. Philad. 1844. 2 Elements of Mat. Med. and Therap., p. 352. Lond. 1845. 3 A. Ure, Provincial Med. and Surg. Journal, Feb. 11, 1843; cited in Brailhwaite's Retrospect, vii. 47. Lond. 1843. * Licbig's Animal Chemistry, Amer. edit, p. 315. Cambridge, 1842. 5 Revue Medico-Chirurgicale, Dec. 1847. • Provincial Med. Journal, Nov. 17, 1847; and Amer. Journ. of the Med. Sciences, Jan. 1, 1848, p. 23 ( J. AMMONIJE PHOSPHAS. 79 in the case of the benzoic acid, examples were not wanting to prove its efficacy in lithuria; although no one now" can believe that it could have exerted any efficacy in the manner suggested. So far as the phosphate of ammonia has been given, it does not seem to have generally fulfilled the expectations excited by Dr. Buckler. In a trial made with it by Dr. C. Voigt, 1 in the dose of only about three grains, a series of alarming and highly irritative phenomena succeeded, caused, he thinks, by the violently irritating action of the salt on the stomach ; yet Dr. Voigt had good reason to suppose that the preparation employed was pure. In commenting on this case, Dr. Ruschenberger, 3 of the United States Naval Hospital, New York, states that he has employed phosphate of ammonia in nine cases in doses of ten grains, repeated every four hours. In no case was the article used for less than a week, and in several it was continued three, four, and even six weeks. The urine was tested before the medicine was prescribed, and during its use ; but no change in its constitution was detected by reagents, nor was there any modification in its quantity or spe- cific gravity. In one case only did any amelioration occur in the symptoms after the use of the salt; but whether this was owing to it he could not decide. Inasmuch, however, as no perceptible effects were induced in any of the other cases, his impression was that the phosphate is useless in the treatment of chronic rheu- matism. Since then Dr. H. Hartshorne, resident physician at the Penn- sylvania Hospital, 3 has reported some cases of rheumatism in which the phosphate was prescribed by Dr. Pepper. The smallest dose given to an adult was ten grains, and in several cases it reached thirty grains, continued three times daily for a number of days. In two or three, in doses of twenty grains, it disordered the alimentary canal. Several of the cases recovered ; but addi- tional treatment w 7 as generally used — as Dover's powder at night, the warm bath, cupping, blisters dressed with morphia, mercurial ointment combined with narcotics, vera tria ointment, &c. These, Dr. Hartshorne considers, may perhaps claim much of the credit of the cures, which w T ere mostly very slow. The phosphate, he says, has been used by his father, Dr. Joseph Hartshorne, with such results as to incline him to think that it may be a valuable addition to our means of treatment of rheumatism. MODE OF ADMINISTRATION. The dose of the phosphate of ammonia is from ten to twenty grains, which may be given, dissolved in w T ater, three times a day. i Med. Examiner, Mav, 1846, p. 289. 2 Jbid. June, 1846, p. 342. 3 Ibid. July, 1846, p. 397; and January, 1849, p. 49. 80 AQUA AMYGDALARUM CONCENTRATA. XIII. ANTHRAKOKALI. 1 Synonyme. Lithanthrakokali. German. Steinkohlenkali. This article was first proposed by Polya, of Pesth, in the year 1837. METHOD OF PREPARING. Two forms are employed, the simple and the sulphuretted. The former is prepared by dissolving carbonate of potassa in 10 or 12 parts of boiling water, and adding as much slaked lime as will separate the potassa. The solution thus obtained contains only caustic potassa. The filtered liquor is placed on the fire in an iron vessel, and suffered to evaporate until neither froth nor effer- vescence occurs, and the liquid presents a smooth surface like oil. To this is added the levigated coal in the proportion of 160 parts to 192 parts of potassa. The mixture is stirred and removed from the fire, and the stirring is continued until a black homogeneous powder results. This powder is kept in a dry place. To obtain the sulphuretted anthrakokali, 16 parts of sul- phur must be mixed accurately with the coal, and the mixture be dissolved in the potassa as directed above. EFFECTS ON THE ECONOMY IN DISEASE. Polya affirms, that Anthrakokali exerts its influence on the skin generally, and especially on chronic cutaneous affections. It has also been given beneficially by Felsach in scrofula and chronic rheumatism. The dose of the simple and sulphuretted preparations is 10 cen- tigrammes (gr. iss.) three times a day. M. Gibert employs it externally in chronic cutaneous affections, in the form of ointment, which may be made of one drachm of the anthrakokali to from one to three ounces of lard.' 2 Fuligokali is an analogous substance. XIV. AQUA AMYGDALARUM CONCENTRATA. Synonymes. Water of Bitter Almonds. French. Eau d"Amandes Ameres. German. Bittermandelwasser. The water of bitter almonds has been received into many of the modern Pharmacopoeias; — into those of Bavaria, Paris, Ferrara, Hanover, Hesse, and Prussia for example. 1 From av&Q. » Ibid. lxi. 5. 6 Ibid. lxii. 3. Mbid. Ix. 1. 8 Ibid. lxv. 3. 9 Ibid. lxv. 3. 10 Ibid. Ixv. 3. II Riehter's Specielle Therapie, B. x. S. 377. Berlin. 1828. » Op. cit. S. 49. ,3 Lancet, July 9, 1836. ARTEMISIA VULGARIS. Ill fected with epileptic fits for four months — three or four occurring daily. A dram of the powder was given three times a day. This was on the 30th of March. On the 9th of April, the dose was in- creased to two drams, when the fits became less frequent, but not less severe. On the 16th, the dose was repeated every four hours. She had only one slight fit in the course of twelve days; and, on her dismissal, on the 24th of May, had had no fit for twenty-six days. Dr. Elliotson was of opinion, that the strong infusion . would be less offensive to the patient, and quite as effective as the powder. Besides epilepsy, artemisia has been used with advantage in other diseases, as in St. Vitus's dance? Wutzer employed it successfully in the convulsive diseases of childhood, and it was recommended by Biermann 3 in eclampsia infantum, occurring during the period of dentition, He advised it to be given to chil- dren in gradually increasing doses, commencing with half a grain; and giving, an hour afterwards, a grain, and, in two hours, two grains, which is usually the last dose required. The gradual aug- mentation of the dose he considers advisable, " to prevent the crisis which the artemisia induces from being too turbulent." ! Kolreutter, of Carlsruhe, administered artemisia in different dis- eases, with great success. He prefers the extr actum resinosum radicis artemisia vulgaris, German, Biefusswurzelextract, to the root in substance. This is prepared in the following man- ner, A quantity of the dried and powdered root is covered with alcohol, and permitted to digest for some time; the filtered liquor is then evaporated in an earthenware vessel, until it has attained the consistence of an extract. Kolreutter employed this advan- tageously in the eclampsia of children, (in certain cases after the application of leeches;) in tormina, unaccompanied by inflamma- tion ; in the diarrhoea of children and adults, in sporadic cases of cholera morbus, and in dysentery, after the bloody evacuations had ceased ; in gastric fevers, on their assuming a nervous cha- racter; and in dysphagia, cardialgia, chronic vomiting, scirrhus of the stomach, chronic cephalalgia and neuralgia of the face; in chlorosis, and in obstruction of the catamenia, as well as in epilepsy. The dose, in the twenty-four hours, is from 3ss. to 3j.; to small children, a few grains. Such is the chief testimony adduced in favour of artemisia by the German writers mainly. It is to be feared, that the ad- vantages to be derived from it in epilepsy have been exaggerated. Where there is no organic disease of the encephalon, substances, which, like it, are nauseous, bitter and aromatic, may be produc- tive of advantage as tonics and revellents. In one case of this nature it was employed by the author, but the results were not I ' Gittermann, in Hufeland's Journal, lxii. 1. Bonorden, Op. cit. 2 Riecke, Op. cit. S. 50. 112 ARTEMISIA VULGARIS. striking. When aided by other means and appliances, it appears to be powerfully diaphoretic; and, doubtless, therefore, in appro- priate cases, especially where there is much nervous impressibility, it may be productive of the good effects ascribed to it by Burdach, Kolreutter, and others. Yet, as Osann has remarked, 1 it must be improper where polysemia, or a tendency to active hyperemia, is present. The analysis of Hergt, Hummel, and Janike afforded, along with traces of volatile oil, some balsamic resin, both of which are excitants to the living economy. MODE OF ADMINISTRATION. The following forms for its administration have been adopted by some of the German authorities: — Tinctura arteniisiae. Tincture of Mugwort, R. Artemis, vulg. rad. concis. §v. « Alcohol, dilut. Oij. M. Digest for three days; express and filter. Dose, — half a drachm to two drachms, four or five times a day, in epilepsy. Rademacher. 2 Decoetum artemisise. Decoction of Mugwort. R. Artemis, vulg. rad. concis. ^j, Coque cum aquae q. s. per semihoram ad. colat. Oj. Half a tea-cupful of this may be taken every two hours, in cases of epilepsy. Hildenbrand. Pulvis arteniisiae. Powder of Mugwort. R. Artemis, vulg. rad. pulv. 3j. Sacch. alb. 9j. M. et fiat pulvis. The powder to be administered daily in the evening, in warm beer, in cases of epilepsy. Lowenstein. Mistura artemisis. Mixture of Mugwort. R. Ext. artemis. vulg. alcoholic, gr. iv. Acaciae 9j. Sacch. ^iij. Mist, amygd. f ^iij. A coffee-spoonful 3 to be given every half hour in eclampsia infantum. The dose may be gradually raised to two coffee- spoonfuls. Kolreutter. 1 Art. Artemisia in Encyc. Worterb. iii. 313. Berlin, 1829. 2 Aschenbrenner, Die neueren A rzneimittel, u. s. w. S. 37. Erlangen, 1848. 3 About two ordinary tea-spoonfuls. ATROPIA. 113 XXX. ATROP'IA. Synonymes. Atrophia, Atropium, Atropinum ; Atropine, French. Atropine. German. A tropin. This is the active principle of Atropa belladonna, and was dis- covered many years ago in the leaves by Brandes. To it is pro- bably owing the whole of the medicinal efficacy of the plant. In 1S25, M. Pauquy found it in the root, and affirms, that he de- tected it also in the stalks of datura, hyoscyamus, and solanum. 1 METHOD OF PREPARING. The most approved processes for extracting this alkaloid, ac- cording to Dr. Pereira, 3 are those of Mein, Thomson, and Richter. The process of Mein is contained in the Pharm. Central-Blatt, fur 1833. The following is given in the United States Dispen- satory, 3 from the Journal de Pharmacie, vol. xx., p.- 87. — The roots of plants two or three years old are selected; of these, re- duced to an extremely fine powder, twenty -four parts are digested for twelve days, with 60 parts of alcohol, of 86 or 90 per cent. The liquid having been separated by strong evaporation, the resi- due is then treated anew with an equal quantity of alcohol; and the tinctures, poured together and filtered, are mixed with one part of hydrate of lime, and frequently shaken for twenty-four hours: the copious precipitate w T hich now forms is separated by filtering; and diluted sulphuric acid is added, drop by drop, to the filtered liquor till slightly in excess. The sulphate of lime having been separated by a new filtration, the alcoholic liquor is distilled to one half, then mixed with six or eight parts of pure water, and evaporated with a gentle heat till the whole of the alcohol is driven off. The residual liquid is filtered, cautiously evaporated to one-third, and allowed to cool. A concentrated aqueous solution of carbonate of potassa is then gradually added, so long as the liquid continues to be rendered turbid, and the mixture is afterwards suffered to rest some hours. A yellowish resinous substance, which opposes the crystallization of the atropia, is thus precipitated. From this the liquid is carefully decanted, and a small additional quantity of the solution of the carbonate is dropped into it, till it no longer becomes turbid. A gelatinous mass now gradually forms, which, at the end of twelve or twenty- four hours, is agitated, in order to separate the mother waters, then thrown upon a filter, and dried by folds of unsized paper. The substance thus obtained, which is atropia in an impure state, 1 Merat & De Lens, Diet. Universel de Mat. Med. Art. Atropine. Bruxelles, 1S38. 2 Elements of Mat. Med. and Therap., 2d Amer.edit. ii. 312. Philad. 1S40. 3 Sixth edition, p. 138. Philad. 1845. 114 ATROPIA. is dissolved in five times its weight of alcohol; and the solution, having been filtered, is mixed with six or eight times its bulk of water. The liquor soon becomes milky, or is rendered so by evaporating the excess of alcohol, and, in the course of twelve or twenty-four hours, deposits the atropia in the form of light-yellow crystals, which are rendered entirely pure and colourless by wash- ing with a few drops of water, drying on blotting paper, and again treating with alcohol, as before. By this process, Mein obtained, from twelve ounces of the root, twenty grains of pure alkali — according to the authors of the Dis- pensatory, — not quite twelve grains, according to Dr. Pereira. Atropia crystallizes in transparent silky prisms, is devoid of odour, and is soluble in alcohol and ether; very slightly so in water. It dissolves in acids, with which it unites to form salts. At a temperature of 212° it is volatilized. As atropia is an expensive article, and therefore very liable to adulteration, Mr. Donovan, 1 to insure its purity, advises that a dram of commercial atropia be dissolved in an ounce of alcohol. If there be a residuum, it must be separated; and six ounces of distilled water be added, shaking the mixture. No change ap- pears at first; but, after twelve or eighteen hours, the atropia crystallizes in beautiful stellated groups, which adhere to the sides of the vessel. These, after pouring off the liquor, must be collected on bibulous paper, and dried. EFFECTS ON THE ECONOMY. Atropia is a most virulent poison. When given to dogs and cats, it causes vomiting, dilatation of the pupil, stupor and death. A tenth of a grain produced, on man, manifestly poisonous phe- nomena. When Brandes applied a "minimum" quantity of the sulphate to the tongue, headache, with alternate chills and flush- ing, trembling, oppression of breathing, and weakness and small- ness of the pulse supervened. 3 An imponderable quantity, applied to the eye, occasions dilatation of the pupil. Reisinger 3 used it for this purpose, dissolving a grain in two scruples of water; and it has been proposed by Mr. W. W. Cooper, 4 surgeon to the North London Ophthalmic Institution, and by M. Bouchardat, 5 as a substitute for belladonna for dilating the pupil in cases of cataract, &c. Mr. Cooper affirms that he has used it, with the greatest satisfaction, in a considerable number of cases, — the pro- portions being two grains of atropia dissolved in a dram of alcohol and seven drams of distilled water. A colourless solution is the result, which — Mr. Cooper affirms — is equally efficacious in its 1 Ranking's Half- Yearly Abstract, July to December. 1848, Amer. edit., p. 215. a Oesterlen, Hnndbuch der Heilmitellcbre. S. 784. Tubingen. 1845. 3 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 41. Erlangen, 1848. 4 London Lancet, June 8, 1844. * Annuaire de Tberapeutique, &c, pour 1847, p. 19. Paris. 1847. ATROPIA. 115 action as, and much more elegant than, the ordinary preparations of belladonna, — a full drop placed in the eye producing speedy and complete dilatation of the pupil in the generality of cases, although, in some instances, a stronger solution may be required. He has never seen ill effects from its use, although he has tried it in the proportion of four grains to the ounce; but, he thinks, two grains will be found to answer every purpose. He directs a drop to be used night and morning, where he is desirous of keeping up the dilatation of the pupil. An objection, which does not seem to be a very forcible one, has been made to this preparation, — that it involves the necessity for the addition of alcohol. Mr. J. Lloyd Bullock 1 proposes, therefore, to substitute the salts of atropia, which are neutral and soluble in distilled water. Dr. Jacob 2 con- siders it more effective and convenient than any extract or tincture of belladonna. In experiments made with it by Messrs. Bouchardat and Stuart Cooper, 3 they found it, in the dose of a centigramme — gr. .1543, produce on man all the severe symptoms of the active solanaceaB — as delirium, coldness of the surface, syncope, depravation of sight, and aphonia ; yet they consider it, owing to the facility of adminis- tering it and of regulating the dose, to be a most valuable agent in every case in which belladonna and other solanacese are beneficial. Its dose is about one-twelfth of a grain; or it may be employed endermically. Tinctura atropise. Tincture of atropia. (Gouttes ou Teinture 6? Atropine.) R. Atropise gr. xv. (1 gramme.) Alcohol. 85 per cent. £x. (40 grammes.) M. Dose — one to five drops. Unguentum atropine. Ointment of atropia. (Pommade d' Atropine.) R. Atropise gr. iv. (25 centigr.) Adipis gj. and 9j. (5 grammes.) M. The size of a pin's head to be introduced, night and morning, between the eyelids, in cases of adhesion of the iris to the lens. Bouchardat.* An ointment, composed of five grains of atropia to three drams of lard, has been much used in neuralgia. 5 Atropia is so lethiferous, that it is not much employed internally. 1 Lond. Lancet, June 15, 1844, p. 393. 3 Dublin Medical Press, cited in Med. Examiner, October, 1848, p. 652. 3 Bouchardat, Annuaire de Therapeutique, pour 1848, p. 10 ; and Ibid, pour 1849, p.7. 4 See, also, Cunier, in Bouchardat, Annuaire pour 1848, p. 10, Paris, 1848. 5 Brookes, Lancet, Jan. 30, 1847. 116 AURI pr^cparata. XXXI. AURI PRiEPARATA. Synonymes. Preparations of Gold. French. Les Preparations d'Or, Les Composes auriferes. German. Goldpraparate. The administration of gold in medicine is not modern. In the times of alchemy, it was frequently used in nervous diseases, con- vulsions, hypochondriasis, mental affections, profuse salivation, Sac. Paracelsus, Horst, and Poterius recommended it, united with corrosive sublimate, in syphilis. Its violent effects, however, brought it into discredit, and during the decadency of alchemy it fell into entire disuse. 1 It is probable, too, that many prepa- rations were brought forward as containing gold, which had none of it, and this may partly account for the discredit into which it lapsed. 2 M. J. A. Chrestien 3 was the first who — in more modern periods, (about the year 1810,) — recalled the attention of practi- tioners to the preparations of gold, and after him many physicians employed them, so that the published results of their observations have furnished us with a considerable amount of evidence in rela- tion to their therapeutical properties, and they have, in conse- quence, been received into many of the modern pharmacopoeias. 4 As the different preparations agree in their effects on the econo- my, it may be well to make a few observations which apply to all. EFFECTS ON THE ECONOMY IN HEALTH- Orfila made many experiments to discover the action of the preparations of gold on animals. Three dogs, into whose jugular veins he injected a small quantity of the chloride dissolved in water, died speedily — death being preceded by difficulty and rattling in breathing, cough, symptoms of suffocation and slight vomiting; these results supervening immediately after the injec- tion had entered the blood-vessels. On dissection, the lungs were found livid, engorged with blood, and without any crepitating noise when cut into; wrinkled, discoloured, and scarcely lighter than water; the heart was of a violet colour ; the left auricle and ventricle full of black blood, and the right cavities empty and contracted. The effect of the salt supervened with such rapidity that the blood of the crural artery — which was opened a few minutes after death — was of a brownish red, almost black, colour. 1 Richter's Specielle Therapie, x. 504, Berlin, 1828; and Nachet, Art. Or, in Diet, des Sciences Medicales, torn, xxxvii. 2 Riecke, Die neuern Arzneimittel, S. 53. Stuttgart, 1837. 3 Recherches et Observations sur les effets des preparations d'Or du Dr. Chrestien, &c. Paris, 1821. 4 See Art. Gold, in Encycl. Wdrterb der Medicinisch. Wissenschaft, B. xv. S. 77, Berlin, 1837. AURI PR^PARATA. 117 In two dogs, to which he gave the chloride, a torpid condition was induced, which terminated fatally in a couple of days. The mucous membrane of the stomach was found inflamed and ulcerated. The effects on man of agents so potent, in appropriate doses, have been investigated by many observers. Experiments on animals had already exhibited the powerful influence which they are capable of exerting on the organs and functions of organic life. One of the most striking effects is said to be, an in- crease of the various secretions; commonly, the urinary secre- tion is largely augmented, as well as the transpiration, and the intestinal and salivary secretions. Not unfrequently, under the continued administration of the gold, actual salivation ensues, which differs, however, from that induced by mercury. It is always slow in appearing, and is by no means so exhausting; nor do troublesome ulcers occur ; and the saliva is thinner, and not so tenacious. Like mercury, the preparations of gold occasion ex- citement in the organism, which often ends in a true febrile condition. After they have been taken for some time in moderate doses, there is generally a feeling of increased warmth in the stomach, and an augmentation of the appetite. The pulse is ren- dered fuller and more active, and the animal heat and vital activity are augmented, so that in such as are predisposed to the affection, hemorrhage is apt to take place. The catamenia recur sooner than usual under their influence, and the quantity lost may be greater. 1 Sooner or later, a regular attack of fever not unfre- quently supervenes, — as indicated by shivering, and pains in the limbs, back, and stomach, — which may continue for a few hours, but sometimes lasts for days, and at length ends by sweating, depo- sitions in the urine, and occasionally by salivation. In very large doses, certain of the preparations of gold are cor- rosive poisons. The symptoms, caused by their use, when they act as such, are — oppression in the region of the stomach ; nausea, vomiting, pains in the abdomen and diaphragm, a metallic taste in the mouth, augmented secretion of saliva, without the teeth or gums being affected, pulse excited, and breathing oppressed. 3 As a general rule, they are not esteemed proper for impressible indi- viduals ; on the other hand, in persons of torpid constitutions, they would appear to have exerted an excitant influence even on the generative system. Certain persons, according to Chreslien and Niel, are not susceptible of this action; and, again, there are some, according to Cullerier, junr., who cannot tolerate them in any form. When too large a dose has been given, the remedy should be entirely discontinued for some time, or the dose be diminished ; and the effects will soon disappear. One of the greatest recommen- 1 Riecke, Op. cit. S. 55. 2 Grotzner, in Rust's Magazin. xxi. 3. 118 AURI PR^PARATA. dations of gold over mercury, in the eyes of many, is that it does not act so destructively on the organism, and never induces such a cachectic condition as the latter occasionally does. 1 EFFECTS ON THE ECONOMY IN DISEASE. The diseases, in which the preparations of gold have been ad- ministered, in modern times, are chiefly the following. Syphilis. — They have been occasionally used in primary sores, but have been mainly employed in secondary syphilis, espe- cially in old cases, where a doubt often exists, whether more of mercurial cachexia or syphilis be present. They are given, also, where there is a scrofulous complication, and where it is desirable to exhibit some other remedy than mercury; and lastly, their use is indicated where mercury has failed to remove syphilis. 3 Many practitioners doubt whether the preparations of gold should be esteemed much inferior to those of mercury. Numerous expe- riments instituted, amongst others, by Chrestien, 3 Cullerier, junr., 4 S. L. Mitchill, 5 Niel, Biett, Lallemand, Wendy and Legrand, 8 have shown, that their employment has been most advantageous in the different forms of syphilis, and that they have rarely disap- pointed expectation. Alibert found them especially useful in sy- philitic eruptions. It must be borne in mind, however, that when they are given in syphilis, their operation is slow, and that, in the first instance, the symptoms may appear aggravated: they are not, therefore, adapted for cases in which it is important to act speed- ily, so as to arrest the disease at once, and prevent its farther de- velopment. Gonorrhoea. — In protracted cases of gonorrhoea, several phy- sicians 9 have extolled the preparations of gold; others, as Wendt and Ritter, have advised them for the sequelae of gonorrhoea ( Trippernachkrankeiten:) it is not probable, however, that they could be of much use in gonorrheal affections, which, as is well known, are curable without any mercurial preparations. Scrofula. — The efficacy of the preparations of gold in scrofula was deposed to by Chrestien, Eberle, Niel, Legrand, 10 Herrmann, and Kopp. 11 According to observation, it would appear that they effect improvement in the mildest cases, and are beneficial where there is much torpor, but that they ought to be avoided in irritable subjects. In scrofulous ophthalmia, and in scrofulous porrigo, they would seem to have been most efficacious. The preparations of gold have been employed by M. Baude- I Riecke, Op. cit. S. 56. 2 Eberle, Treatise on the Mat. Medica, '2d edit. i. 247. 3 Op. Citat. p. 6 ; see, also, Lettre a M. Magendie sur les preparations d'Or, &c. Paris, 1828. * Diet, des Sciences Medicales, Art. Or., torn, xxxvii. 5 Dyckman's Dispensatory, p^20l, and Eberle, Op. cit. s Journal Universel des Sciences Medicales, t. xxvii. 7 Rust's Magazin, Bd. xvi. St. I. 8 Gazette Medicale de Paris, Oct. 30, 1837. 9 Grotzner, Op. cit. 10 Bulletin General de Therapeutique, No. xv. 15 Aout, 1837. II Denkwurdio-k. in der arztl. Praxis, iii. 351. AURI PRJEPARATA. 119 locque, at the Hopital des Enfans Malades, and by M. Velpeau at La Charite.' At the former institution, they were given in enormous doses. M. Baudelocque gave the chloride and the stan- nate in doses of from ten to twelve grains, without producing any effect on the disease, and without any apparent injury to the con- stitution of the children subjected to the experiment. The oxide prepared by potassa was carried as high as tw T enty grains during the day. At La Charite, Velpeau gave fifteen, eighteen, and twenty grains of the chloride and oxide during the day, — and higher doses w T ere not tried, solely on account of the expense of the medicine. These results differ greatly from those of Orfila and Devergie, the former of whom affirms, that the chloride is more active than the corrosive chloride of mercury ; and the latter states, that in the dose of one-tenth to one-twentieth of a grain, it produces more or less inflammation of the lining membrane of the stomach and intestines. Scirrhus and cancer. — The utility of the preparations of gold appears to have been most decided in scirrhous induration of the tongue, according to the observation of Wendt, Helm, and others; in such case, they are rubbed on the tongue; this, indeed, is the most common form of administration. H. Hoffmann relates a case of scirrhus of the pylorus, in which the chloride was entirely successful ; and frictions with the chloride, or the oxide on the labia pudendi have been recommended by Hufeland, Herrmann, Meissner, Grotzner, Gozzi, 2 and others, in cases of scirrhus and cancer of the uterus. In the same affections, Krimer has advised them to be applied to the os uteri. Scirrhosities, it is affirmed, have been dispersed through their agency ; and even in open cancer marked improvement has been perceptible. In tumours of the bones, and in like affections, the prepara- tions of gold have been employed successfully by some practitioners, and especially when the cases originated in syphilis. Several forms of lepra have been treated with them by Alibert, and A. T. Chrestien, and with the best effects. In amenorrhea^ Carron du Villards employed the cyanuret successfully, beginning before the expected menstrual period. Lastly. — Wendt, Delafield, and Grotzner have administered them with benefit as diuretics in dropsy. With others, however, they have failed. According to Riecke, 3 the results of experience would seem to show, that they are especially adapted for dropsy dependent upon organic disease of some viscus. None of the preparations of gold are much employed at the pre- sent day. Their expense is, indeed, a weighty objection, unless there were striking advantages in adopting them in special cases of disease in preference to other articles of the Materia Medica. 1 L'Experience, No. lxxxvii ; and Lancet, March 23, 1839, p. 31. 2 Sopra l'uso di alcuni remedii aurifici nelle malattie veneree. Bologn. 1 81 7; and Omo- dei, Annal. Univers. di Medicin., vol. v. 3 Op. cit. S. 58. 120 AURI CHLORIDUM. XXXII. AURI CHLORIDUM. Synony.mes. Aurum Chloratum seu Mnriaticum seu Oxydulatum Mu- riaticum, Chloretum seu Murias Auri, Aurum Salitum, Chloruretum Auri. Auri Terchloridum, Muriateof Gold, Chloride of Gold. Terchloride of Gold. French. Chloride d'Or, Muriate d'Or. German. Salzsaures Gold, Chlorgold, Goldchlorid, Salz- saures Goldoxydul, Hydrochlorsau res Go ldoxyd , Gold- k r y s t a 1 1 e . This preparation is received into several of the European Phar- macopoeias, and is usually formed by digesting one part of gold leaf in three parts of nitro-muriatic acid, in a sand bath, and evaporating gently to dryness. Magendie, 1 however, recom- mends the following method, which has been adopted in the French " Codex." Take one part of fine leaf gold, divide it into small portions, and put it into a vial of w T hite glass; pour upon it three parts of nitro-muriatic acid — formed of one part of nitric acid, and two parts of muriatic acid — and heat the whole in a small sand bath, so arranged, that in case the retort breaks, the fluid may be recovered without loss. The solution of the gold will soon take place. The fluid must be then evaporated until the smell of chlorine is perceptible. This point can be readily determined, as after the decomposition of the nitro-muriatic acid there is a period during which the nitrous acid is alone given off. The disengage- ment of chlorine indicates the commencement of the decomposition of the chloride formed. The vessel must now be removed from the fire and suffered to cool. The chloride appears immediately as a crystalline mass, in the form of a multitude of beautiful yellow needles. In this condition, chloride of gold is as pure as it need be: it contains no excess of muriatic acid, and is not deliquescent. It can be preserved in the same vessel in which it has been pre- pared — by merely stopping it with paper — without any danger of undergoing decomposition. Chloride of gold, prepared according to Magendie's formula, is very acid, but this property is not owing to its containing any free acid. The taste is also styptic and disagreeable. It only attracts moisture from the air when it contains an excess- of muriatic acid, as is the case in Wendt's preparation. It is readily soluble in wa- ter, with which it forms a solution of a beautiful yellow colour. Many animal and vegetable substances, — and especially the epi- dermis — are coloured by it of a purple violet when it is placed in contact with them. Exposed to a moderate heat, it passes to the state of protochloride. When heated to a greater degree in close vessels, chlorine is disengaged and metallic gold left behind. 1 Formulaire. AURI CHLORIDUM. 121 The chloride is one of the most active of the preparations of gold. It belongs to the class of corrosive poisons, 1 and greatly resembles the corrosive chloride of mercury in its operation on the economy. It must consequently be administered with caution: — even a tenth of a grain has been known to induce unpleasant irri- tation of the stomach. 2 It has been given both internally and ex- ternally in syphilis, dropsy? and glandular affections. M. Chavannes, a pupil of M. Petrequin, 4 of Lyons, has published an account of the great success of the latter in the treatment of the ulcerated form of lupus, lupus exedens, by means of this agent, which he has found of great utility in other forms of cutaneous disease, when they assume an ulcerated form, as carcinoma of the face, eczema, tuberculous syphilide, &c. It is made of one part of pure laminated gold, three parts of chlorohydric acid, and one part of nitric acid. It produces a temporary, sharp pain, and coagulation of the albuminous matters on the surface of the ulcer, which changes its colour successively from an orange yellow to a purple, violet, and black; a crust forms, and, under it, healing takes place without a cicatrix, unless the parts have been deeply destroyed. In the form of ointment, it is said to relieve the pain of rheu- matic gout, often in a truly w T onderful manner. The purple stains caused by it are speedily removed by washing the part with a little wine — a fact that was discovered by accident. 3 The dose is from one-sixteenth to one-twelfth of a grain, once or twice a day, gradually but slowly increased. In the like quan- tity it has been rubbed upon the tongue and gums. Externally, it has been applied in the form of ointment or watery solution — the latter more particularly in ophthalmia, especially of the scro- fulous kind, in which Jahn found it very efficacious; and in chronic granular eyelids, Dr. W. Clay Wallace 6 found a solution of six or eight grains of it in an ounce of water, vastly superior to the nitrate of silver.' In recent cases, however, it was inferior. The following are some of the forms in which it has been pre- scribed : — Boli auri chloridi. Boluses of chloride of gold. {Boli antisyphilitici) Pharmacopeia Batava.) Antisyphilitic Boluses. R. Auri chlorid.gr. ss. ad gr. ij. Extract, aconit. gr. vj.ad gr. xij. Fiant boli sex. Two of these to be taken for a dose, and repeated three times a day. 1 (Mia, Toxicolog. i. 593. 2 Magendie, Formulaire. 3 Wendt, in Rust's Magazin, B. xxv. * Revue Medicale, iii. 45— 70, pour 1848; cited in Brit, and For. Medico-Chirurg. Rev. April, 1849, p. 539. 5 Wilczecoski, in Medicin. Zeitung, cited in Lond. Med. Gaz., Mar. 7, 1845. 6 Boston Medical and Surgical Journal, Nov. 3, 1847. 122 AURI ET SODII CHLORIDUM. Pilul SB auri chloridi. Pills of chloride of gold. (PilulcE chlorureti auri, Ph. Amstelodamensis nova.) R. Auri chlorid. gr. x. Glycyrrhiz. pulv. giij. Syrup, q. s. ut riant pilulaecl. Dose. — One daily, gradually augmenting the quantity. R. Auri chlorid. gr. i. Lycopod. pulv. gr. xv. M. fiat pulv. in part. xvi. dividend. One of the powders to be rubbed upon the tongue and gums daily. Chrestien. Gradually, the same quantity of the chloride may be divided into twelve, and afterwards into ten parts, and be used in tbe same way. Unguentum auri chloridi. Ointment of chloride of gold. R. Auri chlorid. gr. iv. Misce intime cum Uiig. rosee %\, Wendt. Collyrium auri chloridi. Collyrium of chloride of gold. R. Auri chlorid. gr. ij. Solve in Aquae destill. f ^vj. F. collyrium, To be applied by means of linen compresses, or dropped into the eye, Jahn 4' Fischer. XXXIII. AURI ET SO'DII CHLORIDUM. Synonvmes. Aurum Muriaticum [Pharmac. Borussic.) seu Aurum Muri- aticum Natronatum seu Chloratum Natronatum, seu Sesquichloratum Natronatum, Sodii Auro-Terchloridum, Perchloruretum Auri et Sodii, Chloretum Auri cum Chloreto Natrii, Murias Aurico-natricum, Chloru- retum Auri et Sodii, Chloride of Gold and Sodium, Hydrochlorate or Muriate of Gold and Sodium, Auro-terchloride of Sodium. French. Chlorure d ? or et de Sodium, Hydrochlorate ou Muriate d'Or et de Soude. German. Salzsaures Goldnatrium, Chlorgoldn at ionium, Goldnatriumchlorid, Natriumgoldchlorid, Sodahaltiges SalzsauresGold, Salzsaures Goldoxy natrium, Chlor gold- natrium, Figuier's Goldsalz. This preparation is in the Pharmacopoeias of Prussia, Ferrara, Sweden, &c. M. Figuier directs it to be made in the following manner. 1 Dissolve four parts of gold in nitro-mxiriatic acid, 1 Annates de Chimie, Fevrier, 1 82*2, and Riecke, Die Neuern Arznrimittel, S. 63, Stuttgart, 1837. AURI ET SODII CHLORIDUM. 123 and evaporate the solution to dryness; add thirty-two parts of water, and one part of chloride of sodium, and evaporate to one half. On cooling, crystals will form, which consist of 69.3 parts of chloride of gold ; 14.1 parts of chloride of sodium, and 16.6 of water. In the French " Codex" it is directed to be made by dis- solving 85 parts by weight of chloride of gold, and 16 parts of chloride of sodium, in a small quantity of distilled water. The solution is evaporated by a gentle heat until a pellicle forms, and is then put aside to crystallize. The formula of the Prussian Pharmacopoeia is as follows : R. Auri partes vj. Solve in Acidi muriatici q. s. Acidi nitrici quantum ad auri solutionem requiritur, guttatimaddendo. Tunc admisce. Natri muriatici sice. part. x. Et post solutionem leni igne evaporando in pulverem flavum redige. 1 This preparation has a beautiful yellow colour, and appears un- der the form of four-sided prisms. It attracts moisture from the air, but to a less degree than the chloride of gold with excess of sulphuric acid. The Aurum Muriaticum Natronatum of the Germans is milder than the preceding preparations, and is more frequently ad- ministered, especially in Germany, than any preparation of gold. It is used both internally and externally. The close is about the same as that of the last preparation, but it may be carried higher. Kopp 3 affirms, that he has frequently employed it w 7 ith advan- tage, in small doses, in scrofulous tumefaction of the upper lip. He prescribed daily, and once or tw T ice a day, from one twenty- fourth to one-thirteenth of a grain of it, reduced to powder, w T ith two grains of sugar, and rubbed by means of the finger on the inner side of the affected lip. In cases of scrofulous, thick, sen- sible, and slightly , inflamed nose, in the adult, Riecke 3 recom- mends the ointment, described below, to be applied to the nasal fossa?; and three times a day a powder composed of from one-sixteenth to one-twelfth of a grain of the salt of gold to two grains of sugar of milk, to be rubbed on the gums with the moistened finger. The salts of gold, according to Riecke, appear to have a specific ac- tion on the orgaps in the mouth, gums and nose ! ! Pul vis et sodii chloridi. Powder of chloride of gold and sodium. R. Auri et sodii chlorid. part. iij. Irid. florent. in puJv. subtil, part. ix. 1 Take of gold six parts: Dissolve a sufficient quantity of Muriatic acid, adding as much nitric acid as is required to dissolve the gold. Then mix ten parts of the dry chloride of sodium ; and after evaporating the solution over a slow fire reduce it to a yellow powder. a Op. cit. B. hi. S. 351. 3 Die neuern Arzneimittel, u. s. w. S. 44*2, 124 AURI ET SODII CHLORIDUM. Three grains of this represent three-quarters of a grain of the salt of gold. These three grains are divided into thirty frictions for the weakest doses, and into three for the strongest. Starch ma}' be. substituted for powdered orris root. Legrand. Liquor auri et sodii chloridi. Solution of chloride of gold and sodium. R. Auri et sodii chlorid. gr. ij. Aquae destillat. f gj. M. Ten drops to be given every two or three hours, in cases of dropsy. Grotzner. Pilulee auri et sodii chloridi. Pills of chloride of gold and sodium. R. Auri et sodii chlorid. in aquas destillat. q. s. solut. gr. iv. Extract, aconiti ^ss. dulcara. gj. Althseae pulv. q. s. ut fiant pilulse lxxx. Three pills to be taken three times a day. Grotzner. R. Amyli. solan, tuberos. gr. iv. Acacia? gj. In mort. vitr. exacte mistisadde terendo Aur. et sod. chlorid. — in gj. aq. destillat. solut. — gr. x. Fiant pilulae cxx. Each of these contains about one-twelfth of a grain. A. T. Chrestien. Pastilli auri et sodii chloridi. Lozenges of chloride of gold and sodium. R. Auri et sodii chlorid. gr. v. Sacchar. pulv. §]. Misce exacte in mortar, vitreo et adde. Mucilag. acacias q. s. ut fiant pastilli Ix. Each of these will contain about one-twelfth of a grain of the salt. A. T. Chrestien. Unguentum auri et sodii chloridi. Ointment of chloride of gold and sodium. R. Aur. et sod. chlorid. gr. iij. — -iv. Adipis 3ss. Misce exacte. Fiat unguentum. Used in friction. Grotzner. R. Aur. et sod. chlorid. gr. iiss. Adipis giss. M. The size of a bean to be placed in the nasal fossae in scrofulous cases? along with the iatraleiptic use of the powder before de- scribed. Riecke. 1 Sec p. 123. AURI CYANURETUM. 125 XXXIV. AURI CYANURETUM. Synonymes. Auri Cyanidum seu Tercyanidum, Aurum Cyanicum seu Cyanogenatum seu Cyanatum seu Hydrocyanicum, Cyanuretum auri- cum seu Auri, Cyanuret, Cyanide or Tercyanide of gold. French. Cyanure d*Or. German. Blausaures Goldoxyd, Bl austoffgold, Cyangold, Goldcyanid. The mode of preparing this combination, recommended by M. O. Figuier, 1 of Montpellier, is as follows. He decomposes chlo- ride of gold by cyanuret of potassium, but states, that many pre- cautions are necessary to procure it in a pure state. The chloride must be as neutral as possible, which can only be effected by re- crystallizing the salt several times. The cyanuret must not be al- kaline, or contain any formiate or carbonate of potassa, and it is to be added to the solution of the chloride of gold very cautiously as long as there is any precipitate, taking care that there is not the slightest excess of the cyanuret, as this would cause a solution of part of the product, and the formation of soluble double cyanu- rets. The cyanuret, thus made, is to be w T ell washed with pure water, and dried in a dark place. The process in the French " Codex" consists essentially in add- ing very carefully a solution of pure cyanuret of potassium to a solution of chloride of gold, until a precipitate — which is cyanuret of gold — ceases to be formed. The chloride of gold, prior to so- lution, should be deprived of all excess of acid by heating it in a salt water bath. It is a yellow powder, which is insoluble in water. 2 In some experiments, Magendie 3 found, that cyanuret of gold is one of the substances that promote the coagulation of the blood. Where, consequently, it is desirable to impress a modification on that fluid in chronic cutaneous, and other affections, its adminis- tration might perhaps be found useful. M. Pourche, 4 who has used it successfully in syphilis and scrofula, recommends its ad- ministration — in the form of frictions on the tongue — mixed with powdered orris root, well washed in alcohol, and dried. Pulvis auri cyanureti. Powder of cyanuret of gold. R. Auri cyanur. gr. j. Irid. florent. pulv. gr. iij. M. Chrestien. 1 Journal de Pharmacie, xx. S. 99, and Araer. Journ. of Pharm. vi. 82. Philad. 1833—4. See, for another mode of preparing it, Deferre, in Bulletin Ge'ne'ral de Therapeutique, Fevrier, 183S. 3 Pereira, Elements of Mat. Med. &c, 2d edit. i. 686. Lond. 1842; or 2d Amer. edit, by Carson, Philad. 1846. 3 Lecons sur le Sang, &c, and Translation, in Lancet, January 20, 1839, p. G36. * Journal de Pharmacie, xx. 599 and 649. 9 126 AURI IODIDUM. In pills he prescribes it as follows : — Pilulas auri cyanureti. Pills of cyanuret of gold. R. Auri cyanur. gr. j. Ext. mezereon. gr. iij. AHhaese pulv. q. s. ut fiat massa. Each pill to weigh five grains. To children, the dose at first should never exceed one-fifteenth of a grain. Mistura sen Liquor sen Solutio auri cyanureti. Mixture or solution of cyanuret of gold. B. Auri cyanur. gr. iij. Aquae alcoholisat. f ^viij. M. Dose. — A tea-spoonful twice a day, gradually increasing the dose. Chrestien. XXXV. AURI IOD1DUM. Stnontmes. Auri Ioduretum, Aurum Iodatum, Iodide or Ioduret of Gold. French. Proto-iodure d'Or. German. Iodgold ; Goldiodiir, Goldiodid. According to the French Codex, this is made by adding a solu- tion of pure iodide of potassium to a solution of chloride of gold, collecting the iodide of gold, which falls down, on a filter, and washing it with alcohol to remove the excess of iodine, which pre- cipitates with it. M. Meillet 1 recommends the following process in preference. To a solution of gold as neutral as possible is add- ed by degrees neutral hydriodate of ammonia so long as a preci- pitate falls. The^ solution must not be too far diluted. A small quantity of alcohol must now be added, not more than about one- third of the whole volume of the liquid. After some hours' rest, this is decanted, when a precipitate of a blackish colour is obtained, composed of iodine and iodide of gold. It is then washed by de- cantation with a little alcohol; when an almost white and half crystalline iodide of gold is obtained. This is dried in the open air on plates, and is kept free from light in stopper bottles. In this process, the gold is completely precipitated, which never occurs when the iodide of potassium is employed ; and the iodide has an invariable composition. 2 This has been used in the same cases as the other preparations of gold, in the dose of one-fifteenth to one-tenth of a grain. 1 Journal de Pharmacie, Nov. 1841, p. 66f>. 2 For another process for forming the iodide of gold, see M. J. Fordos, Journal de Pharmacie, Nov. 1841, p. 653. AURI OXIDUM. 127 XXXVI. AURI NITROMU'RIAS. Sfnonymes. Aurum Nitrico-Muriaticum, Nitromuriate of Gold. French. Nitromuriate d'Or. German. Salpetersalzsaures Gold^. Nitromuriate of gold has been recommended, of late years, by Recamier, whose attention was directed to it by accident. A worker in gold had a cancerous tumour on the back, which, as it incommoded him, he touched frequently with the hand; this oc- curred whilst he was dissolving gold in aqua regia ; after this the tumour soon presented another appearance, and went away in a short time. Recamier thought it probable that the workman had received some of the solution upon his fingers, which had thus been applied to the tumour. Under such impressions, he employed it in the case of a female, who was affected with an extensive cancer ; the disorganized parts resumed their natural texture, and completely healed, although the cancerous dyscrasy ultimately proved fatal. In the case of a female, wiih fungus of the neck of the uterus, a complete cure was effected by it; and in cancer of the uterus he found it advantageous. Recamier prepares it by dissolving six grains of pure chloride of gold in an ounce of nitromuriatic acid : and he applies it like other corrosive agents, taking care to confine it to the parts to be acted upon. When the object is to cauterize, it must be applied to the affected parts, until a whitish scab or crust is formed, which falls off in three or four days ; after which the application may be re- peated as often as may be necessary. The pain caused by the ope- ration is generally insignificant, and in cases where it is violent it can be allayed by pledgets dipped in laudanum. XXXVII. AURI OX'IDUM. Synonymes. Ann Teroxidum seu Peroxidum, Aurum Oxydatura, Oxide of Gold, Peroxide of Gold, Auric Acid. French. Oxide d'Or. German. Goldoxyd, Oxydirtes Gold, Goldsaure. Oxide of gold, prepared by calcination, is the crocus solis of the Wirtemberg Pharmacopoeia. The oxide is received also into the Pharmacopoeias of Ferrara and Hanover. Magendie 1 recommends the following as one of the modes of preparation. Take any quantity of chloride of gold, put it into a flask of white glass and pour upon it six or seven times its weight 1 Formulaire, &c. 128 AURI 0XIDUM. of boiling water, to dissolve the chloride ; then add crystallized baryta gradually, until the liquid is no longer acid, as shown by a strip of litmus paper. The liquid is then boiled, permitted to cool, and filtered. The precipitate is washed several times with warm water: the water of the various washings is brought together and evaporated nearly to dryness; the saline mass, when cool, is then dissolved in water, and in this way more and more oxide of gold is obtained, which may be added to the other. The oxide is now washed with boiling water, until the water no longer affords a precipitate on the addition of nitrate of silver. It is then washed once or twice with water acidulated with nitric acid, to remove the small quantity of carbonate of baryta formed during the ope- ration, and which may remain mixed with the oxide. These wash- ings are repeated with cold water, until the instillation of sulphuric acid occasions no longer any white precipitate, which indicates that it is free from baryta. The oxide is then dried at a heat of from 167° to 190° of Fahrenheit, after which it is kept in a cool and dark place in a well-stopped bottle. The process recommended by M. Cottereau is the following : An excess of magnesia must be boiled with a dilute solution of chloride of gold, till the solution loses its colour; the whole is then to be filtered, and the precipitate well washed; the result, which is aurate of magnesia, is to be treated with an excess of dilute nitric acid, which removes all the magnesia, and leaves the oxide in a pure state. This is to be again well washed, and dried between sheets of bibulous paper, but without compression or exposure to light or heat. 1 In the French " Codex " it is directed to be prepared by boiling four parts of calcined magnesia with one part of terchloride of gold and forty parts of water. It is then washed, first with water, to remove the chloride of magnesium, and afterwards with dilute nit>ic acid, to dissolve the excess of magnesia. 3 In the condition of hydrate, the oxide of gold is of a yellow colour; when dried, of a blackish-violet. It is never entirely soluble in chlorohydric acid, always leaving behind a small por- tion which is reduced to the metallic state during desiccation. Neither sulphuric nor nitric acid has any action upon it. Oxide of gold has been administered by many physicians, and especially by Westring, Niel, Chrestien, 3 and Legrand, 4 in the same diseases as the other preparations. 1 Amer. Journ. of Pharm. 2d series, ii. 110. Philad. 1837. a Pereira, Elements of Materia Medica, 2d edit. i. C85. Lond. 1842 ; or 2d Amer. edit, by Carson, Philad. 1646. 3 Op. citat 4 Op. cit., and De l'Or, de son Emploi dans Ie traitement de la Syphilis, &c. Paris, 1828. AURUM METALLICUM. 129 XXXVIII. AURUM METALLICUM. Synonymes. Metallic Gold. French. Or Metallique. German. Me t alii sches Gold. Metallic gold is either administered in the form of aurum limatum, " gold filings," — formed by filing the finest gold with a fine-toothed file — or in that of pulvis auri, aurum divisum seu pulveratum, (French, Or divise — Germ. Goldpulver, Fein zertheiltes oder praparirtes Gold,) which is obtained by amalgamating gold with quicksilver, and driving off the quick- silver by heat. 1 According to TrommsdorfF, a very fine gold powder may likewise be obtained by precipitating the gold from a dilute solution of the metal in nitro-muriatic acid by means of green sulphate of iron. The precipitate, thus formed, when washed and dried, is of a brownish colour, but when polished, exhibits the most beautiful golden splendour. 2 It may also be prepared by rubbing leaf gold with sulphate of potassa, sifting and washing with boiling water to remove the sulphate. 3 MM. Chrestien and Niel have exhibited metallic gold largely, and, they affirm, successfully; but, according to Wendt, it has no action on the economy. It is not easy, indeed, to conceive, that a substance so difficult of oxidation can have much, if any, effect. The former gentlemen and Gozzi regard it as the mildest of the preparations of gold, but equally efficacious with the others, al- though more tardy in producing its effects. It has been administered in the dose of from a quarter of a grain to a grain, three or four times a day, in the form of powder or pill, — the dose being gradually increased ; and has been rubbed daily upon the tongue, in the quantity of from one to three grains mixed with starch powder, or powder of lycopodium. Where the condition of the tongue and of the interior of the mouth does not admit of this, Niel advises that a blister should be applied on the side of the neck, and that the denuded surface should be dressed with a mixture of a grain of gold amalgamated with mer- cury, and half a dram of lard ; gradually augmenting the quantity of gold to two grains. In syphilitic ulcers and excoriations, metallic gold is applied externally, amalgamated with the proper quantity of mercury, and united with unsalted butter, lard, or cerate, in the proportion of twelve grains to one ounce. In syphilitic excrescences, frictions with gold powder mixed with saliva are said to have been serviceable. 1 Jourdan, Pharmacopee Universelle, ii. 215. Paris, 1828. 2 Riecke, Die neuern Arzneimit. S. 58. Stuttgart, 1837. 3 Pereira, Elements of Materia Medica and Therapeutics, 2d edit. i. 682, Lond. 1842; or 2d Amer. edit, by Carson, Philad. 1846. 130 BALLOT A LANATA. The following formulae are given by Riecke i 1 Pulvis Auri Compositus. Compound Gold powder. R. Auri divis. gr. vj. Amyli gr. lxvj. M. f. pulv. in part. xij. aequales divid. A powder to be given four times a day. R. Auri divis. Lycopod. aa gr. ij. M. f. pulvis. A powder to be rubbed once a day upon the tongue. Syrupus Auri. Syrup of Gold. R. Auri divis. 3j. Syrup, acacias, ^j. M. Employed to pencil ulcers of the pharynx, and as a dressing to chancres. Hopital de Montpellier. Pomatum Auri. Ointment of Gold. R. Auri divis. gj. . Adipis 5SS. M. To be rubbed on buboes, and applied to blisters. Legrand. XXXIX. BALLOTA LANATA. Synonymes. Leonurus Lanatus. French. Ballote Cotonneuse. German. Wolliger Wolfstrapp, WoHige Ballota. This plant belongs to the Natural Family, Labiatae ; Sexual System, Didynamia Gymnospermia. It grows exclusively and commonly in Siberia, in dry mountainous regions. In its native country it has been long administered as a powerful diuretic, especially in dropsy. Both Gmelin and Pallas refer to it in this relation in their travels in Siberia. Of late years, its use has ex- tended elsewhere; and it is now frequently employed in Russia, Germany and Italy. It is said to be often adulterated with leonurus cardiaca, ballota nigra, and marrubium ; a and it is im- portant that the genuine Siberian plant should be used, as the observations of Brera have shown the cultivated plant to be powerless. For medicinal purposes, the whole plant has been employed, with the exception of the root. It contains, according to Orcesi, tannic acid, a bitter, resinoid, aromatic matter — picro- ' Die neuern Arzneimit. S. 59, Stuttgart, 1837. 2 Schmidts Jahrbuch der in-und auslandisch. gesammt. Medicin. B.'iv. S. 275. BALLOTA LANATA. 131 ballotin — a green, waxy substance, chloride of sodium, nitrate of potassa, and salts of iron and lime. 1 The diseases in which ballota lanata has been administered abroad — for it has not been employed in this country — are the following : 2 Dropsy. — Rehmann prescribed it several times with decided advantage; and, w T here organic disease prevented the cure, the urinary secretion was always largely augmented by it. The chemical condition of the urine was likewise strikingly changed during its use : at first, it was whitish, afterwards darker, and, ultimately, almost black, or of a deep brown, like the darkest beer. At times, when the accumulation of fluid was pretty well removed, a pain would occur in the hypochondres, which indicated that its use should be laid aside. Schilling, in Werchny-Udinsk, asserts, that he cured several cases of dropsy by it. Rupprecht and Muhr- beck administered it with the best effects, and Brera 3 found it extremely serviceable in hydropic conditions, especially where they had been preceded by, or were complicated with, rheumatic or gouty affections. Luzzato prescribed it with equal success; and Heyfelder, who gave it according to the prescription of the Russian physicians, observed the urine to be of a blackish-yellow hue at the commencement, and, afterwards, of a very dark colour. He found, however, that, to keep up the diuresis, it was requisite to combine it with other diuretics, or to change it for other agents. Rheumatism and Gout. — In these diseases, ballota is adminis- tered in Siberia. Brera, as well as his compatriots, Ghidella, Fon- tebuoni, Santini and Luzzato, have tested its efficacy by repeated trials. The pains generally soon disappeared under its use, and a cure took place, without relapse. Adiposis. — In a case of this kind, it was exhibited in St. Peters- burg, by Dr. Weisse. The fatness was inordinate, and the remedy acted most favourably. It did not, however, occasion diuresis, but under its use a hemorrhoidal flux returned, which had previously been arrested. MODE OF ADMINISTRATION. Decoction is the best form for administering the plant; from Jss. to ^j. to §viij. of water ; — this portion to be divided into two halves, and to be taken in the course of the day. Rehmann boils §iss. to ^ij. of the coarsely powdered plant in Oij. of water, down to half; to which he adds, according to circumstances, some diffusible excitant, or a few drops of laudanum. Of this mixture, he directs a cupful to be taken morning and evening, gradually increasing the dose. 1 Bouchardat, Annuaire de Therapeutique, pour 1850, p. 78. 3 Riecke, Op. cit. S. 68. 3 Antologia Medica, No. 2, Febbrajo, 1835. 132 EARII I0D1DUM. XL. BA'RII IO'DIDUM. Stnontmes. Barium Iodatum, Barytium Iodatum, Ioduretum Barytii, Iodide of Barium. German . Iodbaryum, Baryumiodur. In solution, Barytas Hydriodas, Hydras Barii Iodati. Baryta Hydriodioa ; Hydriodate of Baryta. German. Iodwasserstoffsaure Schwererde; Hydriod- saurer Baryt. This preparation has been introduced of ]ate years. METHOD OF PREPARING. Iodide of barium is obtained by boiling baryta earth in a solu- tion of iodide of iron in water, (made by taking one part of pure iron filings, and four parts of iodine, pouring upon them from six to eight parts of water, agitating frequently, and applying warmth gently, until the fluid appears clear and almost colourless,) or, what is cheaper, by boiling a solution of iodide of iron with car- bonate of baryta, which must be added in small portions as long as there is any effervescence. The fluid obtained by either process, after filtering, must be clear and neutral, and yield no bluish or blue precipitate with the ferrocyanuret of potassium: if it yields a precipitate, the decom- position of the salt of iron is incomplete. Should the solution, formed in the first manner, have an alkaline reaction, the excess of baryta must be removed by exposing the mixture to the air, whereby it becomes converted into a carbonate, and falls to the bottom. The solution is then evaporated until a pellicle forms* the heat being gentle; the crystals are placed quickly between printing paper, and kept in a well-stopped glass vessel. They form white radiated plates, which easily deliquesce in the air, and on that account cannot be prescribed in the form of powder, but may be dissolved in some aromatic water. EFFECTS ON THE ECONOMY. Jahn instituted several experiments with iodide of barium, on plants, animals and man, in a state of health and disease. In con- siderable doses, it acts as a poison on the organism, and as one of the acrid class. Administered in very small doses, and with great circumspection, he found it to be serviceable in scrofulous and similar morbid conditions, and as an alterative in morbid growths, hypertrophy, chronic inflammation, &c, in which conditions it proved equally useful with chloride of barium, mercury or iodine. 1 Jahn's observations, it appears, did not lead him to speak positively regarding its advantages or defects; and he adds the caution — " Caute, per Deos, incede, latet ignis sub cinere doloso." 1 Riecke, Op. cit. S. 71. BEBEERIA. 133 Jahn's observations were published in 1830, and, according to Riecke, he has been since silent on the subject. Rothamel ad- ministered the iodide in a desperate case of scrofula, occurring in a patient twenty-one years of age, with great success. He began with one-eighth of a grain three times a day, and increased the dose gradually during a protracted administration of the article, until three grains were taken four times daily. Biett has administered it frequently in cases of scrofulous swellings, and at times externally, according to the following form: — Unguentnm barii iodidi. Ointment of iodide of barium. R. Barii iodid. gr. iv. Adipis §j. M. ut fiat unguentum. XLI. BEBEERIA. Synonymes. Bebeerina; Bebeerinum ; Bebeerine; Bebeerin. French. Bebeerine. German. Bebeerin. A tree known in Demarara by the Indian name Bebeeru, and by the Dutch name Sipeeri, had been observed by M. Rodie, a surgeon in the British navy, to possess a bitter-tasted bark, which, on examination, was found by him to contain a vegetable alkali, to which he gave the name Bebeerine. From this alkali he prepared a sulphate, which he exhibited with success as an antiperiodic. Dr. Maclagan having received some of the bark, and likewise some of the fruit of the plant, subjected them to chemical examination. The bark occurs in large, flat pieces, from one to two feet long, and varying in breadth from one to six inches. It is about four lines thick, of a cinnamon-brown colour, without aroma, pungency, or acrimony, but of a strong, persistent, bitter taste, with consi- derable astringency. The fruit is a nut, with two plano-convex cotyledons, of the size and figure of a walnut. The plant is un- known. It was supposed, by Mr. Lindley and Sir William Hooker, to whom the fruit was sent, to be lauraceous ; but Dr. Maclagan could not discover any genus or tribe of lauraceae to which it could be referred. Dr. Ranking refers it to Nectandra Rodiei.i The timber of the tree is well known by the name of greenheart. It is much employed by ship-builders. METHOD OF PREPARING. Dr. Maclagan treated the bark with water acidulated with sulphuric acid; precipitated the alkaloids by ammonia; dried the precipitate over a water-bath, and purified them by redissolving, 1 Half-yearly Abstract of the Med. Sciences, i. 221 . Amer. edit. iNew York, 1845. 134 BEBEERIA. by means of sulphuric acid ; treating with animal charcoal, and reprecipitating by ammonia. In this way the alkaline matter is ob- tained in the form of a hydrate, nearly quite white. If this be dissolved in alcohol, it forms a clear orange solution, which, on eva- poration, leaves a shining, totally uncrystalline matter, a good deal resembling in appearance a transparent resin. This, however, is not a homogeneous product, for in some parts it seems pale yellow, in others, orange brown, and if agitated with anhydrous ether is separated into two portions, one soluble, the other insoluble in that fluid. Both of these are distinct vegetable alkalies. To the former Dr. Maclagan applied M. Rodie's name — Bebeerine ; the other he called Sipeerine, from the Dutch name of the tree. As obtained by evaporating its solution in ether or alcohol, be- beeria is in thin layers, in the form of a transparent, yellow, shining film ; but when in mass, or powder, it is opaque. The alcoholic solution has a strong alkaline reaction on litmus paper. Its taste is strongly and permanently bitter, with a slight resinous flavour, and it evolves feebly a corresponding odour when united with sul- phuric acid. Bebeeria is soluble in five times its weight of abso- lute alcohol, and dissolves with great facility in alcohol — pure and diluted. Ether takes up a thirteenth of its weight. It is very sparingly soluble in water, requiring 1766 parts of hot, and 6650 of cold water for its solution. It forms, with the sulphuric, mu- riatic and acetic acids, yellow, shining, uncrystallizable salts, all of which are very soluble in water, and intensely and durably bitter, with a slight degree of astringency on the tongue. Sipeerine is that portion of the alkaline precipitate which is insoluble in ether. It is of a dark brown, shining appearance, and forms neutral com- pounds with acids, some of which are crystallizable. Dr. Macla- gan had not, however, obtained it in quantities sufficient to enable him to examine its properties minutely. 1 Sulphate of bebeerine, according to Messrs. Ballard and Gar- rod, 2 is an article of commerce, usually found in brown, crystalline scales, soluble in water, sparingly so in alcohol, and possessing an intensely bitter taste. The solutions of the salt are neutral, and ammonia precipitates the alkaloid. Dr. Maclagan was led to in- stitute experiments, with a view of ascertaining how far, in point of cheapness, the salts of the alkalies of bebeeria might be substi- tuted for quinia ; and he found that, by a modification of the ordi- nary processes for sulphate of quinia, he could prepare a sulphate of bebeeria, which could be sold at a price below the average of sulphate of quinia, during late years. The process for obtaining it for medicinal use in Edinburgh is essentially the same as that of the Edinburgh Pharmacopoeia for sulphate of quinia. The 'Transactions of the Royal Society of Edinburgh, toI. xv., pr, 3, or London and Edinburgh Monthly Journal of Medical Sciences, July, lb'43, p. 653. 2 Elements of Materia Medica and Therapeutics, p. 41 1. Lond. 1845. BEBEERIA. 135 bark is first freed from tannin and colouring matter, by boiling it with carbonate of soda: it is then exhausted by boiling in water acidulated with sulphuric acid, and the alkaline matter is thrown down from the concentrated acid liquor by means of carbonate of soda. The impure bases, thus separated, are washed, dissolved, and neutralized with weak sulphuric acid, and the solution is treated with animal charcoal, concentrated, filtered again, and finally evaporated in thin layers in flat vessels. 1 Owing to the great improvement in the manufacture of the arti- cle for medical use, it is said to be sold at less than half the price of the sulphate of quinia. 3 EFFECTS ON THE ECONOMY IN DISEASE. Dr. Maclagan sent some of the sulphate to Demarara, where it was tried with marked success in the treatment of intermit tents. It appears, indeed, to possess all the antiperiodic properties of the sulphate of quinia, and has, accordingly, been found of great ser- vice in intermittent and remittent fevers, neuralgia. &c. Many such cases are related by Dr. Maclagan as occurring in his own practice, 3 as well as in that of Dr. Watt, of Georgetown, Demarara; of Dr. J. Anderson and Mr. D. Falconer, and of Pro- fessor Simpson, of Edinburgh. The last gentleman made trial of it in periodic neuralgia, occurring during utero-gestation, and w T ith beneficial results. 4 Dr. Gairdner, of Edinburgh, has also given the particulars of a case of intermittent headach occurring in a young, and recently married lady, who, there was some rea- son to suspect, was pregnant, which was cured by the sulphate of bebeeria. In strumous ophthalmia, it has been recommended, by Dr. Llewellyn Williams, 5 as a substitute for sulphate of quinia, not only on account of the moderate price of the drug as compared with the sulphate, but also, because, according to the testimony of Dr. Maclagan and others, it is better adapted to some constitutions and affections than it; not being so liable to excite the circulation, or affect the nervous system. He gave it in the dose of two grains night and morning. According to Dr. Christison, it is in general use in Edinburgh and other places in Great Britain, and it is said not to produce the unpleasant phenomena that occasionally follow the use of the sul- phate of quinia. Dr. Maclagan states, that a secret preparation, sold under the name of " Warburg's Fever Drops," appeared, from chemical examination, to be a tincture of bebeeria, — probably of the seeds of bebeeru ; but this is not the conclusion to which a commmission of 1 Christison's Dispensatory, Amer. edit, by R. E. Griffith, p. 969. Edinb. 1848. 2 Edinburgh Med. and Surg. Journal, April, 1845. 8 Lond. and Edinb. Monthly Journal, Aug. 1843, p. 685. 4 Edinb. Med. and Surg. Journal, April, 1845. 1 Provincial Medical and Surgical Journal, Oct. 18, 1848. i 136 BERBER1NA. pharmaciens arrived, from a recent examination of it. According to them, its chief constituents are, — sulphate of quinia, aloes, saf- fron, camphor, zedoary and angelica. 1 MODE OF ADMINISTRATION. Sulphate of bebeeria may be given in the same manner as sul- phate of quinia. The dose as a tonic is from one to three grains; as an antiperiodic, from five grains to a scruple. XLII. BERBERI'NA. Synonymes. Berberinum, Berberine, Berberin, French. Berberine. German. Berberin, Berberisgelb, Sauerdornbitter. The inner bark of Berberis vulgaris is of a yellow colour, and a bitterish, somewhat astringent taste. It is cathartic, and was formerly used in jaundice; originally, perhaps, in consequence of the " signature" of the yellow colour. 2 In more modern times, it has been again recommended in the same disease on the faith of experiments. 3 The bitter principle of the root was discovered a few years ago by Buchner and Herberger, and its properties have been investi- gated by Brandes. 4 Buchner first recommended, at a meeting of the German Association of Naturalists and Physicians, in the year 1834, that it should be received into the Materia Medica; but hitherto few experiments have been made with it. METHOD OF PREPARING. An alcoholic extract of the root of berberis vulgaris is pre- pared, to which ivater is added. This throws down a pulveru- lent brown substance; the fluid is poured ofT; and the substance dried; it is then treated with alcohol, which takes up the berbe- rin, leaving a small portion undissolved. By evaporating the al- cohol, the berberin remains. 5 • Thus prepared, berberin resembles an extract: it is of a brown- ish-yellow colour, translucent, and smells like the root; its taste is a pure bitter, and it becomes soft in the air. Buchner 6 suc- ceeded in obtaining the bitter principle pure, and in a crystalline form. Its reaction is neither alkaline nor acid ; it is soluble in al- cohol and water, but not so readily in the latter as in the former. When crystallized, it requires 600 parts of water for its solution ; whilst in alcohol, at a medium temperature, it is soluble in 100 1 Fuchs, cited in Canstatt und Eisenmann's Jahresbericht, u. s. w. im Jahre, 1849, Bd. V. S. 136. 2 Ray, Historia Plant, ii. 605. 3 Lond. Med. Repos., new series, i. 38. 4 Archiv. der Apothekervereins. ii 29. 5 Riecke, Op. cit. S. 442. 6 Journal de Pharmacie, xxi. 309, and Philadelphia Journal of Pharmacy, vii. 328. Philadelphia, 1835, BIGNONIA CATALPA. 137 parts. It approximates the alkaloids in its nature, as with certain acids it forms crystallizable compounds. It is not soluble in ether. The brownish-yellow solution formed by it is turned of a reddish- brown by alkalies, like the infusion of rhubarb, and acids restore the colour. EFFECTS ON THE ECONOMY. According to Buchner, no injurious consequences are to be ap- prehended from the administration of berberin as a therapeutical agent. Of this he had an opportunity of satisfying himself both on his own person and on others. When labouring under indi- gestion, he took it with the best effects; not only was the dys- pepsia removed, but also a yellow hue of the skin which had pre- viously existed. He recommends it, therefore, as an excellent stomachic, especially when there is disturbance of the functions of the liver. In doses of two, five or ten grains, it only aids the appetite; but in larger doses — fifteen to twenty grains — it acts upon the bowels without inducing tormina, and therefore not as a drastic. Within the last few years, Koch has published some observa- tions on the use of berberin. He treated several cases with it as prepared by Buchner himself, when he found all his results con- firmed, and that it merited a high rank amongst bitter agents. He gives two cases of marked disturbance of the digestive func- tion, in which berberin afforded essential service; and recommends it highly in convalescence from typhus, cholera, &C 1 XLIII. BIGNONIA. CATAL'PA. Synonymes. Catalpa, Catalpa Cordifolia seu Arborescens seu Arborea, Ca- talpa or Catawba Tree. French. Catalpa. German. Katalpa, B ignon i e nbaum. Bignonia Catalpa belongs to the Natural Family, Bignonia- cese; Sexual System, Didynamia Angiospermia. It is a tree well known in this country, but is not applied to any medicinal use. According to Kampfer and Thunberg, the Japanese physi- cians consider the pods (siliqaoe) to be a powerful remedy in dif- ferent asthmatic affections. This gave occasion to several Nea- politan physicians — and especially Professor Antonucci — to insti- tute experiments in reference to its virtues, and their report was decidedly favourable. Brera also extols it in asthma. As to the precise mode in which it acts, w 7 e have no exact information. Dierbach and Richter 2 place it amongst the Acria ; whilst, accord- ing to the analysis of Grosso, 3 it seems more likely that its active principle is of a fatty nature, resembling the butter of the cacao. 1 Bouchardat, x^nnuaire de Therapeutique. pour 1850, p. 181.' 2 Riecke, Op. cit. S. 72. 3 Gazette Medicale da Paris, 1834, p. 8. 138 BOLETUS LARICIS. It is probable, that it possesses no other virtues than those of a simple demulcent, and that the properties ascribed to it have been mainly, if not wholly, derived from the substances associated with it. Brera, for example, administered it with the following addi- tions: 1 R. Catalp. siliquar. ^ss. Aquae q. s. ad. colatur. f ^viij. Adde Or, Adde Oxymel. scillae f gss. R. Catalp. siliquar. ^ss. Senegoe rad. gij. Aquae q. s. ad colatur. f ^viij. Oxymel. scillae f %]. To be taken by little and little. Brera. XLIV. BOLETUS LARICIS. Synonymes. Boletus purgans seu albus, Agaricus albus, Fungus Laricis, Polyporus officinalis, Fungus of the Larch, White Agaric. French. Agaric Wane. German. Lerschenschwamm. This fungus grows on the stem and larger branches of the larch. Formerly, it was administered as a cathartic, but in this respect it has become obsolete. Still, it has been retained in many Phar- macopoeias; for example, in those of Amsterdam, Bavaria, Bruns- wick, Paris, Ferrara, Geneva, Hamburgh, Hanover, Oldenburg, Poland, Prussia, Saxony, Sweden, Wirtemburg, and Wurzburg. Latterly, it has been administered frequently in the colliquative sweats of phthisis. Barbut, of Nismes, made many trials with it,- which were favourable; and the experience of Andral was si- milar. 3 More recently, however, he has expressed the opinion, that no great advantage has been derived from it. 4 By several of the German physicians equally advantageous results have been obtained — as by Toel and Trautzsch — so that, according to Riecke, 5 it deserves, perhaps, to be better known and investigated. Kopp has added his testimony in its favour. 6 Formerly, as a cathartic, half a dram to a dram of the powdered boletus was given. In profuse diaphoresis it is administered in doses of from two to six grains. The dose, repeated for a few evenings, according to Barbut, arrests the sweating, which, Riecke 1 Riccltario Clinico, Pad. 1825. 2 Burdach. in Journal der Praktisch. Heilluind. von Hufeland, Mars. 1830. 3 Journal de Pharmacie, vol. xx. * Cours de Pathologie Interne, &c., recuelli et redige par A. Latour, p. 157. Edit. Bruxelles, 1637. s Op. cit. S. 73. 8 Denkwiirdigk. in der arztlich. Praxis. Frankf. 1S36, S. 344, cited by Riecke. BRAYERA ANTHELMINTICA. 139 thinks, is effected through its revellent excitation of the abdominal nerves; for which reasons he suggests, that the propriety of the union of opiates with it, to prevent its purgative effect, may be questionable. Kopp gives it in the dose of three grains, morning, noon, and night ; and Pisson 1 in from four to six, eight, and ten grains. If it acts upon the bowels, which is rarely the case, the dose must be diminished, or a small quantity of opium or laudanum be added. Pilulse boleti laricis cum opio. Pills of 10 kite agaric and opium. R. Bolet. laricis gr. xv. Extract, opii gr. iiss. M. et divide in pil. vj.| One or two at bed-time in the colliquative sweats of phthisis. Bayer. 2 XLV. BRAYERA ANTHELMINTICA. Synonymes. Hagenia Abyssinica, Banksia Abyssinica ; Kosso ? Kousso, Cousso, Cusso ? Habbi. This plant is a native of Abyssinia, and belongs to Nat. Ord. Rosacese Sanguisorbese (Decandolle,) Sex. Syst. Icosandria Digynia. It was first taken from Abyssinia to Europe by Dr. Brayer, from whom it received its name. The flowers are the parts used in medicine, and yield, on examination, an extractive matter, containing tannic acid, which is most readily taken up by hot water; and, consequently, the decoction is the best form of preparation. In Abyssinia, the flowers of brayera are said to have been em- ployed with great success in tapeworm. It would seem, that the taenia solium especially is endemic in many parts of that country, — so much so, indeed, that few of the natives are exempt from it. They are in the habit of taking the anthelmintic every two months, children commencing at the age of five or six years, and continuing it through life. Being a drastic cathartic, it cannot be thus taken indiscriminately with impunity, and prolapsus ani is often induced by it. The dose varies from six to eight drams, and is taken in cold water, early in the morning. It usually acts on the bowels in about a couple of hours, the worm — or a part of it, being gene- rally expelled in the third or fourth evacuation. 3 In Europe, no experiments had been made with them until Dr. Plieninger, having become acquainted with a missionary from 1 Annates de Therap. Oct. 1847. " Bouchardat, Anrmaire de Therapeutique, p. 8, Paris, 1842. 3 Transactions of the Med. and Physical Society of Bombay, cited in Dublin Journ. of Med. Science, March, 1845; and in Ranking's Half-Yearly Abstract, Amer. edit, Part I., p. 88. New York, 1 845. 140 BRAYERA ANTHELMINTICA. Abyssinia, and heard his description of their wonderful effects, ob- tained some of them from him, 1 which he submitted to Dr. Kurr, who detected, on examination, the constituents above mentioned. With the rest of the flowers, Dr. PJieninger made trial in two cases. He took a handful of the blossoms, about gj. or §iss. and boiled them in ^xvi. of water down to one half, adding to the strained liquor as much honey as counteracted, in some measure, the objectionable taste. This decoction was taken by a delicate woman, about thirty years of age, who had previously used the extracturn filicis maris in pilular form, according to Peschier's plan, without success. In the course of the day, she passed numerous fragments of taenia, mixed with mucous discharges, with- out experiencing any striking inconvenience from the remedy. From this time, she remained free from the parasite. A robust man, thirty-eight years of age, who had taken large quantities of tartrate of antimony and potassa, in consequence of violent inflammation of the lungs, — whilst he lay sick of this dis- ease, discharged a great many portions of taenia, without having previously experienced any inconvenience from the presence of the entozoon. In July, 1H34, he took the same decoction. Since then, he has had no appearance of taenia in his evacuations. Although but few cases had then occurred in which brayera had been administered in European practice, Dr. Plieninger con- sidered it a valuable addition to the materia medica, inasmuch as it can be administered to delicate persons and children, without violence being done to the whole organism, as is the case with many of the true anthelmintics; but the article had not been im- ported in sufficient quantities into Europe to admit of the neces- sary trials for fully testing its efficacy. Since then, a quantity of the flowers was brought to Europe by M. Rochet d'Hericourt, and trials were made with it in Paris, in the service of MM. San- dras and Chomel, which were entirely successful. M. Sandras followed the directions given him by M. Rochet d'Hericourt, and having kept the patient fasting the evening before the in- tended administration of the remedy, he gave, on the following morning, the whole of an infusion made from 20 grammes — about five drachms — of the flowers coarsely pulverized, to 250 grammes — about eight ounces of warm water. At the expira- tion of about an hour, the cathartic action of the medicine com- menced ; the first evacuations generally contained portions of the parasite; and, in the third or fourth, it was found expelled entire. 3 It has also been used successfully in three cases, by Drs. Budd and Todd. 3 So far as the author knows, this anthelmintic has not been intro- ' Riecke, Op. cit. S. 73. 2 Bouohardat, Annuaire de Therapeutique pour 1847, p. 256. Paris, 1847; and Ibid, pour 1S4<>, p. 2->i, 3 Medical Times, April '.20, 1 850. BROMINUM. 141 duced into this country, where taenia is rare. Should the plant be considered worthy of cultivation, it is said that a supply can be readily obtained at Massowah, on the Red Sea. Being of a hardy nature, it might bear to be transplanted into Europe or this coun- try. Hitherto, the great drawback to the use of Kousso has been the difficulty of procuring it, and its enormous cost. " At the time when it could be purchased in Paris," says Dr.Pereira, 1 " its price was £1 15s. per ounce, or 17s. 6d. per dose. M. Rochet d'Hericourt, the sole holder of the medicine, at the present time, refuses to sell any quantity less than his entire stock, at the rate of one guinea per ounce. His nephew tells me that his uncle pos- sesses 1400 lbs. of it, which, at one guinea per ounce, will cost 22,400 guineas ! The impossibility of effecting a sale on such terms will, I doubt not, ultimately compel the holder to reduce his demands to something approaching to reason." XLVI. BROMINUM. Synonymes. Bromium, Bromum, Brominium, Bromineum, Bromina, Muride, Muriria, Bromine. French. Brome. German. Brora. Brornin, Murid, Murin, StinkstorT. This elementary substance was discovered in 1826, by Balard, of Montpellier. In its chemical properties it is allied to chlorine and iodine; — to the former more than to the latter. 2 Balard de- tected it whilst occupied in some investigations on the water of salt-ponds, and gave it the name bromine — from /3pw^o?, " a stench or smell," — on account of its disagreeable odour. It is met with chiefly in sea water, and in certain animal and vegetable sub- stances that live therein. It has likewise been found in many mineral waters, of this and other countries, and especially in salt springs — as in those of Salina, by Professor Silliman, and of Ke- nawha, by Professor Emmet. It is in the secondary list of the Pharmacopoeia of the United States, (1842.) METHOD OF PREPARING. Balard's mode of preparing bromine consists in passing a cur- rent of chlorine through bittern, after which ether is added, and the two liquids are strongly agitated. The chlorine decomposes the bromide of magnesium— the form in which bromine exists in the bittern — and converts the bromide into a chloride of mag- nesium, setting the bromine free. The ether dissolves the evolved bromine, the mixture assuming a hyacinth-red colour. The ethe- real solution is agitated with caustic potassa, by w T hich bromide 1 Pharmaceutical Journal, July, 1850; or, The American Journal of Pharmacy, Oct 1850. 2 Glover, Edin. Med. and Surg. Journ., July, 1842. 10 142 BROMINUM. of potassium and bromate of potassa are generated ; the ether be- coming colourless and pure, and fit to be used for dissolving fresh portions of bromine. When a sufficient quantity of the bromide has been obtained, it is mixed in a retort with peroxide of man- ganese, and acted on by dilute sulphuric acid, by which the bromine is given off. The sulphuric acid sets free hydrobromic acid, which, at the moment of its disengagement, is deprived of its hydrogen by the oxygen of the peroxide of manganese, and is thereby converted into bromine. The bromine passes over in reddish vapours, and is made to condense under water contained in an appropriate receiver. M. Bussy 1 prefers the following form. The mother waters of kelp, (Soude de Varecq,) after iodine has been precipitated from them by means of chlorine, contain bromine in the state of a metallic bromide, when care is taken to add no more chlorine than is required to precipitate all the iodine. To 1250 parts of these mother waters, 32 parts of peroxide of manganese in pow- der, and 24 of common sulphuric acid at 66° are added. The mixture is then put into a tubulated glass retort, to which a tubu- lated receiver is adapted, and to the latter a tube, which dips into a flask. The retort and receiver, as well as the tube, must be ground so as to fit accurately without lutes or corks, which would be destroyed by the chloride. Every thing being arranged, the retort is heated until the liquid is made to boil, when the bromine condenses in the receiver under the form of red, oily striae, with a small quantity of water. The operation must be arrested when the red vapours cease to be produced. By slightly heating the receiver, without dismounting the apparatus, the bromine may be made to pass over into the flask, in which it will condense on cooling. The mother waters used in this preparation should not be rejected, until it is evident, on the addition of a fresh quantity of sulphuric acid and oxide of manganese, that they contain no more bromine. Bromine, at the ordinary temperature, is a fluid of a blackish- red colour, when regarded in quantities, — but of a hyacinth-red when placed in a thin layer between the eye and the light. Its smell is strong, peculiar, acrid and disagreeable, resembling that of chlorine. Its taste is acrid. It colours the skin yellow 7 — the colour gradually disappearing of itself. Its specific gravity is 2.966. It is readily set free; and, when volatilized, assumes the form of dark-red vapours. It boils at 117°; is sparingly soluble in water, and the solution is of a yellow colour. It is more solu- ble in alcohol, and still more so in ether. In its chemical relations with other bodies, bromine, as before observed, resembles chlorine and iodine; but chlorine appears to have more power, and iodine less than bromine, — as bromine is separated from all its combina- 1 Journal de Pharmacie. Janvier. 1837. BROMINUM. 143 tions by chlorine, whilst it decomposes the compounds of iodine, and assumes the place of the latter. It forms acids both with oxygen and hydrogen. Its test is the production of an orange colour with starch. EFFECTS ON THE ECONOMY IN HEALTH. Experiments have been instituted to discover the influence of bromine on the animal economy, and especially by Barthez. 1 In this respect also it resembles iodine, and, like it, belongs to the class of irritant poisons. Twelve grains, dissolved in water, and injected into the jugular vein of a dog, destroyed it almost instan- taneously. Cough ensued; the respiration and circulation were accelerated; the pupils dilated; the male organ was erect; and these signs were followed by involuntary discharge of the excre- ment, and, at times, stiffness of the upper and lower extremities. On dissection, Barthez found the cavities of the heart full of coa- gulated blood, and the lungs gorged with the same fluid; in the vense cavae there were dark coagula ; and in the stomach and in- testines, small, bloody, blackish cylinders, similar to sticks of lunar caustic. The same quantity, introduced into the stomach, caused death in three or four days, when the oesophagus was tied; when, however, the animal was able to vomit, fifty to sixty drops were requisite. The poison acts less intensely when it is given in con- junction with aliment; it produces coughing, excitement, nausea and vomiting. Constant sucking of the tongue was noticed, with frequently extraordinary restlessness and anxiety, and debility gradually augmenting until death. On opening the body, the stomach has been found contracted; the mucous membrane wrin- kled, at times softened, and frequently the seat of roundish ulcera- tions, of an ashy-green colour. Near the pylorus, Barthez found black spots, which could be readily scraped off with the back of the scalpel, and left gangrenous ulcers exposed. Barthez recom- mends magnesia as an antidote to bromine, but he rests his re- commendation on a single observation only. Butzke obtained similar results from his experiments. In one case, only, in which a dog died a few hours after a dose of three drams, he found the intestines unchanged, and death could only be ascribed to the paralyzing influence of the poison on the nervous system. 3 Two series of effects, according to Dr. Glover, are produced by its introduction, in large doses, into the stomach: one, arising from the volatilized bromine getting into the fauces and air-passages ; and, the other, from its corrosive and irritant action on the stomach and intestines. Another series, he conceives, may be due to its entrance into the circulation. It appears to be more irritant when diluted than when pure. 1 De 1' Action du Brome, &c, (These) Paris, 1828. See, also, Fouvnet, in Bulletin General de Therapeutique, Fevrier, 1838. 2 Christison on Poisons, 3d edit, p, 1 86. 144 BROMINUM. The vapours of bromine do not seem to exert any organic in- fluence on the workmen who prepare it. 1 EFFECTS ON THE ECONOMY IN DISEASE. Pourche first used both pure bromine and bromide of potassium for therapeutical purposes. He found it very efficacious in scrofula, especially in dispersing strumous swellings, both when given internally and applied externally. 2 In a case of very large goitre, it was highly serviceable. According to Pourche's obser- vation, it excited heat in the face, headach, dryness of the throat, &c, which, however, soon disappeared, Pourche gave it internally, diluted with forty parts of distilled water, beginning with five or six drops of this mixture, and gradually raising the dose. It has also been added in a dilute state to lotions and cataplasms. The remedy is not, however, much used. Magendie frequently administered bromine, but more commonly some of its preparations. He prescribed it in cases in which iodine did not appear to exert the proper efficacy, or where the patient had become accustomed to its use. The chief diseases in which he gave it were scrofula, amenorrhea, and hypertrophy of the ventricles of the heart. It has also been administered by M. Fournet, 3 in chronic arthritis, both internally and externally; but his facts, as he himself remarks, were too few to enable him to de- duce any general conclusions as to the therapeutical value of the remedy in those affections. He always gave it in a pure state, in the form of mixture, with a solution of gum : and, externally, it was applied in the form of "alcoholic mixture" to the affected joints. The dose was at first two drops in four ounces of the vehicle ; and it was gradually increased by two drops at a time, until as much as sixty drops were given in the twenty-four hours. The alcoholic mixture, used by M. Fournet as an external application, consisted, at the commencement, of ten drops of bro- mine to an ounce of alcohol: this was augmented daily by five drops until it reached one hundred and twenty drops. Dr. Glover 4 considers a solution of bromine in water an ele- gant and useful application in scrofulous, syphilitic, and specific ulcers, as well as in eczematous eruptions. He gives a case of ob- stinate tuberculous eruption, where an ointment of bromine and bromide of potassium, — eight minims of bromine, and half a dram of the bromide to an ounce of lard effected a cure ; and also, a case of sarcomatous tumour of the knee removed by a similar but stronger ointment. He thinks that, physiologically, bromine and the bromides are nearer the group of chlorine and the chlorides, than that of iodine and the iodides. He maintains, that the che- 1 A. Chevallier, Annates d' Hygiene Publ. &c, Avril, 1842. 3 Bulletin General de Thcrapcutique, No. 14. 30 Juillet, 1837. >J Ibid. Fevrier, 1838. * Edinb. Med. and Surg. Journal. Oct. 1842. BRUCIA. 145 mica! and physiological relations are alike, and that the same is true of the medicinal properties. 1 The preparations of bromine are described in other parts of this volume. XLVII. BRUCIA. Synonymes. Brucina, Brucinum, Brucium, Caniramium, Caniraminum, Pseudangusturinum, Vomicina, Brucine. French. Brucine. German. B r u c i n, K a n i m a r i n. This alkaloid was discovered by Pelletier and Caventou,in 1819, in the bark of the false angustura — Brucea antidy sent erica. It is found also in small quantities in nux vomica, and in St. Ignatius's bean. METHOD OF PREPARING. An alcoholic extract of false angustura bark is prepared, which is dissolved in a large quantity of cold water, and filtered, in order to separate the fatty matter. The colouring matter is precipitated by acetate of lead; the excess of this is thrown down by sulpho- hydric acid gas, and the brucia by an alkaline base, for which purpose magnesia may be employed. The precipitate from the magnesia is then washed, dried, and treated with alcohol, which lays hold of the brucia : this is obtained by evaporation. As brucia is somewhat soluble, the precipitate ought not to be washed too much. Brucia, thus obtained, is coloured, but it may be procured colour- less by forming an oxalate of brucia, and treating it with a mix- ture of equal parts of alcohol and ether. The oxalate is thus de- prived of its colouring matter; after which it is decomposed by magnesia: brucia is thus obtained wholly pure and devoid of co- lour. Pure brucia is of a white colour, and in regular crystals of the form of oblique prisms, having a base representing a paralle- logram; it has a pearly lustre, very bitter taste, and is soluble in 500 parts of boiling water, and in 850 parts of cold. In alcohol it dissolves readily, from which solution it is obtained in the crys- talline form. When exposed to the influence of heat, it melts at a temperature very little above that of boiling water. At a higher temperature, it is decomposed, and affords the same products as ve- getable substances that do not contain nitrogen. With acids, brucia forms neutral salts, which differ from the salts of strychnia. The sulphate of brucia crystallizes in very fine needles, and re- sembles the sulphate of morphia, but it has a much more bitter taste. Nitrate of brucia does not crystallize, which constitutes an essential difference between brucia and strychnia. With an 1 Edin. Med. and Surg. Journal, Oct. 1842, and Lond. and Edinb. Monthly Journal of Med. Science, Nov. 1842, p. 1011. 146 BRUCIA. excess of nitric acid, the salt has a beautiful pearly (nacre) aspect. EFFECTS ON THE ECONOMY. Brucia acts energetically on the animal economyan the same manner as false angustura, but much more strongly. It is similar, in its operation, to strychnia, but is considered to be weaker in the proportion of one to ten, according to Pelletier ; one to twelve, ac- cording to Magendie; 1 and one to twenty-four, according to An- dral. 2 It requires four grains to kill a rabbit, whilst half a grain of strychnia is sufficient. A tolerably strong dog, to which three grains of brucia had been given, was affected with symptoms re- sembling tetanus, but did not die. Pelletier is of opinion that brucia, or rather the alcoholic extract of false angustura, might be substituted in practice for the extract of nux vomica ; its operation is nearly the same, whilst there is no danger of its acting too violently. Andral has frequently pre- scribed it, and his deductions are, that it is far more under our control than strychnia. Like strychnia, it has been given in cases of paralysis with varying success. It would appear to have acted most beneficially in that resulting from lead poisoning. M. Bri- cheteau, from his observations on man, and M. Bouchardat, 3 from his on animals, infer that brucia is more active than is usually ad- mitted. In para lysis succeeding apoplexy, the former employs it with much advantage, and accords with M. Andral in its being more manageable than strychnia. He is of opinion, that no be- nefit is to be expected from it in paralysis until six months have elapsed from the attack of apoplexy. Earlier than this it may- induce serious effects, owing to its toxical influence on the cerebro- spinal system. He commences with about the sixth of a grain, [un centigramme^) and increases the dose each day by the same quantity, so long as no effect is induced. Should convulsions su- pervene, it must be discontinued, until the effects are decidedly di- minished, when it must be again augmented by a sixth of a grain in the day. M. Bricheteau has found some patients bear as much as three grains in the day. Magendie administered it with success in two cases of atrophy, one of the leg, and the other of the arm. MODE OF ADMINISTRATION. Brucia, according to Magendie, may be given either in pills or tincture, gradually augmenting the dose. Andral raised it from half a grain to five grains. Magendie recommends, that the alka- loid should always be that obtained from false angustura, — the bru- cia of nux vomica being mixed with a portion of strychnia, which 1 Formulaire, &c., dos Nouveaux Medicamons, &c. 2 Journal de Physiologie de Magendie. iii. '2(57, Juillet, 1823. 3 Annuaire de Therapeutique, &c, pour 1847, p. 42. Paris, 1847. CAINCiE RADIX. 147 adds to its activity, and renders it difficult to determine the dose. The following formulas are recommended by him : — Piluloe bruciff. Pills of brucia. R. Brucise pur. gr. xij. Confeet. rosse ^ss. M. exactiss. et fiant pilules xxiv. One pill to be begun with twice a day. Magendie. Tinctura brucise. Tincture of brucia. (French, Alcool de Brucine.) R. Alcohol (36° Areon., s. g. 847,) f 5J. Bruciee gr. xviij. M. Of this tincture, from six to twenty-four drops may be given, in the form of mixture, in any vehicle. Magendie. Mi st lira brucise. Mixture of brucia. (Potto Stimulans.) R. Brucise gr. vj. Aquae destillat. f ^iv. Sacchar. ^ij. M. Dose. — A table-spoonful night and morning. Magendie. XL VIII. CAIN'CiE RADIX. Synonymes. Bad. Chiococcas, R. Cainanas, R. Caninanse, R. Cahincae, R. Kahincas, R. Serpentarice Braziliensis; Cainca Root. Portuguese. Raiz Crusadiaha, R. Preta. German. Caincawurzel. The plant which furnishes the root introduced into Europe of late years, and which has since become known as a remedial agent, is Chiococca anguifuga, of the Family Rubiacese ; Sexual System, Pentandria Monogynia. 1 The shrub grows wild in the forest of Brazil, especially in the province of Minas Geraes, and the root is used there against the bites of serpents. This is of the thickness of the finger, round, and knotty ; the surface smooth or irregularly wrinkled ; the wood tough, and of a whitish colour ; the smell disagreeable, especially that of the fresh root ; and the taste at first like that of coffee* but afterwards nauseous and pun- gent. The bark of the root alone possesses efficacy, the woody portion having no action! The bark separates readily from the wood ; it is thicker on the root itself than on the branches; and, on the outside, is of an amber, or brownish yellow green colour ; yellower and brighter on the youngest parts ; the epidermis is not easily separated. According to the chemical investigations of 1 Art. Chiococca, in Encyclop'ad. Worterb. vii. 531. Berl. 1831 ; and Von Martius, Spec. Mat. Med. Brasil, i. 18, :i 148 cainca RADIX. Pelletier and Caventou, 1 the following are found to be the consti- tuents of the bark: — 1. A bitter principle, crystallizable in small, white, silky, shining needles ; inodorous, and very soluble in hot alcohol, which communicates to the whole plant a degree of as- tringent bitterness, and at the same time has an acid reaction on litmus paper. In order to separate this acid, which has been termed by those chemists — ctcidum cahincicum seu cainanicum seu. cainanium seu cai&anum, German, Caincasaure, Cain- c a bitter — in a pure state, the alcoholic extract of the root must be dissolved in water, filtered, and precipitated by lime, until the fluid loses all its bitterness ; the precipitate is then decomposed by- oxalic acid, and boiling alcohol or acetic or muriatic acid may be dropped into an aqueous decoction of the bark of the root, and, in the course of a few days, the acidum cahincicum will separate in the form of small crystals. With cahincic acid, prepared in this way, however, some colouring matter is still united. 2. A fatty, green, nauseous-smelling substance, which communicates to the plant its odour. 3. Yellow colouring matter; and 4. A viscid co- louring matter. 2 EFFECTS ON THE ECONOMY. The effect of cainca root seems to be especially exerted on the digestive and urinary organs. It occasions watery evacuations, and diuresis. From the experiments, however, of Albers, 3 made on a great number of dropsical patients in the Charite, at Berlin, he was induced to deny its diuretic powers, and to place it amongst the drastic purgatives, by the side of helleborus niger. Wolff was of the same opinion. According to Von LangsdorfT, 4 it is a highly efficacious emmenagogue, possessing, also — to use his own language — considerable resolvent virtues, and hence em- ployed in dropsies that are connected with obstructio7is in the abdomen. Riecke 5 asserts that he had occasion to employ it in two cases of ascites complicated with induration of the liver. He had no expectation of effecting a radical cure, but it afforded no palliation; diuresis was not excited, whilst nausea, colic, and diar- rhoea supervened, so that he discontinued it : he gave it in decoc- tion. Others have observed the same inconvenience from its use, or have found it wholly ineffectual; for example, B. Heyfelder, Reinhardt, Bartels, 6 and others. Riecke suggests the possibility, in these cases, of adulteration of -the drug. On the other hand, cainca has been highly extolled by Francois, Ribes, Wagner, Solieer, Lowenstein, 7 &c, but particularly by Von Langsdorff. The main diseases in which cainca is recommended, are, 1. Drop- 1 Journal General de Medecine, Mai, 1830, and Phila. Journ of Pharmacy, iii. 165. Philad. 1831. » Journal de Pharmacie, xvi. 465. 3 Medicin. Zeitung. No. iv. Sept 1832. 4 Hecker's Litter. Annal. B. iv. S. 395, and Rust's Repertorium, B. xiv. S. 458. 5 Die neuern Arzneimittel, u. s. w. S. 84. Stuttgart, 1837. 6 Grafe und Walther's Journal der Chirurgie, u. s. w. xxiv. S. 470. Berlin, 1836. ' De Radice Caincse ejusque in morbis hydropicis virtute. Berol. 1828. cainca RADIX. 149 sies, in which many favourable trials have been made by Von Langsdorff, Spitta, 1 Guddoy, Engler, Francois, Wagner, Solieer, Beral, Robredo, 2 &c. 2. Intestinal worms, against which it appears to act like other drastics. 3. Obstructed menstruation: on this subject, however, farther trials are needed. When it ope- rates as an emmenagogue, it is probably altogether like cathartics that act more especially on the lower part of the bowels, that is, by contiguous sympathy. 4. M. Francois has recommended it highly in catarrhus vesicas, but the experience of others has not confirmed this. 3 It may be mentioned, that, in its native country, it is used for rheumatic pains ; in a peculiar kind of pica expe- rienced by the negroes of South America ; and, as already re- marked, against the bites of serpents. MODE OF ADMINISTRATION. Cainca is given in various forms — powder, infusion, and decoction; and, besides these, a tincture and an extract have been made of it. A syrup and a wine have also been recom- mended. To form the latter, one ounce of the powdered root is infused in a pint of wine: the tincture is made with one part of the root and eight parts of alcohol at 20°. The alcoholic extract is considered to be the most uniform in strength, and has, there- fore, been preferred by many. The syrup is formed by dis- solving 3iiss. of the extract in a little alcohol, mixing this with a pint of hot simple syrup, and allowing it to boil for some time, in order that the alcohol may evaporate. The dose of the powder is from 9j. to 5ss. in the twenty-four hours. It appears, however, to be the most objectionable form, and to give rise to unfavourable symptoms more frequently than the others. Opinions vary as to whether the infusion or the decoction should be preferred. Ac- cording to Caventou and Pelletier, boiling extracts very well the efficacious parts of the root, and there are cases in which the decoc- tion has rendered essential service after the infusion had been admi- nistered without success. Of the decoction, from f 3j. to f 3iij. are given in the day. Of the extract, the dose, in the twenty-four hours, is from twenty to thirty grains; of the tincture, f 3j. to f 3ij. 4 The decoction used by Spitta and others was made as follows: Decoctum radicis caincse. Decoction of cainca root. R. Caincae rad.gij. Coque cum aquae Oiss. ad dimidiam partem, et cola. Dose. — A table-spoonful three times a day. Von Langsdorff 5 §• Francois, 1 Hecker's Litterar. Annal. iv. 396. 2 Journal dela Academia de Medicina de Megico, Oct. 1836; cited in Brit, and For. Med. Review, p. 562, Apl. 1838. 3 Bulletin General de Therapeulique, No. 13, Juillet, 1837. 4 Journal de Chimie Medicale, Mai, 239-242. Paris, 1827. s Hufeland und Osann's Journ. B. lxii. St. 2. .150 CALENDULA OFFICINALIS. By others, the following form has been employed : R. Cainc. rad. ^j. Aquae Oij. Coque ad dimidiam partem et cola. Dose. — Two table-spoonfuls three or four times a day. Engler. Dr. John H. Griscom, 1 of New York, considers there is a re- markable analogy between cainca and apocynum cannabinum. The Aciduni cahincicum, described above, is said to possess tonic, cathartic and diuretic powers, and has been used success- fully in some cases by Franc, ois, in the dose of six grains gradually increased to fifteen. XLIX. CALEN'DULA OFFICINALIS. Synonymes. Calendula Sativa, Caltha Sativa, Verrucaria, Chrysanthe- mum, Sponsa SoliSj Single Marigold, Garden Marigold. French. Souci, S. Ordinaire. German. Ringelblume, Gemeine Ringelblume, Tod- t e nbl um e. This plant belongs to Family Synanthereae ; Sexual System, Syngenesia Necessaria. It is much cultivated in the gardens of southern Europe more especially, and grows wild there. The whole plant has a feeble aromatic smell, which is not, however, unpleasant. The taste is bitter and somewhat pungent. It was examined chemically by Geiger and Stoltze, 2 who found in it a pe- culiar glutinous matter, readily soluble in alcohol, insoluble in ether, and in ethereal or volatile oils, and but little in water : to this they gave the name calendulin. EFFECTS ON THE ECONOMY. The term officinalis indicates, that the calendula was formerly received into the lists of the Materia Medica as an "officinal;" but it had become entirely obsolete, when Westring, 3 a Swedish physician, in 1817, recalled attention to it. He recommended it particularly in cases of cancer of the breast and uterus, having noticed its good effects by accident. Visiting an aged female, who had suffered for a long time under an extremely painful indu- ration of one mamma, he found she was able to allay the burning pain by the application of the fresh plant. This induced him to try it in several cases of cancer, and from the results he was led to infer, that it is perhaps the best agent that can be employed in that frightful malady. He never, however, employed it alone, but associated with it other active remedies, so that but little attention 1 Amer. Journal of the Medical Sciences, for May, 1838, p. 55. 2 Berlin. Jahrb. d. Pharmac B. xxi. S. 282. 3 Erfahrung iiber die Heilung der Krebsgeschwiire, u. s. w. Translated from the Swedish into German, by K. Sprengel. Hal. 1817. CALENDULA OFFICINALIS. 151 was paid to his recommendation; — a great portion of the efficacy of the agents employed, being — it was thought probable— ascriba- ble to the associated articles. Some time after Westring's publication, the remedy was used by others, and his observations were confirmed. Rudolph 1 em- ployed it with advantage internally, in a case of induration of the mamma in a young female; but the acetate of iron was at the same time applied externally in solution. Fehr 2 found it highly useful not only in incipient, but in advanced scirrhus: Stein praises it in cancer of the integuments, (Hautkrebs.) He forms the expressed juice of the young plant and flowers into an ointment with fresh butter, and applies it once or twice a day by means of lint, having previously washed the ulcers with a de- coction of the plant. Internally, the calendula is prescribed in the form of decoction, made with milk or water, or of a mellago pre- pared from the fresh juice, dissolved in an aromatic water; or made into pills. When the salve is applied, a sense of burning arises, which speedily becomes absolute pain. This soon, how- ever, abates, and almost wholly disappears; and if it be too vio- lent, more butter may be added; the ichorous discharge becomes improved; the offensive odour corrected, and in from fourteen to twenty-one days, the ulcer is converted into one of a benign and readily cicatrizable character. Rust, also, frequently administered the extractum calendula in cancerous ulcers, and as a discutient in chronic indurations, in combination, however, with other efficacious agents. Schnei- der affirms, that he prescribed the extract with the best effects in induration of the stomach, and in tumefaction and decided induration of the glands and uterus. He employed a decoc- tion of the flowers and plant in cancer of the uterus, and found it an excellent soothing and discutient agent. Muhrbeck 3 used the extract with eminent success in chronic vomiting ; Carter 4 in extremely obstinate vomiting; and De Camp in a case of car- dialgia, where the excitability of the stomach was so great, that every remedial agent was rejected before it had opportunity to act. Fehr also extols it in amenorrhoea, in which disease it was ce- lebrated with the older physicians; but, as Riecke 5 has remarked, the amount of experience with calendula is yet small — too small for us to pronounce whether it merit a fixed place in the lists of the materia medica. ' Hufeland und Osann's Jour, der prakt. Heilk. B. Iviii. St. 1, S. 119. 2 Verhandlungen der verein. arzllich. Gesellschaft. der Schweiz. Jahrg. 1831, and Dierbach, in Heidelberger Annalen, B. x. H. 4, S. 501. Heidelberg, 1834. 3 Hufeland 's Journal der prakt. Heilk. B. lxii. St. 5, S. 128. Rust's Magazin. der gesammt Heilk. B. xi. S. 350. 4 London Med. Rep. April, 1820, p. 347. See. also, Link und Osann, in art. Calen- dula, in Encyc. Worterb. u. s. w. B. vi. S. 520. Berl. 1831. 6 Op. eit. S. 101. 152 CALENDULA OFFICINALIS. MODE OF ADMINISTRATION. The extraction calendula is contained in the Hanoverian and Saxon Pharmacopoeias; in the latter it is directed to be prepared in the following manner: — R. Calendul. officinal, part. j. Aquas part. viij. Macerate for twenty-four hours ; then boil for a quarter of an hour, and strain forcibly; boil the remainder with four parts of water; mix the two liquors, and, after twenty-four hours' rest, evaporate to the proper consistence. 1 The dose of the extract is different according to different obser- vers. Muhrbeck gave four grains five times a day. Fehr allows 3ij to 3vj. Phobus directs the dose of the extract, prepared ac- cording to the Prussian Pharmacopoeia, to be from eight to sixteen grains, gradually increasing it to 3ss and more, from two to four times a day. It may be given either in the form of pill or mixture. Externally, the extract is used in solution, to moisten the dressings of ulcers, and to form ointments. The dose of the decoction of the fresh plant is f gj. to f §ij. The Sardinian Pharmacopoeia has a Corner va flomtm calen- dula, made by beating together one part of the flowers and two parts of powdered sugar. It has, also, an Jicetum florum calen- dula, made of one part of the petals digested in four parts of vi- negar ; and the Wirtemberg Pharmacopoeia has an Unguentum florum calendula, made of four ounces of the petals boiled in a pound of fresh butter, until the mixture is entirely evaporated. This is used as an emollient and resolvent. Pilulae calendula. Pills of calendula. R. Ferri subcarb. Calend. pulv. Extract, calend. aa gj. Mucilag. acac. q. s. ut riant pilulse xc. Dose. — Five to eight, three times a day, as a soothing agent in cancerous ulcers. Rust. R. Hydrarg. chlorid. mit. 7)ss. Antim. sulphur, aur. J}j. Extr. calendul. conii, aa 9ij. M. f pil. pond. gr. ij. sing. Dose. — Five pills, three times a day, as a discutient in chronic indurations. Rust. Lotio extracti calendula;. Lotion of the extract of calendula. R. Extract, calend. anthemid. aa gij. 1 Pharmacopee Universelle, &c, par Jourdan, ii. 53G. CALX CHLORINaTA. 153 Solve in Aq. lauroceras. f ^ij. Adde Tinct. opii f gj, As a dressing wash (Verband wasser) in cancerous ulcera- tions. Rust. It is obvious that the precise agency of the calendula cannot be tested in any of these formulae, the substances associated with it being themselves active agents. In this country, it is never per- haps used. L. CALX CHLORINATA. Stnonymes. Calcis Chloridum seu Hypochloris, Oxychloruretum Calcii, Protochloruretum Calcii, Chloru return Oxydi Calcii, Bichloruretum Calcii, Oxymurias Calcis, Calx Oxyrrmriatica, Calcaria Chlorata seu Chlorica seu Chlorinica, Chlorum Calcariae, Chloretum Calcariae, Chlo- rinated Lime, Chloride, Chloruret, Hypochlorite, Chlorite or Qxymu- riate of Lime, Tennant's Bleaching Powder. French. Protoxichlorure de Calcium, Oxichlorure de Chaux, Chlorure d'Oxide de Calcium, Bichlorure de Chaux, Oximuriate de Chaux, Mu- riate Suroxigene ou Oxigene de Chaux, Chlorate ou Souschlorate de Chaux, Poudre de Bianchement, Poudre de Tennant. German. Kalkchlorid, Chlorkalk, Chlorigsaurer Kalk, Chlor- calciumoxyd, Oxydirt Salzsaurer Kalk, Bleichpulver . Chlorinated lime is a compound of chlorine and oxide of cal- cium. METHOD OF PREPARING. It may be prepared either in the dry or moist way. In the former case, chlorine is made to act on hydrate of lime in a pul- verulent form ; in the latter, chlorine, in a gaseous state, is passed into lime water. For technical purposes, the latter is most used ; for pharmaceutical, the former. In the London Pharmacopoeia, it is directed to be prepared as follows : — Take of hydrate of lime a pound ; chlorine, as much as may suffice ; send in the chlorine to the lime in a proper vessel, till it is saturated. Chlorine is very easily evolved from binoxide of manganese, mixed with chlorohy- dric acid, by a gentle heat. 1 It is generally, however, prepared in large chemical establishments for the use of bleachers, and is therefore in the list of the Materia Medica in the Pharmacopoeia of the United States, (1842.) Chlorinated lime has the appearance of a white, loose powder, of a sour, bitterish and somewhat biting taste, exhaling a marked smell of chlorine, and dissolving with tolerable facility in water, at the same time giving off much chlorine gas. 2 Its nature and 1 Brande's Dictionary of Materia Medica, p. 1 35. Loud. 1 839. 2 Link, Art. Chlor, in Encyc. Worterb. der Medicin. Wissenschaft, vii. 579. Berlin, 1831. 154 CALX CHLORINATA. composition are a subject of dispute, and hence the term " chlori- nated lime," which has been adopted by the London, Edinburgh, and United States Pharmacopoeias, in place of chloride of lime. M. Hunoux Desfontenelles' affirms, that having prepared pills of chlorinated lime, extract of opium and honey, they experienced a spontaneous combustion a short time after they were prepared ; and he states, that the reaction took place at times whilst the mix- ture was being made. He found, that powdered marsh mallow root and liquorice, when united with chlorinated lime and honey, produced the same result. It would hence appear that chlorinated lime and organic substances ought not to be associated in the same prescription. EFFECTS ON THE ECONOMY. The action of chlorinated lime is generally esteemed to be ana- logous to that of liquid chlorine ; Hufeland, however, assimilates it to that of chloride of calcium. The data have been considered as scarcely, perhaps, sufficient to determine its precise operation. It appears, however, to act mainly by means of its chlorine, which, being loosely combined, is readily disengaged, — all acids, even the carbonic, occasioning its separation. It is not much employed in- ternally; but, according to Cima, it occasions slight pains in the abdomen, burning in the stomach, and at times diarrhoea. As to its internal administration, Cima gave it in cases of scro- fulous swellings. By Cloquet, it was used both internally and externally in gangrenous ulcers ; and by Grafe, Deschamps, Graves, 3 and the author in fcetor oris. In a case of pectoral dis- ease, with great fcetor of the breath and expectoration, it was ad- ministered by Drs. Graves and Stokes with remarkable benefit — a pill of three grains with one of opium being given three times a day, and the quantity being increased to twelve grains a day: the bed was also sprinkled with a solution of it. It has been used with advantage by the author in a similar case; and in gangrene of the lungs. By Reid, 3 it was prescribed in dysentery, and in a bilious typhus occurring in summer; by Copland 4 in the last stage of typhus fever, when the evacuations were highly offensive, given in draughts of aromatic water with mucilage. Dr. Pereira 5 also states that he can bear testimony to the good effects of it in bad cases of fever ; but the same results were not observed in the fever of Edinburgh* It was likewise given by Groh, Cohen, and Schlesier 7 in phthisis, and by Grafe in gonorrhoea. In none of 1 Jour, tie Chimie Medicale, and Soubeiran, Jour, de Pharmacie, Fevrier, 1842, p. 121 . 3 Dublin Hospital Reports, vol. v. 3 Transactions of the Association of Fellows and Licentiates of the College of Physi- cians in Ireland, vol. v. 1838. * Houlton's Appendix to translation of Magendie's Formulary, p. 163. 5 Elements of Materia Medica, &c, 2d edit. p. 503, Lond. 1842; or 2d Amer. edit, by Carson. Philad. 1846. ' 8 Christian, Dispensatory, p. "--12. Edinb. 1H42 1 Casper's Wochenschrifl ftlr die gesammte Heilkunde, iNo. 37, 1838. CALX CHLOEJNATA. 155 these cases is it presumable, that chlorinated lime possesses virtues not contained in liquid chlorine. For external use it has been adopted in various cases, and espe- cially in ulcers. According to Trusen, an aqueous solution is proper for torpid ulcers of almost all kinds — the phagedenic, the scrofulous, &c. In syphilitic ulcers, it appears to be of use when the chancre is sloughing, and eats deeply into the flesh. 1 Trusen employed a solution formed by rubbing from oiij- to 3iv. with a pint of water, pouring off the supernatant fluid after it had stood a quarter of an hour, and applying it by means of pledgets of lint to the ulcer, renewing the application whenever the lint became dry. In this way, he found the profuse ichorous secretion from old ulcers diminish, the offensive odour abate, and fresh and healthy gra- nulations spring up. By the same kind of treatment, phagedenic, herpetic and scrofulous ulcers generally cicatrized speedily and per- manently. 2 Trusen employed, at the same time, crude antimony with cathartics; and in all cases he directed strict repose, and re- gulated diet. Trusen's observations have been confirmed by many modern physicians, amongst whom may be mentioned Labarraque, Lis- franc, Ekl, Lemaire, Heiberg, and Kopp. In ozcena, good effects were observed from it by Horner, 3 Awl, 4 Heron, 6 Detmold,' 5 and Strathing: and a solution of it, in the form of injection, was found serviceable in fistula, by Trusen and Ricor*d. In cancerous ulcers, recourse has been had to it by Heiberg, Labarraque, Du- parcque, Martinet, een applied in purulent ophthal- mia, Varlez 1 cured contagious blennorrhea of the eye, by dropping upon it a solution of it. Colson, Delatte, and Reynaud 2 also saw good effects from it, both in acute purulent ophthalmia, and in chronic ophthalmia with granulations, obscurity of the cornea, and especially in copious secretion from the Meibomian glands. Guthrie 3 applied a solution successfully in three cases of ophthalmia neonatorum; and Pereira 4 advises a weak solu- tion in the same cases. Farvagnie used it beneficially in scro- fulous and catarrhal ophthalmia* Dr. Radclyffe Hall 6 has treated purulent ophthalmia, both in the adult and in children, with success, by a saturated solution. His plan of using it is as follows. The eyelids are slowly and gently separated, until the cornea can be seen, when that is prac- ticable; and all secretion is wiped away with a fine, soft sponge. A large, bushy camel's hair pencil, charged with the strong solu- ' Cited in American Journal of Med. Sciences, i. 459. 2 Journal fur Chirurgie, u. s. w. B. xiv. H. 4, 3 Medical and Physical Journal. Nov. 1827. 4 Elements of Mat Med. 2d edit., i. 593, Lond. 1842; or, 2d Amer. edit, by J. Car- son. Philad. 1846. * Verhandlung. der vereinigt. arztlich. Gesellschaft. der Schweiz. Jahr. 1829. Zurich, 1830. 6 Provincial Med. and Surg. Journal, Dec. 1S44. CALX CHLORINATA. 159 tion, is then insinuated beneath the upper eyelid, and swept round the front of the eye; the pencil is again charged with the solution, and applied to the lower eyelid everted. Unless plenty of the fluid be thus applied, it will be less effectual, but equally painful. There is considerable pain, of a smarting, burning character, for half an hour or longer, and the already swollen eyelids become still more tumid. In a few hours, a serous discharge oozes out from between the eyelids, and the swelling partially subsides. This is followed by a secretion of matter; but, after two or three applications of the solution, it is in perceptibly diminished quan- tity, and the discharge gradually loses its characteristic yellow colour, and is seen in flakes on opening the eyelids. After three or more applications, the eyelids no longer swell, and the pain is much less. As the inflammation lessens, the eyes must be kept clean with warm water, and matter must never be suffered to collect beneath the upper eyelid; a little spermaceti ointment is smeared on the edges of the eyelid, and the strong solution is ap- plied once in every twenty-four hours, until the secretion ceases to be in the least degree puriform. The longest period required for the cure was a month; the shortest, four days. It has likewise been employed advantageously in other hlen- norrhoeas besides the one mentioned, and especially in the gonor- rhoea!? Grafe, of Berlin, 2 affirms, that he succeeded with it when copaiba and cubebs had failed. He used it both in the form of pill, made as described hereafter, and of injection — the injection being made by dissolving gr. xxiv. in f ^vj. of water, and add- ing £ss. of wine of opium. His observations are confirmed by Dr.Radclyffe Hall, 3 who observes, that in the treatment of diseases attended with a contagious discharge, it is desirable not only to lessen the inflammatory action which causes the secretion, but, at the same time, to alter the contagious character of the matter secreted; and he advises chlorinated lime as capable of fulfilling these indications. In the first stage of gonorrhoea , before the discharge has become completely puriform, or the scalding great, a single injection of about two fluidrams of a saturated solution in water, will always, he says, put a stop to the disease. In the second stage, w 7 here there is a considerable discharge of pus, and more pain, several injections are required. In gleet, also, pro- vided the discharge be not kept up by some structural change in the urethra, the strong injection is useful, but not to so striking a degree. The effects of injecting this strong solution are, — sharp pain, and often erection for the moment; slight puffi- ness and eversion of the orifice of the urethra, and tenderness 1 Alcock, Essay on the Use of Chlorurets, &c. Lond. 1827. 2 American Journal of Medical Sciences, and Amer. Journal of Pharmacy, 2d series, vol. ii. 86. Philad. 1838. See, also, M. Roussf, Bulletin General de Therap.Janv. 1842 " Op. cit. 160 CALX CHLORINATA. on pressure, with a feeling of unusual firmness for two or three inches down the corpus spongiosum, where these did not already exist. In a short time the pain subsides, and in a quarter or half an hour, a serous discharge issues from the mouth of the urethra. Occasionally, oedema of the prepuce, with its attendant sense of numbness in the part, ensues. There is scalding, but, usually, not to any very great degree, for the first two or three times of pass- ing the urine, which may be, in a great measure, obviated by in- jecting a little oil of almonds a short time previously. In about eighteen or twenty-four hours, the lips of the urethra are found to be separated by a clot of firm, yellow pus. This is removed by the stream of urine, and may, or may not, form a second time. If the disease be only in its first stage, it will now, according to Dr. Hall, be cured; but if more established, the injection will have to be repeated as often as the peculiar tingling sensation and gonorrhoeal secretion reappear. In this case, the small, firm clot is not formed; but, in its stead, there is a discharge of more fluid pus. The number of injections, and, consequently, the length of time required for cure, depend chiefly upon the anterior duration of the disease. In the acute stage of a first attack, where both pain and discharge are considerable, Dr. Hall has never seen any harm from employing this strong injection, — using, at the same time, mild aperients, tartrate of antimony and potassa and opium internally, enjoining perfect rest and abstinence, and frequently washing out the urethra with some weak, astringent solution, as that of acetate of zinc, formed by the double decomposition of sul- phate of zinc and acetate of lead. On the contrary, the course of the disease has appeared to be materially shortened. When the inflammation is subacute, but the discharge still purulent, as in persons habituated to the disease, or after a certain period of a first attack, copaiba or cubebs have been given in the usual way, but the injection has been manifestly of service. In gleet, a sin- gle injection has sometimes cured, after the failure of almost every other kind of injection. More frequently, several injections have been required. In a few instances, the chlorinated lime has wholly failed ; but, in these cases, no other injection has succeeded afterwards. But one of the most important of the applications of chlorinated lime is as an antiseptic and disinfecting agent. 1 It is admirably adapted for preventing and checking putrefaction, and for cor- recting the offensive odour of parts already putrefied:' 3 and hence its application is most useful in anatomical investigations. 3 Some time before dissection, the body may be enveloped in a cloth wetted with a solution of it, {Calc. chlorin. §ss., Jlqax Oj.,) which must be kept wet by sprinkling it from time to time: in 1 Labarraque. on the Use of the Chlorides of Soda and Lime, translated by Jacob Porter. JNew Haven, 1629. 3 ^Alcock, Op. cit. * Magendie, Formulaire, &c CALX CHLORINATA. 161 this manner the offensive odour is speedily corrected. It is equally well adapted for purifying the air of the wards of hospi- tals, jails or ships; a little of the solution being sprinkled, from time to time, on the floors; or shallow vessels, containing it, being placed in different parts of the room. It is used, moreover, for neutralizing contagious miasmata dispersed in the air, or contained in clothing, furniture, &c, care being taken, in all these cases, that due ventilation be practised. It has been properly doubted, however, 1 whether its use be productive of any advantage in pre- venting the spread of infectious, contagious, or epidemic diseases. It has been affirmed, indeed, to be positively injurious, by dete- riorating the atmosphere, and in this there may be truth, unless the precautions, mentioned above, be taken. In various cases, in which such diseases have prevailed, it has destroyed all offensive odour, — acted, in other words, as an antibromic or deodorizer, — but the extension of the malady has not been prevented. 3 MODE OF ADMINISTRATION. Chlorinated lime has been given internally both in the form of pill, solution and troches, the dose being from gr. ij. to gr. vj. four to six times a day. Externally, it is generally applied in solution of different strengths, (from 3j. to giv. to eight ounces of water) — being decanted to remove the particles of lime from it, unless where it is considered advisable to employ the turbid solution. In cases of very offensive evacuations from the bowels, ten or fifteen grains may be added to a common enema. It is, likewise, applied in the form of ointment, and of liniment, and also of paste made by admixture with water. The following forms have been given for its administration : 3 Troehisci ealcis chlorinate, Lozenges of chlorinated lime. K. Calcis chlorin. gij. Sacchar. ^viij. Amyl. %). Tragac. £j. Carmin. gr. iij. M. Fiant troehisci. pond. gr. iij. sing. One of these to be taken three or four times a day, and allowed to dissolve in the mouth, in cases offostor oris. Deschamps. Mistura calcis chlorinate. Mixture of chlorinated lime. R. Calcis chlorin. ^j. Mist, amygd. f |;vij. Syrup, acaciae f ^j. M. A table-spoonful every three hours in gonorrhoea. — E. Grqfe.* 1 Observations on the Chlorides and Chlorine as " disinfecting agents," and as Preven- tives of Cholera, by H. Bronson. Boston, 1832. See, also, American Journal of the Medical Sciences, for Feb. 1833, p. 481 ; Alters, in London Med. Gaz. viii. 410, (as to its inefficacy in cholera;) and Pereira, Elements of Mat. Med., &c, 2d edit., i. 591. Lond. 1842; or 2d Amer. edit., by Dr. Carson, Philada. 1846. 2 Pereira, Ibid. p. 592. 8 Riecke, Op. cit. S. 94. * Journal fur Chirurgie, u. s. w. B. xiv. St. 2. 162 CALX CHLORINATA. Pilnlse calcis chlorinate. Pills of chlorinated lime. R. Calcis chlorin. gj. Ext. opii gr. ix. Mucilag. acac. q. s. Divide in pilulas liv. Dose. — One, every two or three hours, in gonorrhoea, gra- dually increasing the dose until eight, ten or twelve are. taken every hour. Grafe. Collutorinm calcis chlorinate. Collutory of chlorinated lime. R. Calcis chlorin. grs. xv. ad £ss. Mucil. acac. f £;}. Syrup, aurant. f ^ss, M. A little of this solution to be applied by means of a mop of charpie to nicer s in the mouth. Angelot. R. Calcis chlorin. giij. Aquas destillat. Alcohol, aa. f ^ij. 01. rosse g u - iv. Solve et filtra. Chevallier. A tea-spoonful of this solution is mixed with a glass of water, and used in fcelor oris. According to Riecke, 1 an analogous nostrum has been sold at a high price under the name — Pneu- mokatharterion. R. Calcis chlorin. ^j. Solve, leniter terendo. in Aquas destillat. Ovj. tunc adde Alcohol. (.830) f gviij. Mist, reponatur in loco frigido per horas xxiv.; tunc filtretur et reserv. in lagena. bene obturata.. (" Let the mixture be put aside in a cold place for twenty-four hours; then let it be filtered and kept in a well stopped vessel.'") It has been recommended that the mouth should be rinsed with this after the teeth have been brushed. — Freyburg von Kluge. R. Calcis chlorin. ^ss. Solve exactiss. trituratione in Aq- f gij. et post limpid, clarificat. admisce Alcoholis f 3 ij. 01. rosse g»- iv. M. The mouth is rinsed, in cases of salivation, with a mixture made by adding a tea-spoonful of the solution to a glass of water. Trusen. The Pharmacopoeia of Sweden has an antiscorbutic collutory, called Linctus ad stomacacen seu oxymuriatis calcici, which is formed as follows : 1 Op. cit. S. 94. CALX CHLORINATA. 163 R. Solat. calcis chlorin. gss. AqusB ? Mellis, aa. gvj. M. Dentifricium calcis chlorinate. Dentifrice of chlorinated lime. R. Calcis chlorin. in pulv. gr. iv. Corallinse rubrae gij. M. A new tooth-brush should be slightly wetted, then dipped in this powder, and rubbed over the teeth. Employed to give their natural colour to teeth. Magendie. Solutio calcis chlorinate. Solution of chlorinated lime. R. Calcis chlorin. ^iij. Solve in Aquae destill. Oj. Adde Tinct. opii crocat. vel Vini opii f gj. ad f gij. M. Applied to frost-bites. Trusen. R. Calcis chlorin. gss. Tere invicem et sensim aliunde Aq. (seu Aq. rosae) Oj. Et post clarificat. limpid, admisce Mucil. acac. (seu sem. cydon.) ^ij. Applied, by means of linen rags, in cases of burns. — Trusen. R. Calcis chlorin. £ij. ad giij. Aquae Oj. Solve. To be applied, by means of rags kept constantly wet, in cases of hospital gangrene; the mixture being shaken. Rust Sf Kluge. R. Calcis chlorin. giij. Aquae destillat. Oj. Solve et cola. Used as a lotion in cases of itch on the thighs, legs and arms, twice or thrice daily. In general, six or eight days are sufficient to effect a cure. Magendie. The disinfecting liquor of Labarraque, Liqueur desinfec- tante de Labarraque, is made by adding ten parts of water to one part of chlorinated lime divided in a mortar; suffering the solution to settle, and then filtering. Collyrium calcis chlorinate, Colly Hum of chlorinated lime. R. Calcis chlorin. gr. iv. ad vj. Vin. opii Tr^x. Mucilag. acac. f giss. Aq. rosae f gij. M. et filtra. To be dropped on the eye, in cases of catarrhal and scrofu- lous ophthalmia. Farvagnie. 164 CANNABIS INDICA. Injectio calcis chlorinate composita. Compound injection of chlorinated lime. R. Calcis chlorinat. gij. Decoct, kramer. f gxiij. M. Half an ounce of this to be injected into the nose three or four times a day, in cases of ozsena. Detmold, of Hanover. Cataplasma calcis clilorin atse . Cataplasm of chlorinated lime. R. Calcis chlorin. Sodii chlorid. aa. gss. Aqua3 destill. Oss. FarinaB sem. lin. q. s. ut fiat cataplasma. Used in cases of scrofulous swelling of the joints. Grafe. Ungnentnm calcis chlorinate. Ointment of chlorinated lime. R. Calcis chlorin, gj. Adipis gj. M. et fiat unguentum. To be rubbed in, in cases of scrofulous swellings. Cima. R. Calcis chlorin. gss. Adipis §j. M. et f. unguent. Used in goitre. Werneck. R. Adipis 3j. Sodae borat. Calcis chlorin. aa. gj. M. exactissime. In cases of chilblains. Trusen. R. Sulphuris ^iss. Calcis chlorin. bene tritur. ^ij. Adipis gx, M. In itch, morning and evening. Hospital. Linimeutum calcis chlorinate. Liniment of chlorinated lime. R. Calcis chlorin. £ss. Tere in mortario vitreo et sensim aliunde Aq. rosae (seufontanae) f gj. Et post, limpid, clarificat. admisce 01. amygd. f gj. To be applied, by means of a pencil, in cases of tinea capitis. Trusen. LI. CANNABIS INDICA. Synonymes. Indian hemp, Gunjah, Haschisch. French. Chanvre Indien. German. H a n f . Cannabis, which grows in India, and has been described by some botanists under the name Cannabis lndica, does not appear CANNABIS INDICA. 165 to possess any specific differences from the common hemp, Canna- bis saliva; and accordingly by many botanists they have been re- garded as identical. 1 The term "Indian hemp" has long been assigned, in the United States, to Apocynum cannabinum : this has given occasion in Eu- rope, and occasionally in this country, to confusion in regard to the two articles, which are very distinct in their natural and me- dical characters. 3 The narcotic effects of cannabis have been long known to the peo- ple of Southern Africa, South America, Turkey, Egypt, Asia Mi- nor, India, and the adjacent countries of the Malays, Burmese, and Siamese, by whom it is used in various forms to induce intoxica- tion. It is, likewise, extensively employed in popular practice in various diseases. In Western Europe its use is unknown, and it is questionable, whether the hemp of that region or of this coun- try be possessed of the same properties. Dr. O'Shaughnessy, of Calcutta, states, that the extraordinary symptoms produced by the oriental plant depend upon a resinous secretion with which it abounds, and which seems to be wholly absent in the European plant. The absence of the resinous secretion, and consequent want of narcotic power, he ascribes to difference of climate. M. de Courtive 3 .has submitted to analysis cannabis procured from Al- giers, or from Indian seeds reared in France. He finds the active principle to reside in resin, which he extracted by a complicated process of maceration and the action of alcohol. From 9 to 10 parts of this resin — cannabine — were procured from 100 parts of the plant: the Algerian article furnishing it in greater abundance; and he affirms, that a grain and two-thirds, or even half the quan- tity, produced in some temperaments an equal effect with half a dram of the thick extract. The Cannabis sativa of Italy fur- nished an active but much weaker resin. The resin obtained by M. de Courtive is of a deep greenish-brown colour, of an aromatic but nauseous odour, and of a hot, acrid, and enduring taste. It is soluble in cold ether, alcohol, and volatile oils; insoluble in water and dilute alcohol. The Messrs. Smith, of Edinburgh, satisfied themselves that the resin concentrates in itself the whole properties of the plant. The following is their mode of preparing it. Digest bruised gun j ah in successive portions of warm water until the expressed water comes away colourless, and again for two days at a moderate heat in a solution of carbonate of soda, in the proportion of one part of the salt to two of gunjah. Colouring matter, chlorophyll and 1 Royle, Mat. Med. and Therap., Amer. edit, by J. Carson, p. 551. Philad. 1847, and Pereira, Elements of Materia Medica, 2d edit. p. 1066. Lond. 1842. 2 Farre, in Lond. Med Gaz., May 5, 1843, p. 209. 3 Bouchardat, Annuaire de Therapeutique, pour 1849. p. 52. Paris, 1849; and Ran- king's Half yearly Abstract, viii. 214, Amer. edit. Philad. 1849. 166 CANNABIS 1NDICA. inert concrete oil, being thus removed, express and wash the resi- duum, dry it, and exhaust it by percolation with rectified spirit. Agitate with the tincture milk of lime containing an ounce of lime for every pound of gunjah; and, after filtration, throw down excess of lime with a little sulphuric acid. Agitate with the fil- tered liquor a little animal charcoal, which is afterwards to be removed by filtration. Distil off most of the spirit: add to the residual tincture twice its weight of water in a porcelain basin, and let the remaining spirit evaporate gradually. Lastly, wash the resin with fresh water till it comes away neither acid nor bit- ter ; and dry it in thin layers. Dry gunjah yields six or seven per cent, of it; and its strength as a narcotic corresponds with this proportion. 1 In certain seasons and in warm countries, a resinous juice ex- udes, and concretes on the leaves, slender stems and flowers of cannabis. This constitutes the churrus of Nipal and Hindoo- stan, and in it resides the pow ? ers of all the preparations of hemp. This resin — cannabine, has c his chine 2 — is very soluble in alcohol and ether; partially soluble in alkaline, but insoluble in acid, solu- tions. When pure it is of a blackish-gray colour; it is hard at 90° of Fahrenheit, but softens at higher temperatures, and fuses readi- ly. It is soluble in the fixed and in several volatile oils. Its odour is fragrant and narcotic; taste slightly warm, bitterish and acrid. The dried hemp plant, which has flowered, and from which the resin has not been removed, is called Gunjah or Haschich. It is made into bundles of 24 plants each. These bundles are 2 feet in length, and 3 inches in diameter. 3 It yields to alcohol twenty per cent, of resinous extract, composed of the resin — churrus — and green colouring matter. The Gunjah is used for smoking. The larger leaves and capsules, without the stalks, constitute Sidhee, Subjee, or Bans;, which is used to form with water an intoxi- cating drink. When the plant is distilled with a large quantity of water, traces of volatile oil pass over, and the distilled liquor has the powerful narcotic odour of the plant. 4 EFFECTS ON THE ECONOMY. Cannabis Indica, raised in India, appears to have the greatest activity. Mr. Donovan made numerous experiments with hemp cultivated by himself, and was satisfied that domestic hemp is des- titute of the principle " which renders the Indian plant so desira- ble an extract to the voluptuous people of the East." The effects of this remedy would appear to have been well known to the Arabian and Persian physicians of both modern and 1 Christison, Dispensatory, Amer. edit. p. 973. Philad. 1848. a Bouchardat, Annuaire de Therapeutique, pour 1&50, p. 10. * Ballard and Garrod, Elements of Mat. Med. and Therap., p. 413. Lond. 1845. 4 For the history of the Haschisch, see Moreau, Louradour and Bouchardat, in Bou- chardat, Annuaire pour 1847, p. 11. Paris, 1847. CANNABIS INDICA. 167 ancient periods; but the first person, who seems to have well tested its properties was Dr. O'Shaughnessy. 1 In his various ex- periments, he did not observe the least indication of pain, or any degree of convulsive movement. They all, he affirms, " Jed to one remarkable result, — that while carnivorous animals and fish, dogs, cats, swine, vultures, crows, and adjutants invariably and speedily exhibited the intoxicating influence of the drug, the gra- minivorous, —such as the horse, deer, monkey, goat, sheep, and cow, — experienced but trivial effects from any dose that was admi- nistered." Encouraged by these results, he felt no hesitation as to the perfect safety of giving the resin of hemp an extensive trial in cases in which its apparent powers promised the greatest degree of utility. The general effects observed on man were alleviation of pain in most cases, remarkable augmentation of the appetite, aphrodisia, and great mental cheerfulness. The more violent ef- fects w T ere a peculiar form of delirium, and a cataleptic state. Under the influence of fourteen grains of the resinous extract taken at bed-time, Mr. Donovan 2 awoke early in the morning, with a rush of strange sensations through his head, accompanied by a crackling and singing noise, and a vibratory motion through the whole body. These gradually subsided, and whilst dozing off, he thought an explosion took place in his head, followed by the same rushing noise and vibration as before, and afterwards by a strange metallic sound. Various other noises succeeded. His sense of touch and feeling had gradually become more and more obtuse, until at length he lost all feeling, unless he pinched himself se- verely. " The effects," says Mr. Donovan, " were now 7 at their height, and the consequences w T ere surprising. I absolutely lost the consciousness of having a body, and my corporeal existence, appeared to be comprised within the head, and a small portion of my chest near the throat: in these spots I felt as much alive as ever, but all other parts w 7 ere without feeling, and, to my percep- tion, annihilated. My intellect was not in the least disturbed; memory was as good as ever. I reasoned well enough; was con- scious of external objects as in perfect health ; but I had some no- tion that if I gave way to sleep, I should never wake in this world ; yet, strange to say, I felt perfectly resigned to this sudden termi- nation of existence." Similar phenomena have appeared in others from a much smaller dose. 3 On trying an alcoholic extract, sent to Dr. Christison* by Mr. An- drew Robertson of Calcutta, 5 for toothache, he found, that about 1 On the Preparations of Indian Hemp, or Gunjah, (Cannabis Indica,) &c, Cal- cutta, 1839; and Brit, and For. Med. Rev., July, 1840, p. 2'24. 2 Dublin Journal of Med. Science, Jan. 1 845. 3 Op. cit. 8 See the author's General Therapeutics and Mat. Med. 4th edit. i. 380. Philad. 1850. 4 Op. cit. p. 973. 5 For an account of this extract, see Pharmaceutical Journal, cited in American Jour- nal of Pharmacy, for August, 1847, p. 195. 168 CANNABIS INDICA, four grains, taken at three A. M., caused, in an hour, cessation of pain, a pleasant numbness in the limbs, giddiness, a rapid succes- sion of unassociated ideas, and impossibility to follow a train of thought, frequent intervals of sleep, and slight increase in the force of the pulse. Next morning there was an ordinary appetite, much torpidity, great defect and shortness of memory, extreme apparent protraction of time, but no peculiarity of articulation or other ef- fect, and these symptoms lasted until two P. M., when they en- tirely ceased in a few minutes after taking lemonade. The results, however, of different observers, in regard to this agent, are by no means in accordance. Whilst some believe it capable of replacing opium, where the latter disagrees, others have found it fail where opium had failed. Dr. Lawrie, of Glasgow, 1 has reported its ef- fects in twenty-six cases, from which he drew the following con- clusions. First. It seems to belong to that class of narcotics, which rapidly induce excitement and intoxication, followed by sleep — neither sound nor refreshing. Secondly. In a full dose it acts powerfully on the heart, causing palpitation, and a rapid, weak, intermittent pulse; and on the nervous system, producing delirium, coma, convulsions and dilated pupils. Thirdly. Its ef- fects are generally transitory. In one case, however, the intoxi- cation and dilatation of the pupils lasted nearly forty-eight hours. Fourthly. It is a very uncertain agent, in some cases producing the most violent and seemingly dangerous symptoms; in others, being nearly inert. Fifthly. It very frequently causes vomiting, which, whether it occur spontaneously, or from emetics, very speedily relieves its unpleasant, and perhaps dangerous effects. Sixthly. Applied around the eye, it does not dilate the pupil. Seventhly. It exerted little influence on the few patients to whom it was given in the form of enema. Eighthly. He does not think it a valuable addition to our narcotic medicines. In very few cases did it act as an agreeable soporific and anodyne. In none did it succeed when opium had failed ; and in one case only was it pre- ferred to opium. He does not think it is to be trusted to. Ninthly. So far from acting generally as an anodyne, its effect was so disagreeable, that the majority of those who took it once, only did so a second time on compulsion, and this was the more remarkable, as the patients on whom he experimented belonged to a class to whom stimulants of all kinds were familiar, and who would greedily swallow opium and spirits to an unlimited amount. Tenthly. It seemed useful in two cases of subacute rheumatism; and, lastly, it caused an immediate craving for food, and, in a few, permanently increased the appetite. Professor Miller, 2 of Edinburgh, believes cannabis to be compa- ratively valueless as an anodyne, as well as hypnotic, in ordinary 1 Lond. and Edinb. Monthly Journal of Medical Science, Nov. 1844, p. 497. 3 Ibid. Jan. 1845. CANNABIS INDICA. 169 circumstances. Its virtue seems to him to consist in a power of controlling inordinate muscular spasm. This it exhibited in a case of traumatic tetanus reported by him. Many cases have been published, in which its anti-convulsive power was confirmed. In opposition, however, to Professor Miller, Dr. Clendjnning 1 has no hesitation in affirming, that its exhibition has usually, and with remarkably few substantial exceptions, been followed by manifest effects as a soporific or hypnotic, in conciliating sleep; as an ano- dyne, in lulling irritation; as an antispasmodic, in checking cough and cramp; and as a nervine stimulant, in removing languor and anxiety, and raising the pulse and spirits; and these effects have been observed by him in both acute and chronic affections, in young and old, male and female. Dr. Corrigan 2 believes, that the action of cannabis is primarily on the motor nerves; its influence he inclines to think being trans- mitted along these to the sensorium, and nerves of sensation. Speaking of its peculiar advantages as a sedative, he affirms, that even in over-doses it does not produce the dry tongue, or the de- rangement of the digestive organs, which occasionally follows the use of opium. Its effects on different persons, however, he re- marks, are very different. In the case of a lady who had long suffered from neuralgia of the face, neck and head, twenty drops of the tincture caused temporary loss of power in almost all the muscles, followed by sleep; while a similar dose has been taken by other patients three times daily, for weeks, with impunity and advantage. Dr. Pereira 3 experimented on some specimens of Gunjah and Nipalese churrus, which were sent to him by Dr. O'Shaughnessy. He tried them both on animals and man, and gave specimens of them to medical friends; but their effects were found to be com- paratively slight. "Whether," — says Dr. Pereira, — "this be owing to the preparations having undergone some deterioration in their passage, or to the comparative phlegmatic temperament of the English, I know not. My experiments on animals were made in the lecture-room of the London Hospital before the students of the Materia Medica class; and the trials on the human subject were made in the wards of the hospital." Messrs. Ballard and Garrod 4 state, that when the dose was large, they have observed the urine acquire an odour something like that evolved when the tincture is mixed with water, and in part like that of the Tonquin bean. 5 1 Provincial Med. and Surg. Jour., May 27, 1843, and Med. Chirurg. Trans., xxvi. 208. 2 London Med. Times, cited in Med. Examiner for Sept. J 845. 3 Elements of Mat. Med. 2d edit. ii. 1098. Lond. 1842. * Op. cit. 5 For the experiments of M. Lieautaud and Brierre de Boismont/ and of M. E. de Chaniac, see Bouchardat, Annuaire de Therapeutique, pour 1845, p. 29, Paris, 1845, and Ibid, pour 184G, p. 13. See, also, Lieautaud, cited in Ranking's Abstract, p. 342. Amer. edit. iNew York, 1846. 170 CANNABIS INDICA. Indian hemp was prescribed by Dr. O'Shaughnessy in various dis- eases. In rheumatism, acute and chronic, the results were not very satisfactory. In one case, the most marked catalepsy super- vened along with the usual intoxicating effects. In a case of hy- drophobia, the soothing influence of the remedy was very great; but the disease terminated fatally. In cholera, he considered its agency to be " promising, and to deserve the attention of the prac- titioner;" and since then it has been extolled in that disease by MM. Aubert-Roche, Chaniac, Willemin, 1 Gastinel, Legroux 2 and others. The testimony is strongest in regard to its influence in traumatic tetanus" of which Dr. O'Shaughnessy refers to fourteen cases ; of these, nine appear to have recovered. It is well remarked, how- ever, by Messrs. Ballard and Garrod, 1 that it is no easy matter to determine the claims which a medicine holds forth to control teta- nus; and that we should be cautious of advancing statements in reference to the subjugation of such a formidable disease unless on the most unexceptionable evidence. " Tetanus has been occasion- ally recovered from under a variety of treatment, and hence the disappearance of it in a few cases during the treatment by this drug must not rashly be used as a decided evidence of its curative capabilities. Of two cases lately treated with it in the University College hospital, one died, and the other recovered: the former was traumatic ; the latter idiopathic. However, it is difficult to say how far it influenced the favourable termination ; inasmuch as full and repeated blood-letting and colchicum were also employed." This difficulty exists in most of the reported cases. In but few- has cannabis been given alone. It is proper, too, to add, that in the hands of Mr. Stafford, 5 Mr. Potter, 6 and Dr. Babington, it failed, or, at the most, afforded only temporary relief, although the utmost care was taken to obtain the article in a state of purity. 8 From the results of his cases, Dr. O'Shaughnessy concludes, that the resin of hemp, given boldly and in large doses, is capable of arresting effectually the progress of that formidable disease, "and in a large proportion of cases, of effecting a perfect cure ;" — and further; "that in hemp the profession has gained an anti-convul- sive remedy of the greatest value." The commendations of Dr. O'Shaughnessy gave occasion to the employment of cannabis by many practitioners. Mr. Ley pre- scribed it with advantage in various spasmodic diseases, — chorea, sciatica, &c, which gave him the most perfect confidence in its 1 Bouchardat. Annuaire de Therapeutique pour 1849, p. 51. 2 Ibid, pour 1850, p. 10. 3 See, also, cases by Lev, Lond. Lancet, April 1, 1843, and Isaac Heister, Bost. Med. and Surg. Journal, June 17, 1846, p. 394. * Op. cit. p. 414. 5 Lond. Med. Gaz.. April -2 ( .>, 1845. 6 Lond. Lancet, Jan. 11, 1845, p. 3G. -■ Ibid. Dec. It, 1^44, p. 352. * Charlton, Retrospective Address, in Transactions of the Provincial Med. and Surg. Association, xiv. 20. Lond., 1840, CANNABIS INDICA. 171 power to produce relaxation of the muscles, heavy sleep, and during its action, abatement of pain; 1 and Wolff 2 and Ruhbaum, 3 found it valuable in neuralgic affections. Mr. Lynch 4 likewise prescribed it with success in a case of neuralgia above and around the right orbit ; and in an epidemic neuralgia of the head, but especially of the jaw, which prevailed around Rathenow in the last quarter of the year 1847, Ruhbaum 5 found great benefit from 16 to 20 drops of the tincture of cannabis, which contained about a grain of the alcoholic extract. It has also been given in mania with advantage, by M. Moreau. 6 Dr. Conolly, it appears, in a clinical lecture upon mental disorders, remarks, that he believes there is very little of the genuine Indian hemp now in Europe. He thinks, that if his observation of its effects in the Hanwell Asylum be not altogether erroneous, it must become an important article of commerce. After some careful trials of the tincture, he feels justified in speaking well of it. It is chiefly useful, he thinks, in chronic cases. A dram and a half, and sometimes two drams, have frequently been given in chronic cases of recurrent mania, and although generally with good effects, sometimes without any whatever. 7 By Dr. Corrigan, cannabis has been administered with great success in chorea, in the Richmond Hospital, Dublin. With such evidence in its favour, it is certainly important, that Indian hemp should be subjected to a full and fair trial; and even admitting that it may fall short of the character given of it by Dr. O'Shaughnessy and others, it can scarcely fail to be an important addition to our Materia Medica. Dr. Churchill 8 speaks favourably of the powers of cannabis in checking uterine hemorrhagic discharges, from his own experience, as well as from that*of others. The largest class of cases in wmich he found it of the most unqualified benefit was of menorrhagia, where the discharge, although excessive, is fluid, and but little mixed with clots, and when the uterus is not enlarged. In many such cases, five drops of the tincture, three times a day, arrested the flow in from twenty-four to forty-eight hours. In several cases of threatened abortion, when employed sufficiently early, it succeeded remarkably well. He prescribed it, too, in three cases of cancer uteri, at a tolerably early period, on account of conti- nued draining of blood; and he thought temporary relief was afforded. It appeared to him to exert an astringent power in hemorrhages from mucous surfaces, and to have a sedative or ano- 1 Provincial Med. and Surg. Journ., Aug. 20, 1842. 3 Schmidt, Op. cit. s. 155. 3 Schmidt's Jahrbucber u. s. w., No. 9, Jahrgang, 1848, S. 277. 4 Provincial Med. and Surg. Journ., April 1, 1843. 5 Schmidt's Jahrbucher der gesammten Medicin. Jahrgang, 1848, No. 1 1 ; S. 155. K Du Hachischet de l'Alienation Mentale, Etudes Psychologiques ; Paris, 1845. Noticed by Dr. Pliny Earle, in Amer. Journ. of the Med. Sciences, April, 184G, p. 423. 1 Amer. Journal, loc. cit. 8 Medical Times, May 12, 1849. 172 CANNABIS INDICA. dyne effect. The preparation he invariably used was Mr. Dono- van's tincture of the resin, with which he begins in the dose of five drops, three times a day, increasing it, in a few cases, to ten, but seldom more. The effects are very soon seen, generally in twenty-four or forty-eight hours; often much sooner. In some cases, indeed, the effect was instantaneous. In consequence of Dr. Churchill's belief, that cannabis possesses powers similar to ergot in arresting hemorrhage from the uterus, Dr. Simpson ] was induced to try, whether it is possessed of any oxytocic property; accordingly, he gave it in several cases of te- dious labour, and he states that parturient action seemed to be very markedly and directly increased after its exhibition ; but, far more extensive and careful experiments would be required before a decided opinion could be attained in regard to its possessing such powers, and their amount. MODE OF ADMINISTRATION. The preparations used by Dr. O'Shaughnessy are the follow- ing: — Extractum cannabis Indies alcoholicum. Resinous or alcoholic extract of Indian hemp. This is prepared by boiling the rich adhesive tops of the dried Gunjah in alcohol (-835) until all the resin is dissolved. The tincture, thus obtained, is evaporated to dryness in a vessel placed over a pot of boiling water. The mode of preparing the resin by the Messrs. Smith, of Edinburgh, is given before. The ordinary dose of the extract is from two to five grains; that of the pure resin of Messrs. Smith appeared to them to be active in the dose of two-thirds of a grain, although made with old gunjah. 2 In hydrophobia, the resin in soft pill, to the amount of ten to twenty grains, is directed to be chewed by the patient, and to be repeated according to the effect. Tinctura cannabis Indies. Tincture of Indian hemp. R. Extract, cannab. Indie, alcohol, gr. xxiv. Alcohol, dilut. fgj. Of this a dram is given in tetanus every half hour, until the paroxysms cease, or catalepsy is induced. In cholera, ten drops given every half hour were often found to check the vomiting and purging, and bring back warmth to the surface. Dr. O'Shaugh- nessy's experience leads him to prefer small doses of the remedy in order to excite rather than narcotize the patient. 1 Monthly Journal of the Medical Sciences, July, 18o0. 9 See, on all this subject, Bouchardat, Annuaire de Therapeutique, pour 1849, p. 51— 60. Paris, 1849. CARBO ANIMALIS. 173 Haustns cannabis Indies. Draught of Indian hemp. R. Tinct. cannab. Indie. n\ xv. Alcohol, -n^ xlv. M. ut f. haustus. Donovan. Mr. Donovan ] recommends that the patient should either swal- low the whole of this directly from the bottle, to avoid loss — or pour it into a little w T ater, and instantly swallow it off. If it be not taken instantly, the resin will be precipitated — will adhere to the vessel, and thus escape being swallowed, which always hap- pens when the prescriber directs water to be mixed in the draught by the apothecary; and Mr. Donovan says he has seen several dis- appointments in consequence. L1I. CARBO ANIMALIS. Synonymes. Carbo Carnis, Caro Vitulina Tosta, Animal Charcoal. French. Charbon Animal. German. Thierische Kohle, Flei schkohle, Thierkohle. Animal charcoal is an ancient remedy, which has been revived amongst us. The older physicians used several kinds, and recom- mended them in various diseases, but without having any fixed principle: the circumstances, indeed, that suggested their exhibi- tion, in many cases, are entirely unintelligible to us of the present day. In the old Wirtemburg Pharmacopoeia, we find the Erina- ceus combustus, or "burnt hedgehog," as an antihydropic; the Sericum tostum, or " burnt silk," and the Hirundines combustce, or "burnt swallows," as antiepileptics; the Lepus combustus, or " burnt hare," as an antilithic; the Reguliusti, or " burnt wrens," advised in nephritis and calculous affections; and the Talpce com- busta, or " burnt moles," at one time much extolled in erratic gout, lepra, scrofula, ulcers and fistulas! All have properly fallen, however, into oblivion with the profession, although there may yet be some who cling with pertinacity to these relics of ancient ignorance and superstition. The "cancer remedy" of Cosme, into the composition of which burnt shoe-soles entered, appears to have kept up the employment of animal charcoal, as well as the " burnt sponge," Spongia usta, in which, however, the charcoal is of but little efficacy compared with the iodine it contains. These were, perhaps, the only forms in which animal charcoal was used at the time when Weise, a German physician, revived its employ- ment; and many ph}'Sicians soon came forward to attest favourably in regard to it. 1 Op. cit 12 174 CARBO ANIMALIS. METHOD OF PREPARING. Weise gives the following method of preparing it: Cut ribs of veal, with the flesh attached, into small pieces, and put them into a drum for roasting coffee — turning the 'drum constantly whilst it is placed over the fire. When inflammable air begins to pass off, which is distinguished by the flame playing around the drum, the combustion must still be kept up a quarter of an hour longer. If it be continued as long as any inflammable air is disengaged, the preparation is inefficacious. The substance, most commonly met with under the name of " animal charcoal," is obtained by burning bones. The residue, when reduced to powder, is the well known substance bone black or ivory black. This generally contains more or less phosphate of lime, according to the kind of bone from which it has been procured. It is directed in the London Pharmacopoeia, and in the last edition of the Pharmacopeia of the United States (1842,) to be purified by digestion in dilute muriatic acid, as fol- lows : Take of animal charcoal, a pound ; muriatic acid and water, each twelve fluidounces. Mix the muriatic acid with the water, and gradually pour it upon the charcoal; then digest for two days in a gentle heat, occasionally agitating. Set aside, and pour off the supernatant liquor; then w T ash the charcoal with repeated portions of water till no traces of acid are perceptible; lastly dry it. 1 Char- coal, prepared in this way, should be a combination of carbon, car- bonate and phosphate of lime, hydrogen, and nitrogen. From an analysis, which Meurer made of animal charcoal, prepared accord- ing to Weise's formula, it contains, also, chloride of sodium and a little carbonate of soda, as well as a portion of iron. EFFECTS ON THE ECONOMY. In the case of a young man of scrofulous diathesis, Weise saw a tumour, of the size of a hazelnut, and very painful, situate under the nipple, disappear under the use of animal charcoal. Accord- ing to him, its efficacy is strongly exerted on the uterus and mam- mae. Rothamel and Hohnbaura extol it in dyspepsia and gastri- cism, as well as in cases of diarrhoea. In obstinate chronic glan- dular indurations, especially of the mammary glands, Weise affirms it to be a certain remedy: he, at the same time, however, considers a regulated diet to be indispensable. Scirrhus of the lips, he says, also disappears under its use, and even scirrhous goitre, when the charcoal is associated w T ith burnt sponge. On cartilaginous polypi, it is said to have exerted a beneficial agency, and to have diminished the tendency of mucous polypi to return after opera- tion. Even open cancer, it is asserted, has been healed by it. 3 On these recommendations of Weise, animal charcoal has been 1 For the mode of preparation on the large scale, see Pereira, The Elements of Mate- ria Medica and Therapeutics. 3d edit. i. 312. Lond. 1849. a Riecke, Die neuern Arzneimittel, u. s. w. S. 104. CARBO ANIMALIS. 175 used by several German physicians, especially by Wagner, Kopp, Pitschaft, Radius, Rothamel, Hesselbach, Gumpert, Hohnbaum, Fricke, Michaelsen, and Siebenhaar; and, as a general result of their observations, it would seem not to be devoid of therapeutical agency; although many of the experimenters failed in noticing any sanative effect from it. Fricke, for example, did not observe the least benefit in the very cases mentioned by Weise. He gave it, also, in the way of experiment, in several other cases, but without detecting the slightest influence on the organism. 01 her physicians saw advantages from its use in open cancer, but these were only transient. On the other hand, the experience of Wag- ner, Kopp, Michaelsen, and Rothamel would seem to show, that it was effectual in removing incipient scirrhus of the mammcs. Kopp employed it successfully in scirrhous goitre, and Pitschaft in a case of what he terms struma varicosa. Radius dispersed under its use a considerable swelling of the submaxillary glands. In scrofulous affections, especially in scrofulous indurations of the glands, it'is said to have proved useful in the hands of Kopp, Rothamel, Speranza, Kuhn, and others; but Baudelocque did not find it possess any therapeutical property. 1 Pitschaft, in a deli- cate, strumous woman, who was suffering constantly under ozcena, found it of eminent service after other remedies had failed. Radius thought it aided the absorption of a disintegrated cataract, and Siebenhaar saw good effects from it in induration of the pancreas. Riecke 2 suggests, that farther trials may show, that it might be used in the place of iodine, which it appears to resemble in its ac- tion on the economy, whilst it affects the organism less injuriously. It is doubtful, however, whether the properties of the two sub- stances can be regarded as at all analogous, and whether animal charcoal be possessed of any other properties than those usually ascribed to prepared charcoal — carho ligni. MODE OF ADMINISTRATION. Carbo animalis is given in doses of from half a grain to three grains twice a day — commonly in the form of powder with sugar, or with powdered liquorice root. Weise advises it to be sprinkled on the hard edges of cancerous ulcers, and Speranza extols an ointment made of charcoal, and oil, or simple cerate, as a discutient in scrofulous swellings. Pulvis carbonis animalis. Powder of animal charcoal. R. Carbon, animal, gr. ij. Glycyrr. pulv. gr. v. F. pulvis. 1 Dubois (d' A miens,) Traite de Pathologie Generate, 2eme edit. p. 206. Bruxe'les' 1835. M)p.cit. 176 CARBONIS SESQUI-IODIDUM. A powder to be given morning and evening in induration of the mammae, Michaelsen. R. Carbon, animal, gr. vi. Spong. ust. gr. xij. Glycyrrhiz. pulv. £ss. M. f. pulv. in partes vi. aequales dividendus. A powder to be taken night and morning in scirrhous goitre. Riecke. R. Carbonis animal, gr. iv. Glycyrrh. pulv. £)iv, M. et divide in part. viij. One of these to be taken dry, morning and evening, a little water being drunk afterwards, in cases of scirrhous indurations of the mammce. After the eight powders have been taken, the dose may be increased gradually by half a grain, until it ultimately attains four grains. At the same time, unirritating and spare diet should be inculcated. Bolus carbonis animalis* Bolus of animal charcoal, R. Carbon, animal, gr. iij. Ammon. muriat. pulv. 9j. Ext. conii gr. ij. glycyrrhiz. q. s. ut fiat bolus. One of these to be given three times a day; — in cases of swell- ing and scirrhus ofthejwostate, and of the mucous membrane of the urethra. Magendie. LIII. CARBONIS SESQUI-IODIDUM. Synonymes. Carbonis Sesqui-ioduretum, Iodidum Carbonis, Ioduretum Carbonii, Carbonei ioduretum, Iodo^ormum, Iodoforma, Carbonium seu Carboneum iodatum, Sesqui-iodide or Sesqui-ioduret of Carbon, Iodo- form. French. Iodure de Carbone, Iodoforme. German. Iod kohlenstoff, Iodkohlen was serstoff, Iodatherid, Formylsuperiodid. This preparation is made by mixing concentrated alcoholic solutions of iodine and potassa until the former loses its colour. A solution is obtained, from which the addition of water throws down a yellow precipitate — the sesqui-iodide of carbon, which is soluble ir. alcohol and ether, but insoluble in water. The ethereal solution yields large yellow T crystals by slow evaporation. It has a sweet taste, and a strong, saffron-like odour. Mitscherlich 1 considers the taste very disagreeable. M. Bouchardat gives the following form for its preparation. 3 Take, of iodine, 100 parts; bicarbonate of potassa, 100 parts; water, 750 parts; alcohol, 1 Traite de Chimie, traduit par Valerius. 2 Annuaire de Therap. pour 1844, p. 116. Paris, 1644; and Nouveau Formulaire Magistral, p. 333. Paris, 1845. CETRARINA. 177 250 parts: mix the whole in a flask, which must be placed in a water bath, the heat of which must be gradually raised, to favour reaction. When the liquor has lost its colour {sera decoloree,) add, of iodine, 25 parts ; heat again ; renew the addition of iodine when the liquor has lost its colour; and, a short time after the point has been passed at which it no longer changes by heat, add a few drops of a solution of potassa, to deprive the liquor of colour. Filter, and wash the precipitate produced, which will consist of crystalline plates of iodoform, of a beautiful citrine colour. The evaporated liquor will yield a large quantity of crystals of pure iodide of potassium. According to M. Bouchardat, iodoform furnished by this pro- cess, will be as economical as any other product of iodine; and, he does not doubt, it will occupy a useful rank amongst the prepara- tions of iodine employed internally. Fifty grains, given by Dr. Cogswell, 1 to a strongly made terrier dog, proved fatal; and, on dissection, the large vessels were found congested; the inner membrane was closely corrugated, and the apices of the rugae were of a rose-red colour. M. Bouchardat gives it in the form of pill, united with extractum absinthii in scrofulous affections, and of lozenges. EFFECTS ON THE ECONOMY IN DISEASE. The dose of iodoform is one grain three times a day. Dr. Litchfield 3 used it with advantage in five cases of enlarged glands; in two of lepra, and three of porrigo, in the form of ointment composed of gss. of the powder to 3vj. of simple cerate. Pulvis earbonis sesqui-iodidi. Powder of sesqui-iodide of carbon. {Iodoform powder.) j£. Carbon, sesqui-iodid. Elseosacchar. Vanill. aa gij. Sacchar. pulv. ,§ij. M. Dose. — Fifteen grains, three times a day, in scrofula. Bouchardat.* LIV. CETRARINA. Svnonymes. Cetrarinum, Cetrarium ; Cetrarin, Cetrarine. French. Cetrarin. German. Cetrarin, Moosbitter, Flechtenbitter der Island- ischen Flechte. This substance was extracted from Cetraria Islandica, by M. Herberger, a pharmacien at Kaiserslautern. 4 1 Essay on Iodine, p. 122. Edinb. 1837. 2 Lond. Med. Gaz., Aug. 1836. 3 Armuaire, &c, pour 1842, p 129. * Buchner's Repertorium, B. viii. H. 1, 1837. 178 CETRARINA. METHOD OF PREPARING. The coarse powder of cetraria is boiled for half an hour in four times its weight of alcohol 'at .883; it is then left at rest until vapours cease to be given off, to avoid the loss of the alco- hol; when it is strained and pressed. Three drams of muriatic acid, previously diluted with water, are now added to each pound of the moss; this is mixed with from four times and a quarter to four times and a half its bulk of water, and the mixture is left at rest for a night in a closed flask. The next day, the deep yellow fluid, which sw T ims above the copious deposite obtained, is poured off; this deposite is the impure cetrarin, the colour of which is more or less greenish. It is now collected on a filter (chausse,) left to drain as little as possible, and subjected to pressure. To purify it, it must be divided into small fragments, and washed, whilst still moist, with alcohol or ether, which deprives it of colour; it is then treated with two hundred times its weight of boiling alcohol, in which the inorganic matter, that has hitherto accompanied it, is scarcely soluble. The greater part of the cetrarin is gradually precipitated on the cooling of the alcoholic solution. The portion which still remains in solution may be separated by the evaporation of the alcohol. One pound of cetraria, according to Messrs. Ballard and Gar- rod, 1 yields about two drams and a half of cetrarin. Pure cetrarin is, at times, in the state of a white powder, re- sembling magnesia; at others, in small globules united in the form of arborizations, which do not present — even under the microscope — any crystalline texture. When gently compressed, it has a slight silky splendour. It is neuter, light, unalterable in the air, inodorous, and has a very intense, bitter taste, especially in the alcoholic solution. Its best solvent is absolute alcohol, one hun- dred parts dissolving 1.70 of it at the boiling temperature, but only 0.28 at 14° centie. (58° Fahr.) Alcohol, at .830 dissolves 0.44 when boiling; 0.28 at 25° cent. (77° Fahr.,) and only 0.04 at 14° cent. (58° Fahr.) It is still less soluble in boiling and in cold water, the essential oils, creasote, &c. It is somewhat more soluble in ether, but insoluble in the fixed oils. 2 EFFECTS ON THE ECONOMY IN DISEASE. Muller, of Kaiserslautern, 3 details two cases in which he has administered cetrarin. One of these was a quartan, the other, a tertian intermittent. The effects appeared to be exerted more sknvly than those of quinia, but it seemed to him not to affect the stomach as much.[?] Its price must be considerably less, as M. 1 Elements of Mat. Med. and Therap., p. 365. Lond. 1845. * Journal de Phartnacie, xxiii. 505. Paris, 1637; and Bulletin General de Thera- peutique, No. 18, Sept. 30, 1837. 3 H. Bruck, in Bulletin General de Therapeutique, No. 17, 15 Sept., 1837. CHIMAPHILA. 179 Herberger succeeded in obtaining, from a pound of cetraria, 135 grains of very pure cetrarin. It has also been prescribed success- fully in intermittents, by Regatelli and Von Lippich. 1 It has not been given, so far as the author knows, in this country. MODE OF ADMINISTRATION. Muller gave it in the form of powder, according to the following prescription : — R. Cetrarin. Acaciae aa. gr. ij. Sacchar. £)ss. M. et fiat pulvis. Dose. — One of these every two hours, during the apyrexia. Bruck, 3 suggests, that if dissolved in alcohol, its action may be incomparably more potent, and that it may more speedily arrest the paroxysms of an intermittent, than when given in powder. LV. CHIMAPHILA (FOLIA.) Synonymes. Chimaphilae vel Chimophilae Umbellatse Folia, Chimaphilae Corymbosse Folia, Pyrola ; Pyrolae Umbellatae Folia, Winter Green, Umbellated Winter Green, Pipsissewa. French. Herbe a pisser, Pyrole en Ombelle. German. Die Blatter des holdenbluhtigen Wintergriins, Wintergriin- Blatter. This plant is not new to us; but numerous trials have been made with it of late in Europe. It is admitted into the Phar- macopoeia of the United States, is a beautiful evergreen, and is indigenous in the northern parts of Europe, Asia, and America. It belongs to the Natural Family EricineaB of Decandolle ; Pyro- laceae Lindley; Sexual System, Decandria Monogynia. A good description of it is given by Barton. 3 The leaves have a bitter-sweetish taste, with some degree of astringency. The taste of the stems and roots is, in addition, con- siderably pungent. Boiling water and alcohol extract the virtues of the plant. The constituents, so far as ascertained, are bitter extractive, tannic acid, resin, gum, lignin, and saline matters. The active principle has not been determined. It probably resides in the bitter extractive — the resin and tannic acid, however, con- tributing to its effects. 4 EFFECTS ON THE ECONOMY IN DISEASE. The leaves of Chimaphila were long used by the Indians of this continent, and from them the American physician was induced 1 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 71. Erlangen, 1848. 2 Op. cit. 3 Medical Botany, i, 17; see, also, Art. Chimaphila, in Wood and Bache's Dispensatory . 4 Pereira's Elements of Materia Medica, &c., ii. 1333. Lond. 1842; or 2d Amer. edit., by Carson. Philad. 1846. 180 CHIMAPHILA. to employ them. The first regular treatise respecting the plant is said to have been a thesis of Dr. Mitchell, published in the year 1803. ' In Canada, it is said to have been long used in diseases of the urinary passages, especially calculus; in dropsy, and in chronic gout and rheumatism; its effects appearing to resemble — but not to exceed — those marvellously ascribed to uva ursi. 2 Somerville 3 and Barton extol it as an excellent diuretic in different forms of dysuria, and in dropsies, especially such as succeed to acute diseases; in nephralgia as a palliative, especially when the paroxysms are occasioned by gravel which has accumulated in the kidney; and even in vesical calculus. During its use, the appe- tite has improved, and the digestive powers have augmented ; the patients often experiencing — immediately after it was taken — an agreeable sensation in the stomach, and in the region of the' kid- neys. Radius* found it especially serviceable in dropsy, gout, and rheumatism; and in inordinate activity of the secretory function of the mucous membranes — chronic catarrh, phthisis pituitosa, &c. According to him, it is contraindicated where there is much fever, disposition to diarrhoea, gastricism, and great debility of the stomach. Heyfelder affirms, that it appears to be advantageous in the debility of the digestive organs attendant upon dropsy, but its diuretic effect is not considerable or enduring, so that it requires to be associated with more powerful agents. Experiments, w T hich have been made in the Burger-hospital, at Pesth, and which have been collected by St. Rochus, and pub- lished by Windisch, the director of the hospital, are extremely favourable to the chimaphila. Within two years, nearly two hundred dropsical cases are said to have been radically cured by it. Windisch recommends it most strongly to the attention of his colleagues; he asserts it to be one of the best diuretics we possess; that it does not impair digestion; moderately accelerates the cir- culation; gently encourages the action of the bowels, and power- fully augments the urinary secretion; that the patients willingly take it, and that it induces no nausea. It was administered with advantage in dropsies unaccompanied by fever, and not dependent upon organic mischief, upon " corruption of the humours or para- lysis of the lymphatic textures." In febrile conditions and inflam- matory diatheses, it is said to have been always injurious, as well as w T hen it was administered prior to the resolution of obstructions remaining after long protracted intermittents; but when these are removed, and no excitement exists, — more, according to Windisch, is to be expected from it than from any other agent, and he 1 Barton's Collection, ii. 2. 2 See the author's General Therap. and Mat. Med., 4th edit. i. 276. Philad. 1850. * Medico-Chirurgical Transactions, v. 340. 4 Auserlesene Heilformeln zum Gebrauche fur praktische Aerzte und Wundirzte, u. s. w. S. 175. Leipz. 1836. CHIMAPHILA. 1 81 strongly advises, that careful trials should be made with it in the proper cases. He advises, also, that its use should be persevered in, in order that good effects may be derived from it. The author has frequently administered chimaphila in public and private practice, and has found it serviceable, where a tonico- diuretic was indicated. It is probably owing to its tonic proper- ties, that it has been found occasionally serviceable in scrofula. MODE OF ADMINISTRATION. Chimaphila is given either in infusion, or, what is preferable, in decoction; the dose in the day being from half an ounce to an ounce of the drug. Where it does not act sufficiently on the bowels, Radius advises, that a few 7 senna leaves should be added. In affections of the chest, he found the addition of the spirit of nitric ether advantageous. Generally, however, he gave it alone. Windisch found a combination of it with tartrate of antimony and potassa, sulphuret of potassium, muriate of ammonia, squill, and, in very great weakness, cinchona and preparations of iron, ser- viceable. Radius often administered, also, the aqueous or spirit- uous extract. Decoctum chimaphilae. Decoction ofpipsissewa. R. Chimaphil. £j. Aquae Oij. (Oiss, Ph. U. S. and Lond.) Coque ad colatur. Oj. To be used daily in dropsy.' Somerville. Dr. Joy 1 adds to this two drams of Liquor Potassss Carbo- natis, and directs four table-spoonfuls of the mixture to be taken three times a day. He recommends it "in dropsy and chronic affections of the urinary organs" as if all these affections were identical or even analogous pathological conditions ! R. Chimaphil. ^ss. ad gj. Coque cum aquos f ^xij. ad reman, f ^vj. Coctione finita, adde Spiritus frumenti (gm, malt spirit or whisky) f ^ij. Digere frigide per horas vj. et cola. Dose. — Two spoonfuls, to be taken four times a day, in dropsy and gout. Radius. R. Chimaphil. gvj. Coque cum aq. f |xij. ad reman, f Sjvji Sub finem coctionis adde Fol. sennae ^ij. et cola. Dose. — A spoonful to be taken every two hours. Radius. A fermented decoction was used by Dr. Parrish, in the Penn- sylvania Hospital, in cases of strumous disease, particularly white swelling and similar affections of the joints. According 1 Tweedie's Library of Medicine, 2d American edit. vol. iii. p. 692. Philad. 1842. 182 CHLORINUM. to Dr. Carson, 1 it makes an agreeable beverage. A decoction or infusion is first formed with half a pound of cfdmaphila leaves, to a gallon of water: a pound of sugar or half a pint of molasses, half an ounce of powdered ginger, and some yeast are then added. This mixture is placed in a tight vessel, and kept in a warm place, until fermentation is accomplished. Instead of the ginger, or, in addition to it, essence of spruce may be used. The dose is half a tumblerful three or four times daily. J. Par risk. LVI. CHLORINUM. Svnonymes. Chlorinium, Chlorineum, Chlorum. Chlorine, Murigene, Acidura Muriaticum Oxygenatum seu Marinum Dephlogisticatum, Spiritus Salis Marini Dephlogisticatus, Dephlogisticated Muriatic Acid, Oxygenated Muriatic Acid. French. Chlore. German. Chlor, Chlorgas. Uncombined chlorine is employed medicinally not only in the gaseous but in the liquid state. Each of these will be treated in succession. The forms for evolving it in the gaseous state, as well as the gaseous chlorine itself, have had various names as- signed them expressive of their chemical or medical properties. They have been termed, respectively, Jicidum muriaticum oxy- genatum ad contagia ; Fumigatio muriatico-oxygenata ; Fumigatio Guyton-Morveauniana; Pulvis ad fumigationes muriaticus ; Species pro vaporibus superoxydi muriatici; Suffitus oxy muriaticus ; S. chlorini; Jilexiterium Chlori- cum, Fumigation de Chlor, F. de Guyton, F. Guytonienne, F. Hygienique, &c. METHOD OF PREPARING. Chlorine is obtained from chlorohydric or muriatic acid. For this purpose, one part of well pulverized peroxide of manganese with five or six parts of concentrated muriatic acid, is put into a retort, to which heat is applied, and the gas received over water. Or, it may be obtained from a mixture of one part of peroxide of manganese, four parts of kitchen salt, two parts of concen- trated sulphuric acid, and four parts of water. Chlorine is a greenish-yellow gas; of a peculiar, strong, disa- greeable, stifling odour. The flame of a lighted taper introduced into it becomes at first pale, afterwards red, and is ultimately ex- tinguished. It remains unchanged in the highest temperatures. It has a great affinity for hydrogen, so that it abstracts this gas from every substance that contains it, and forms with it chlorohy- dric acid. Hence it decomposes all the gases that contain hy- drogen, and all organic colouring matters, as well as — it is con- ceived by many — miasmata and contagious matters. 1 Pereira's Elements of Mat. Med. and Therap., 2d Amer.edit p. 391. Phila. 1846. CHLORINUM. 183 EFFECTS ON THE ECONOMY. Chlorine, when diluted, and received into the lungs, occasions coughing, and symptoms of suffocation, to which a protracted ca- tarrh often succeeds: not unfrequently, too, we observe in those who are compelled to be exposed to it, bronchitis and pneumonia. Animals soon die when they are immersed in it. 1 In Mr. Brough- ton's experiments, mice exposed to it fell dead in less than thirty seconds. On opening them, the heart was found palpitating ; the peristaltic motion of the intestinal canal continued, and could be kept up by irritating it with a probe. The vessels of the brain were collapsed. The lungs were tinged with the yellow colour of the gas, and the peculiar odour of chlorine was perceptible throughout their structure. Coagulation of the blood took place as under ordinary circumstances. A rabbit, two or three weeks old, was immersed in it, and died in less than half a minute. On opening the thorax, the heart was found acting freely, and on puncturing the aorta, the blood jetted out forcibly to a con- siderable distance. The peristaltic motion of the bow r els was also going on. The vessels of the brain were in a collapsed state. The lungs were very much distended, tinged yellow, and, when re- moved from the chest to a distance, emitted the odour of chlorine. The right ventricle of the heart was distended with dark blood. The eyes were much glazed in each experiment. "It has been generally thought," adds Mr. Broughton, "that chlorine is inca- pable of passing the epiglottis" [the glottis] "but from the above observations it is evident that this gas enters the bronchial tubes in the act of inspiration. A portion of it probably circulates through the brain, suspending the cerebral functions without di- rectly destroying the action of the involuntary organs, — contracti- lity remaining long after the destruction of animal life, as is evinced by the activity of the heart and of the intestinal canal" 3 These very facts, however, seem to show, that but little of the gas enters the lungs; probably no more than what passes imme- diately preceding the closure of the glottis by the forcible contrac- tion of the arytenoidei muscles. When inhaled in a dilute state, it is absorbed-; and, according to Mr. Wallace, the urine acquires bleaching properties. It would appear, also, that, in manufacto- ries, the chief consequences from exposure to an atmosphere of it are acidity, and other stomach complaints, which the men gene- rally remove by taking chalk: 3 this fact is confirmatory of the view, that acidity of the stomach is usually, if not always, depen- dent upon excess in the secretion of the gastric acids, the most important of which is the chlorohydric. When chlorine is inhaled, ' See Christison on Poisons, Amer. edit. p. 152. Philad. 1845. 2 Journal of the Royal Institution, from Jan. to June, 1830. 3 Pereira, Elements of Mat. Med. &c, 2d edit. i. 228, Lond. 1842 ; or 2d Amer. edit, by Carson, Philad. 1846. 184 CHLORINUM. it is reasonable to suppose that more of this acid may be secreted in the stomach. The irritating effects of chlorine become less and less, where persons are exposed to the fumes, and workmen are able to carry on their operations with impunity in an atmosphere impregnated with it, where one unaccustomed to such exposure could not re- main with impunity for more than a few minutes. 1 MODE OF ADMINISTRATION. 1. By inhalation. — In the way of inhalation, chlorine gas is never administered in a state of purity, but always diluted with atmospheric air; often, too, it is united with watery vapour. Gan- nal affirms, that the workmen in a bleaching establishment, who suffered under diseases of the chest, were visibly improved, and ascribed the amelioration to the inhalation of air containing it. He, therefore, instituted various experiments on consumptive in- dividuals, from w T hich good results, he conceived, followed. Sir James Murray 2 also mentions, that a friend of his had observed similar effects among his workmen who were exposed to the inha- lation of watery vapour strongly impregnated with chlorine. The experiments, however, which w T ere instituted at La Charite, in Paris, on this mode of treating phthisis, were by no means en- couraging; and the same may be said of those at the Hotel Dieu of that city, instituted by Rullier. 3 In many cases, indeed, the disease appeared to be aggravated. Bayle, likewise, thought the inhalation of it generally unfavourable, although he asserts that he cured a case of tubercular phthisis with it. Since then, it has been recommended by Cottereau. Professor Albers, 4 of Bonn, who administered it repeatedly, and carefully watched its effects, conceives, that it acts as a stimulant when applied to the mem- brane, but that, when it gets into the blood, its effects are anti- phlogistic; and he is of opinion, that when there is no haemoptysis or violent local irritation present, chlorine inhalations may be used in diseases of the lungs and air-passages. Its stimulant effect gradually diminishes, and, after a time, the mucous surfaces of the lung become less sensible to its exciting influence. In tubercles of the lung, chronic catarrh, chronic inflammation, and ul- ceration of the bronchial mucous membrane, and in dilata- tion of the bronchi, he found it of no service; and, in most cases, it could not be borne, in consequence of the irritation it induced ; but its operation was very salutary in pure ulceration of the lungs, or vomica. It had always, however, to be administered 1 Christison, A Treatise on Poisons, 1st Amer. edit. p. 616. Thilail. 1845. 3 A Dissertation on the Influence of Heat, &c, Lond. 1829; cited in the Dub. Jour, of Medical Science, for March, 1839, p. 96. 3 See, also, Pereira, Op. cit. p. 229 ; and E. J. Coxe, Practical Treatise on Medical In- halation, p. 83. Philad. 1841. * Hannoversch. Annalen, 1836, cited in Brit, and for. Med. Rev. July, 1837, p. 215. CHLORINE* 185 cautiously and experimentally. Dr. Stokes always found chlorine inhalations prejudicial in phthisis, as they produced, in every case, increase of bronchial irritation, dyspepsia, and arrest of the pul- monary secretion. In his trials of the remedy in gangrene of the lungs, 1 he found it decidedly beneficial, correcting the fcetor of the breath and expectoration, and, therefore, calculated to obviate not only the local but the constitutional symptoms. Sir James Clark 2 is of opinion, that the inhalation of chlorine has only pro- duced relief in persons whose lungs have been diseased to a very limited extent. Dr. A. T. Thomson 3 considers it "the best topi- cal expectorant, and the most salutary excitant to the mucous membrane of the lungs that has yet been inhaled;" and Dr. Chris- tison 4 affirms, that he has tried the practice repeatedly ; and al- though, like Dr. Elliotson, he has witnessed "such amelioration as he never saw before under the use of narcotics or any other means," he has not met with any instance where the amelioration was permanent. Such, likewise, has been the experience of the author. Dr Pancoast informed him, that a case of aphonia oc- curring in a young lady, in which there was but little voluntary power over the diaphragm, was cured by the inhalation of chlorine, after the galvanic plates and the electro-magnetic apparatus had been used in vain. Chlorine may be inhaled from a common dish or inhaling appa- ratus, by dropping any of the acids on a mixture of chlorinated lime, so that the gas may be disengaged slowly ; but the best me- thod of inhaling it, as well as iodine, is that recommended by Dr. Corrigan. 5 He properly remarks, that, in order for inhalation to have a fair trial, it is requisite, first, That the apparatus should be simple in its construction, and easily kept in order. Secondly, That it should be capable of keeping up a supply of vapour for any length of time, and that the evolution of the vapour should be steady and easily regulated. Thirdly, That it should also fur- nish a sufficient supply of aqueous vapour to prevent any irritation of the larynx, or lining membrane of the air-tubes ; and, fourthly, and most important of all, that its employment should entail nei- ther trouble nor fatigue on the invalid. 1 Dublin Hospital Reports, vol. v. 2 Treatise on Tubercular Phthisis, p. 84, Lond. 1834 ; also, Amer, edit. Philad. 1835, 3 Elements of Mat. Med. and Therap. 2d edit. Lond. 1835. 4 Dispensatory, p. 312. Edinb. 1842. 3 Dublin Journal of Medical Science, March, 1839, p. 94. 186 CHLORINE. To fulfil these objects, Dr. Corrigan advises the apparatus represented in the marginal fi- gure. It consists of a light open iron-wire frame, about eighteen inches high, at the bottom of which is a spirit-lamp, A: at the proper height above it is an eva- porating porcelain dish, about six inches in diameter, B: above this is a glass globe, C, with its neck downwards. In the neck of the globe is a cork, D, bored, and through the opening is drawn, moderately tight, a short plug of cotton wick, such as is used in a spirit lamp: in the glass globe at E, opposite the neck, is drilled a pin-hole, to allow air to pass in, according as the fluid within drops out through the neck. To use it, the porcelain dish is filled with hot water, the spirit lamp is lighted, and as soon as the water in the dish has begun to boil, the glass globe containing chlorinated lime, (if this be the substance used,) is placed as in the illustration. The rate,, at which the fluid in the globe shall percolate the cotton wick and drop into the hot water beneath, is easily regulated. If it should not drop with sufficient rapidity, one or two of the threads of cotton may be removed. Should it drop too rapidly, this is corrected by pressing in the cork more tightly, or introducing one or two additional threads of wick. Eight ounces of a saturated solution of chlorinated lime may be poured into the glass globe; and into the water of the porce- lain dish, two ounces of the diluted sulphuric acid of the phar- macopoeia. As the solution drops, the acid seizes on the lime, and the chlorine is evolved in connexion with aqueous vapour." 1 Chlorine is but little used in this form, and can only be adapted for cases in which the pathological condition of the bronchial mu- cous membrane, or neighbouring parts, requires the exhibition of an excitant. 2 In this way, it may be occasionally serviceable in chronic bronchitis ; but its administration requires great caution. 3 In cases of poisoning by hydrocyanic acid, as well as t>y sulphu- retted hydrogen, it is a most efficacious agent. Chlorinated lime may be used for this purpose. 1 London Medical Gazette, April 6, 1839, p. 40. 3 Toulmonehe, in Revue Medicale, Avril. 1834. See. on the various modes of inha- lation. Sir C. Scudamore, in Lond. Med. Gaz., Feb. 7, 1 840, and E. J. Coxe, Practical Treatise on Inhalation. Philad., 1 84 1 . . 3 Archives Generates, Avril, 1834; and a communication on the excellent effects of chlorine vapour in catarrh, in Gazette Medicale de Paris. June, 1838. CHLORINUM. 187 2. By Fumigation. — Fumigations of chlorine have been par- ticularly recommended" by Dr. Wallace, of Dublin. 1 They appear to resemble, in their action, the nitrous and nitro-muriatic acid baths, and have been especially employed in liver diseases, un- accompanied by inflammation, but in which there is a disturbance of the biliary secretion. According to Wallace, they are more certain than ablutions and baths of nitro-muriatic acid, and have the advantage, that their application subjects the patient to less inconvenience. 2 The good effects of chlorine, in such cases, have likewise been tested by Zeise, 3 in his bathing establishment at Altona. When chlorine is brought in contact with the skin, in this way, it soon occasions a pricking sensation; increase of tran- spiration; great afflux of fluids to the surface of the body, and sometimes a pustular eruption; increased secretion of saliva, urine, and bile ; slight inflammation of the mouth and fauces, and im- peded respiration and circulation. Dr. Mettauer is disposed to re- fer the action of the compound, in every case, to the presence of chlorine, and to believe, with Dr. Scott, of India, who first intro- duced the nitro-muriatic acid to notice, about thirty-three years ago, (1817,) that a solution of chlorine in w T ater will answer, in all cases, as well as the acid. In the last edition of the Pharma- copoeia of the United States, the following formula has been intro- duced for the preparation of the Acidum Nitro-muriaticum. Take of Nitric acid, f ^iv., Muriatic acid, f gviij. Mix them in a glass vessel, and, when effervescence has ceased, keep the product in a well stepped glass bottle, in a cool and dark place. Dr. Wallace found chlorine fumigations serviceable not only in hepatic diseases ivith disordered secretion of the liver, but in several other morbid conditions, as hypochondriasis, cachexia, and in all affections in which a prolonged excitation of the skin, and a restoration of its suppressed or impaired functions are es- teemed serviceable, — hence, in old cases of syphilis, scrofula, chronic catarrh, and rheumatism. Generally, cathartics were combined with the fumigations, and the evacuations were con- stantly observed to present a highly bilious character. In chronic cutaneous affections , as in lepra, psoriasis, and scabies, these fumigations have been found useful; but, generally, fumigations of sulphurous acid are employed in preference, in consequence of the greater facility with which they can be prepared. 4 Injections of chlorine gas have been employed for the radical cure of hydrocele by M. Deblois, of Tournay, and M. Deconde. 5 1 Researches respecting the Medical Powers of Chlorine, &c. Lond. 1822. 2 See. on the Nitro-Muriatic Mixture, as a remedial agent, J. P. Mettauer, American Journ. Med. Sciences, Feb. 1840, p. 291. 8 Nye Hygea udgived af C. Otto, 1825, and Hufeland und Osann's Journ. derprakt. Heilkund. B. Ixiii. St. 1. * Green on Diseases of the Skin, American Library edit. Philad. 1838. * Bulletin Medical Beige, Janvier, 1836. 188 CHLORINUM. The gas is contained in a bladder, to which is attached a pipe and stop-cock adapted to the canula of the trocar, into which it is fixed after the fluid is evacuated ; the stop-cock is then turned, and the bladder pressed so as to force the gas into the tunica vaginalis. When this is distended, the pipe and bladder are removed, and the thumb is placed over the mouth of the trocar, so as to prevent the issue of the gas for the space of two minutes; it is then allowed to pass, and two or three repetitions of the injection are made, which are sufficient for the cure. It would appear, that risk must be in- curred from the injection of such an acrid substance, but M. De- conde says not. Fumigations of chlorine, with the view of destroying the mat- ter of contagion, and of preventing the spread of contagious diseases, have long been used. 1 As long ago as the year 1773, they were proposed for these purposes; and were subsequently extensively used by Guyton de Morveau ; hence they have been called the "Guytonian" or " Guyton Morveau fumigations ." In fumigating the extensive general penitentiary at Milbank, Westminster, Dr. Faraday adopted the following method. One part of common salt was intimately mixed with one part of black oxide of manganese ; the mixture was placed in a shallow earthen pan, and two parts of oil of vitriol, previously diluted with two parts by measure of water, were poured upon it, — the whole being stirred with a stick. Chlorine was liberated for four days. The quantities of the ingredients employed were 700 pounds of common salt, the same quantity of oxide of manganese, and 1400 pounds of sulphuric acid. 2 Whatever may be the virtues of chlorine fumigations as an antibromic or smell destroyer, experience would seem to have shown that they are useless in preventing the spread of zymotic diseases. Possessed, as all the preparations of chlorine are, of po- tent antibromic virtues, it was natural to suppose, that they might equally destroy morbific miasmata, and therefore be valuable pre- ventives of cholera, and other zymotic maladies. In the fever of the Niger, they were fully tried and totally failed, and there is no reason to believe that they are more effective in other forms. Some years ago, chlorine was employed at the Small Pox Hospi- tal, London, with the view of arresting erysipelas in the wards. 3 The offensive smell was removed as usual, but the propagation of the disease appered to be unaffected. During the progress of cho- lera on the continent of Europe, in 1831 and 1832, extensive trials were made with it, but without any beneficial result. 4 At 1 Link, Art. Chlor. in Encyclopad. Worterb. der medicin. Wissenschaft. B. vii. S. 575. Berlin, lb31. a Fereira, Op. cit. p. 228. 3 Pereira, Op. cit, 2d edit., i 371, Lond. 1849. * Dierrach, Die Neuestcn Entdcckungen in der Materia Medica, i. 411, Heidelberg und Leipzig, 1837. CHLORINI AQUA. 189 a time when the Cholera Hospital at Moscow, was filled with clouds of chlorine, 1 the greatest number of attendants was attacked; and similar facts were noticed by distinguished observers in Ber- lin and elsewhere. 2 When chlorine is evolved in the manner above described, it is liable, like all the acid gases, to the objection, that it is extremely irritating when respired. It cannot, therefore, be used in the sleep- ing apartments of the sick, although it may be employed benefi- cially after they have been withdrawn, and the object is to disin- fect the chamber. It ruins all polished surfaces, but this can be effectually obviated by painting them over with a compost of starch. The chlorides are not liable to the same amount of objec- tion, as they exhale the chlorine slowly. LVII. CHLO'RINI AQUA. Synonymes. Aqua Chlorinii seu Chlorinei seu Chlorata seu Chlorinica seii Chlori seu Oxymuriatica seu Oxygenata muriatica seu Oxygeno-mu- riatica, Liquor Chlori seu Chlorini seu Acidi Muriatici Oxygenati seu Alexiterius Oxygenatus, Chlorum liquidum, Solutio Chlorinii seu Alexi- teria Oxygenata, Solution of Chlorine, Liquid Oxymuriatic Acid. French. Chlore Liquide, Eau de Chlore. German. Chlorwasser, Wasseriges Chlor, Chlorfliissigkeit, Dephlogistisirte oder Oxydirte Salzsaure, Uebersaure Salzsaure, Oxydirt Salzsaures Wasser. This preparation is contained in many of the foreign pharma- copoeias. It is in those of Austria and Anvers ; and in the Bata- vian, Bavarian, Belgian, Danish, Dublin, Edinburgh, Parisian, Finnish, Hanoverian, Polish, Prussian and Swedish. 3 It has been more extensively administered on the continent of Europe than in this country or in Great Britain. METHOD OF PREPARING. The Prussian Pharmacopoeia directs chlorine gas, made after the manner before described, to be passed into the bottles of a Woulfe's apparatus filled with distilled water, until two-thirds of the water are displaced : the bottles are corked under water, and the water is agitated until it takes up the gas. The liquid is then drawn off into small bottles, which are well filled, and kept in a dark place. In this way, liquid chlorine may be kept for a long time undecomposed. In its preparation, some little chlorohydric acid is formed, so that it has at times to be purified by treating it with a solution of nitrate of silver. ' Albers, Lond. Med. Gazette, viii. 40. 2 Gerardin and Gaimard, Du Cholera-Morbus, 3 eme edit., p. 110, Paris, 1833, and the author, in Report of the Sub-Committee on Cleansing the city (Philad.,) p. 15, Phila. 1849. 3 Pharmacopee Universelle, i. 405. Paris, 1626. 13 190 CHLORINI AQUA. The process of the Dublin Pharmacopoeia is similar to this. That of the Edinburgh Pharmacopoeia differs; and is as follows: Take of Chloride of sodium, sixty grains ; Sulphuric acid (com- mercial,) two fluidrams; Red oxide of lead, three hundred and fifty grains; Water, eight fluidounces. Triturate the chloride of sodium and oxide together ; put them into the water contained in a bottle with a glass stopper; add the acid, and agitate occasionally till the red oxide becomes almost white. Allow the insoluble matter to subside before using the liquid. EFFECTS ON THE ECONOMY IN HEALTH. From experiments made by Orfila 1 on dogs, it appears, that considerable doses of a moderately concentrated solution of chlorine prove fatal by exciting, sooner or later, inflammation of the stomach, accompanied with great languor; and when death takes place very rapidly, signs of organic alteration are met with in the stomach. In its action on the economy, chlorine is closely allied to the acids, and especially to the chlorohydric. Introduced into the stomach in moderate doses, solution of chlorine excites an agreeable feeling of warmth, which soon spreads over the whole of the body : in strong doses, according to L. W. Sachs, a kind of intoxicating stupor is induced by it, soon succeeded by prostration. It has been conceived to act equably as a moderate excitant of the nervous system, and thereby to moderate inordinate action in any part ; and is, to a certain extent, antiphlogistic, without possessing any of the debilitating qualities of the antiphlogistics proper. In the opinion of some of the German pathologists, it powerfully stimulates the organic actions, especially the lymphatic and glandu- lar systems, moderating inordinate secretion. Its antiseptic pro- perties are likewise considerable. It would appear, however, that the number of observations has not been sufficiently great — although they have been by no means few — to allow of any com- prehensive appreciation of its exact modus operandi on the hu- man organism. 2 EFFECTS ON THE ECONOMY IN DISEASE. Although solution of chlorine is properly no new remedy, it is only of late years that it has been frequently administered. At the present clay, in some countries, it is in common use. It is not long since Meurer maintained, that it is impossible to administer chlorine internally, and that in every case in which it was believed to have been given, the article really taken was chlorohydric or muriatic acid ; for, owing to the affinity of chlorine for hydro- gen, whenever any union takes place between it and organic mat- ters, the chlorine, he affirmed, disappears, and chlorohydric acid alone exists, as he had proved by repeated experiments. In this 1 Toxicologic Generate, i. 141. Q Riecke, Die neuern Arzneiroittel, u. s, w. S. 30, Stuttgart, 1837. CHLORINI AQUA. 191 assertion, however, he was opposed by many observers. Herzog and Barmann came forward with experiments, to show that Meu- rer had gone too far in his deductions ; and, from all the experi- ments, it would appear, that in prescribing aqua chlorini many mistakes had been, and — we may add — still are, committed. From Barwald's experiments, it would appear, that if water which has rested on aromatic or other vegetable substances be chosen for the dilution of the solution of chlorine instead of distilled water, a dif- ference is produced in the rapidity of the decomposition. In a mixture of aqua chlorini, distilled water, and simple syrup, the de- composition takes place tardily ; but if, in place of syrup, a muci- laginous juice be substituted — for example, the syrupus althaeee — acids are speedily formed; as well as when a decoction of althaea is substituted for distilled water; whereas a mixture of decoction of salep, (gr. v. to water gj.) syrup, and aqua chlorini, in well stopped bottles, remained undecomposed above twenty -four hours. In these experiments, however, the persistence of the smell and taste of the chlorine exhibited, that the whole of it had not been con- verted into chlorohydric acid. In the same manner as in the case of the decoction of marsh-mallows, the addition of infusum sennse and infusum Valerianae, as well as of the solutions of extracts, and especially of liquorice, destroyed the smell of the aqua chlorini in- stantaneously, even when the taste of chlorine could still be de- tected. When the solution was combined with remedial agents that contained much colouring matter, the decomposition took place with great rapidity. From the results of these experiments, Barwald advises aqua chlorini to be given in admixture with dis- tilled water and simple syrup, as in this way only can we be sure that the patient has taken the chlorine undecomposed. Herzog lays it down as a rule, that the solution of chlorine should only be mixed with colourless transparent substances — w T ater, simple syrup, gum Arabic or decoction of salep. In respect to its administration in disease, it may be well to speak first of its internal use, which, in several morbid conditions, seems to have rendered good, and in some cases eminent, service. The following are the diseases in which it has been chiefly recom- mended : — Irritative fever, — as in the violent irritative fever that occurs during the period of dentition; in which it has been administered with great success by Kopp, Mehlhausen, Goden, Trusen, and Riecke. 1 Dangerous determinations to the head have been, in this way, obviated, along with the unpleasant complications which are apt to be occasioned thereby. ToeP exhibited it in convul- sions during dentition, which were accompanied by too great ac- tivity of vessels ; and he affirms, that he has prescribed no remedy, which, in all respects, answered so well. 1 Op. cit. S. 30. 2 Archiv. <]. med. Eifahrung. Marz und April, 1825. 192 CHLORINI AQUA. Nervous fever, especially when tending to the putrid character. In the plague, according to Wagner, it is of no avail ; but in putrid fever, according to Kopp, it is highly useful. Spangenberg observed good effects from it in an epidemic tophus with hepatic derangement. It is likewise extolled in typhus by Wolf, Braun, Hufeland, and others; and by Sacco in the fever called petechial, — itself a typhus. Of late, it has been much used in Germany in typhus abdominalis, which corresponds to our typhoid fever, to oppose the origin and development of the intestinal ulcerations; but when the disease is farther advanced it has been found useless. It is especially recommended in this disease by Clemens, but he commonly premised the use of an emetic. Trusen considers the emetic unnecessary. He first applies leeches to the epigastrium, and then prescribes immediately aqua chlorini in considerable doses ; — in lighter cases, a dram every two hours ; and if the disorder of the head be already great, the tongue chapped and the peculiar expression of countenance present, he gives two drams every two hours. Bartels is less satisfied with the action of chlorine in abdominal typhus. It raises, he says, the sinking powers very speedily, but often excites the sanguiferous system, and not unfrequently increases the abdominal symptoms so palpa- bly, that the physician is compelled to have recourse to other agents. Riecke 1 thinks, however, that it may be of essential ser- vice in this disease, which so frequently mocks the best directed efforts of the practitioner; and he suggests, that farther experi- ments are highly desirable, especially as those instituted by Trusen and others are not free from objection, by reason of their having associated substances with chlorine that quickly decompose it. Carhunculus malignus (Milz bra ndkar bunkel.) — In the variety of malignant anthrax caused by handling the skins of cat- tle, the internal and external use of chlorine has been found of essential service by EttmiJller, Herbst, Stumpf, and Hoffmann. The benefit derived from its use externally, in this and similar affections, induced Dr. Cramer 3 to try its effects on bad furuncu- lous swellings, the progress of which was surprisingly expedited, and the extension of the ulceration much limited, compared with what occurs under the use of poultices. Scarlatina.— Pfeufer,Wendt, Kopp, and Trusen extol it highly in this disease for which, on theoretical grounds, it would seem to be appropriate, by reason of the great turmoil in the san- guiferous system, — indicated by rapidity of pulse and inordinate evolution of heat, which bear but little direct ratio to the degree of vital energy. Braithwaite, who, it is asserted, was one of the earliest, if not the earliest, that advised- chlorine in scarlatina, sup- 1 Op. cit. S. 33. ' 2 Casper's Wochenschrift, No. 8, cited in Brit, and Foreign Medico-Chirurg. Rev. July, 1850, p. 276. CHLORINI AQUA. 193 posed that it acted as specifically as the bark in intermittent, or mercury in syphilis ! and Trusen asserts that it may be advan- tageously used in cases where other remedies have been found ineffectual. It is especially recommended by Braun and Spiritus in malignant scarlatina. Dr. Watson 1 says, that from several dis- tinct and highly respectable sources, chlorine has been strongly pressed upon his notice as a most valuable remedy in the severest forms of scarlatina. His informants have stated, that whereas they formerly dreaded to be summoned to cases of that disease, they now, having had experience of the virtues of chlorine, felt no misgivings in undertaking its treatment. Dr. Watson himself has not had opportunities enough for trying it to speak confidently of its sanative power, but presumes that its disinfecting properties may account in part for the good it does. It probably deprives the foul secretions of their noxious quality. The author has often used it, but, in highly malignant forms of the disease, like every other agent, it fails. He gives it internally ; sponges the surface with it ; and employs it, or a solution of chlorinated lime or chlorinated soda, as a gargle. Dr. Cramer saw great relief follow its applica- tion to the neck, in a case of this disease in a child, in which suffocation was impending. He kept compresses well soaked in it to the part. In other febrile affections — small-pox, measles, rubeola, &c. — it has been prescribed with advantage ; and Dr. Schneider 2 strongly recommends it as a gargle in small-pox and angina. He applies it diluted with water, and finds it exert a remarkable ectrotic effect over variola when affecting the tongue and throat; and over an- gina in general. In putrid dysentery, (faulige Ruhr,) it is extolled by Nysten and Kopp; and in intermittent, by Kopp and Kretschmar. Trusen recommends it in the irregular, and espe- cially in the anticipating forms, where danger exists of their be- coming continued. Under its use, he found the paroxysms become regular, with perfect apyrexia, so that the ordinary febrifuges could be given advantageously. In gastric fever, Trusen trusted to it solely for the removal of the disease ; he found that it corrected the morbid secretions from the mucous membrane of the digestive tube. Other physicians have also derived equally favourable results from its administration in that malady. In gastromalacia, it has been prescribed by Rhades, Blasius, and Winter, but as Riecke, 3 — from whom this detail of the expe- rience of the German practitioners has been chiefly taken, — properly observes, farther observation is necessary before we can decide as to its efficacy in such cases. In erysipelas, especially of children, it has been recommended by Kopp. 1 Lectures on the Principles and Practice of Physic, 2d Amer. edit., p. 1024. Philad. 1845. 2 Cramer, Op. cit. 3 Op. cit. S. 34. 194 CHLORINI AQUA. In inflammation of the liver, favourable results were obtained from it in the Children's Hospital at St. Petersburg; and it exhi- bited, in these cases, the analogy to calomel in its action, which has been pointed out by many observers. In hydrophobia, it has been used both internally and externally as a preventive, especially by the Italian physicians Brera, Previ- tali, 1 Ghisaldoni, Agliati, Arrigoni, Narcisi, and Anelli, whose experience is in its favour. Wendelstadt and Ruppius have like- wise published favourably regarding it. It is obvious, however, that much fallacy may arise as to the precise agency of reputed preventives. Every one, for example, who may be bitten by a mad dog is not attacked with hydrophobia; and, unless great cau- tion be used, any article may be regarded as a preventive. This is the main reason why we have so many preventives of this and other diseases. Solution of chlorine has been advised by Ruppius and Mertzdorf in dropsy, especially such as supervenes on the acute exanthemata. In the diathesis phthisica, it has been recommended by Goden, and has been affirmed to moderate the hectic in phthisis, and to make the remissions more marked. In these cases, it requires to be given in large doses, and to be exhibited for a considerable time. In many cases of chronic cutaneous affections with diminished plastic energy, it has been used with success by Kopp. In noma or cancrum oris, and in fcetor of the mouth, it has been recommended internally as well as topically; and, according to the experiments of Persoz, Nonat, and others, it renders emi- nent service in cases of poisoning by hydrocyanic acid. Externally, it is used either pure, diluted with water, or in com- bination with oil. Godier affirms, that he cured strumous swell- ings of the glands by a cerate of chlorine. Eisenmann, Culle- rier, and Blache recommend it — at times pure, at others diluted — in the way of injection, in gonorrhoea and leucorrhcea. It is em- ployed, also, in flabby, putrid, and offensive ulcers, in carbuncu- lus malignus, and in chronic cutaneous affections — as tinea capitis, itch (Deimann,) herpes (Alibert,) asthenic aphthce, &c. In large abscesses and in buboes, great advantage was derived by Mr. Cramer 2 from its external use. The matter was at times absorbed, and when this was not the case, the progress of the case was still very favourably influenced. Lastly: ablution with a solution of chlorine, or of the chlorides, has been advised as a preventive of venereal infection. In can- cerous ulcers, it corrects the unpleasant odour, and excites a new action in the part, causing the secretion of better pus: farther than this, we cannot expect much from it. Baths of it are recommended by Wagner as an excellent means for preventing the plague. 1 Pratiche Osservazioni sulT Idrofobia, &c. Milan, 1820. 2 Op. cit. CHLORINI AQUA. 195 Schonlein advises, that in scarlatina the whole surface of the body should be washed with a mixture of aqua chlorini and water, which he prefers to ablution with cold water. Finally : aqua chlorini is occasionally sprinkled in the sick cham- ber, to purify the atmosphere during the prevalence of contagious or other diseases. MODE OF ADMINISTRATION. As already remarked, whenever aqua chlorini is prescribed, its facility of decomposition must be borne in mind. It is, for this reason, best to prescribe it, for internal administration, with water only, 1 or at most with the addition of simple syrup. For exter- nal use, water alone should be associated with it. As to the pre- cise mode in which chlorine is affected by fatty substances, we have as yet no accurate knowledge; it maybe calculated, however, that part undergoes decomposition. Such combinations have, notwith- standing, been found useful. The solution should never be prescribed in quantity larger than is necessary for twenty-four hours, as by frequently opening the vessel in which it is contained, decomposition readily ensues. The vessel should be put in a dark place, and be surrounded by black paper. The average dose for an adult, in the twenty-four hours, may be fixed at an ounce, although much larger quantities may be given without inconvenience. It is scarcely necessary to say that the precise dose must vary with the degree of concentration. Unguentum chlorini. Ointment of chlorine. Unguentum oxygenatum ex tempore parandum. R. Aquas chlorin. p. j. Adipis p. viij. M. Used in itch. Pharmacopoeia of Austria. Linimentum aquae chlorini. Liniment of chlorine. R. Aquae chlorin. f gj. Oleioliveef §j. M. Externally, in obstinate itch, tinea capitis, and herpes. Deimann 8f G. A. Richter. R. Cerse albse gij. Leni calor. liquef. adde 01. amygdal. q. s. ut fiat linimentum cui refrig. adde Aq. chlorin. giss. M. Used externally in ulcers, Ludwig. i Lepage, Journ. de Chiraie Med. cited in Encyclop. des Sciences Med. Janv. 1842. p. 22. 196 CHLOROFORMUM. Gargarisma aqnse chlorini. Gargle of chlorine. R. Tragac. pulv. gr. xij. Aquse f Jiv. Aquae chlorin. t Syrup, aa. f £ss. M. To be used as a gargle in ulceration and chronic inflammation of the mouth and fauces. Ratier. 1 LVIII. CHLOROFORMUM. Synonymes. Chloroforma, Carboneum chloratum, Superchloridum for- mylicura, Chloroform, improperly called, by some, Chloric ether, 2 and Terchloride of Carbon. French. Chloroforme. German. Chloroform, Formylsuperchlorid. This preparation, which was admitted into the Supplement of the last edition of this work, has acquired fresh interest, in conse- quence of its introduction and extensive employment as an anaes- thetic in the same cases'as sulphuric ether ; which it has indeed, in the practice of many, wholly supplanted. METHOD OF PREPARING. Chloroform was discovered separately and about the same period by Mr. Guthrie, 3 M. Soubeiran, 4 and Liebig. 5 It is obtained in the following manner, according to the process of Mr. Guthrie. Into a clean copper still put three pounds of chlorinated lime, and two gallons of well flavoured alcohol, s. g. -844, and distil. Watch the process, and when the product ceases to come over highly sweet and aromatic, remove and cork it up closely in glass vessels. The remainder of the spirit should be distilled off for a new operation. These proportions are not essential : if more chlorinated lime be used, the ethereal product will be increased ; nor is it necessary that the proof of the spirit should be very high. Mr. Guthrie says he " has commonly used the above proportions and proof, and has every reason to be satisfied with them." From the above quantity he has commonly obtained about a gallon of ethereal spirit. It may be obtained also in the following manner. 6 One part of hydrate of lime is suspended in 24 parts of cold water, and chlorine is passed through the mixture until nearly the whole lime is dissolved. A little more hydrate is then added to restore the 1 Formulaire Pratique des Hopitaux Civils de Paris, 3eme edition. Paris, 1827. 5 Dierbach, Die neuesten Entdeckungen in der Materia Medica, iii. 930, Heidelberg, und Leipzig, 1847. 3 Silliman's Journal, xxi. 64, Jan. 1832. "*"" 4 Annales de Chimie et de Physique, xlviii. 131. Paris, 1831. ' Ibid. xlix. 146. Paris, 1832. « Fownes, Elementary Chemistry, p. 339. Philad. 1845. CHLOROFORMUM. 197 alkaline reaction : the clear liquid is mixed with one part of alcohol v or wood spirit, and after an interval of 24 hours is cautiously dis- tilled in a very spacious vessel. A watery liquid containing a little spirit, and a heavy oil collect in the receiver ; the latter, which is the chloroform, is agitated with water, digested with chloride of calcium, and rectified in a water bath. The most fragrant form is obtained by the action of chlorinated lime on alcohol. Dr. Christison 1 gives the following mode of pre- paring the article, which he and others have used so successfully as an anaesthetic. One pound avoirdupois of bleaching powder, with three pounds of water and three ounces of rectified spirit, yields, by distillation in a roomy vessel, about nine fluidrams of crude chloroform of the density 1*220. After this, the residuum begins suddenly to froth up. The crude chloroform, which is covered in the receiver by a stratum of weak spirit, is purified by shaking with it half its volume of sulphuric acid, gradually added ; and water and alcohol being thus removed, the strong chloroform is freed of a little sulphuric acid by redistilling it from milk of lime or baryta. The product, which is pure chloroform, if the process be well conducted, amounts to about half a fluidounce. Dr. Christison has not found the quantity to be increased, as some have represented, by increasing the quantity of alcohol. Chloroform is a transparent, colourless fluid, of the specific gravity 1*480 ; of a peculiar, fragrant, ethereal odour, resembling that of apples; and of an ethereal, slightly acrid, intensely sweet, taste. It speedily evaporates; and boils at 140° Fahr. It is readily soluble in alcohol and ether, but only in 2000 parts of water. It dissolves volatile oils, camphor, caoutchouc, wax, and resins. Its most frequent adulteration is with alcohol, which is easily detected by the reduction of its density. Dr. W. Gregory, 2 however, ascribes the injurious effects of the chloroform in ordinary use to the presence of certain volatile oily impurities, which must be removed before it can be safely em- ployed. These oils contain chlorine, have a disagreeable smell, and, when inspired or smelt, cause distressing headache and sick- ness. The test recommended by Dr. Gregory for these impuri- ties is to agitate the chloroform with sulphuric acid, which should be quite colourless, pure, and of the full density of 1*840 at least. This, when agitated with impure chloroform, becomes yellow or brown, from its action on the oils, which it chars and destroys. Any change of colour is readily seen by the contact with the colourless chloroform that floats above. Pure chloroform gives no colour to the acid. Dr. Beatty 3 accords with Dr. Gregory in 1 Dispensatory, Amer. edit, by R. E. Griffith, p. 974. Philad. 1848. 2 Monthly Journal of Med. Science, May, 1850, p. 414 ; or Amer. Journ. of Pharmacy, Oct. 1850, p. 328. J 3 The Dublin Quarterly Journal of Med. Science, August, 1850. 198 CHLOROFORMUM. the belief, that we have thus in our power a very simple means of testing and purifying chloroform before employing it. EFFECTS ON THE ECONOMY. The medical properties of chloroform are like those of sulphuric ether, than which, when sufficiently diluted, it possesses a more agreeable taste, so that it is readily taken even by children. Dr. H. Hartshorne 1 experimented with it on himself and others when in health. He found that seventy-five drops gave him a sensation of general diminution of consciousness and sensorial capacity. Sight, hearing, and touch w 7 ere made less impressive ; but no feel- ing of exhilaration or perversion occurred. He was drowsy. The pulse was not at all accelerated; it was, indeed, two beats slower in the minute ; and the same effects were observed in two other medical gentlemen, from two or three times the quantity. One took over two hundred drops. He became very heavy, and, in a short time, passed into a sound sleep. In all of them, the influence had departed after an hour or two. No one felt as if he had taken alcohol, and in none was the pulse increased ; and the conclusion with all of them was, that it is a direct sedative to the encephalic nervous system, — a sedative narcotic. Chloroform is said to have been used with advantage in asthma, spasmodic cough, atonic isthmitis, " and other diseases in which a grateful and composing medicine is indicated." 2 In cases of cancer it has been given internally in the dose of two or three drops by Mr. Tuson, 3 and has produced sleep and perfect ease. As a local application to the cancerous part its action was of a sedative character. He also gave it with advantage in uterine irritation or neuralgic affections of the uterus. In such cases, he prescribed it internally, but in others, attended with obstinate discharge, it ought to be injected as w T ell. In obstinate vomiting, three drops have " at once taken effect;" and in such cases Mr. Tuson has found benefit from applying it to the pit of the sto- mach. In cancer of the pylorus, "it has proved most efficacious in preventing the return of the food, and in relieving the pain and suffering of the patient." In sloughing ulcers, he has used it extensively, and he is not acquainted with a remedy more bene- ficial. " In phagedena, there cannot be a more useful local application ; but care should be taken to apply it only to the sloughing parts." "In fungoid disease, the application of the chloride of carbon has been very remarkable." Mixed with water, it is said to form a very useful gargle in foul ulcerated sore-throat, removing the fcetor, and giving the ulcers a healthy appearance. It is also, according to Mr. Tuson, of the greatest use 1 Amer. Journ. of the Med. Sciences, p. 353, Oct. 1848. 2 Dispensatory of the United States, 6th edit., p. 1242. Philada. 1345. 3 Lond. Lancet, July 15, 1843, p. 553, and The Structure and Functions of the Fe- male Breast, p. 410. Lond. 1846. CHLOROFORMUM. 199 in affections of the gums and teeth, " removing the unpleasant stinging pains produced by the exposure of some nervous filament; and its use not only gives ease, but removes any unpleasant fcetor from the breath." Such is a picture — doubtless overdrawn by Mr. Tuson — of the efficacy of chloroform as a remedial agent. As a narcotic, chloroform has been given internally in asthma? spasmodic cough, cancer, uterine irritation, hysteria, 2 neuralgia, 3 chronic vomiting from nervous causes, such as that which occurs in pregnancy , and in short wherever sulphuric ether has been found of service. As a sedative and soothing external application it has been used in open cancer, sloughing ulcers, orchitis, 4 neuralgia, 5 neu- ralgic tooth-ache, 6 lumbago, 7 painful pelvic tumours; 8 and as a collutory in fcetor oris; and internally it has been prescribed in neu- ralgia, 9 flatulent colic; in cough, as an addition to pectoral mix- tures ; and by M. Delcoux, in intermittent fever, who ascribes to it febrifuge and antiperiodic virtues. Soon after its discovery, it was prescribed by the Doctors Ives, 10 of New Haven, in asthma, spasmodic cough, scarlatina, and atonic quinsy, and with favour- able results. But its most interesting and important application is as an anaesthetic agent administered in the way of inhalation. As long ago as the year 1832 it was employed in this manner by Professor Ives, 11 of New Haven, in a pulmonary affection attended with great debility and dyspnoea, which was effectually relieved by it; but no farther attention appears to have been paid to it until Professor Simpson, 12 of the University of Edinburgh, instituted trials with it, and other anaesthetic agents, and found it infinitely more effica- cious than any. In his first publication, after having tried it on upwards of fifty individuals, he detailed some striking cases of midwifery and surgical practice, in which it had been inhaled with the most satisfactory results. The main advantages which he conceived it to possess over sulphuric ether, were ; — that a much less quantity is needed ; that its action is much more rapid and 1 M. Guillot, cited in Christison, Op. supra cit. ; and Dispensatory of the United States, 8th edit., p. 1243. Philad. 1849. 2 Formby, Christison's Dispensatory, p. 975. Philad. 1848. 3 Mr. Tuson, Op. cit: also Wahu, Annuaire de Medecine, et de Chirurgie pratiques, pour 1850, p. 15. 4 Buisson, L' Union Medicale, No. 4, cited in Brit, and Foreign Medico- Chirurg. Rev. July, 1850. 5 Ranking, Half-yearly Abstract, ix. 219, Amer. edit. Philad. 1849. Tuson, Op. cit.; Hays and Bond, Transactions of the College of Physicians of Philadelphia, vol. 2, No. 6; and Laroque, Bulletin de Th6rapeutique, Mars, 1849, p. 209. 6 Pigeolet, cited by Wahu, Annuaire de Medecine, et de Chirurgie pratiques, pour 1849. p. 247. 1 L'Union Medicale, 21 Oct. 1848. 8 Ibid. 31 Octobre, 1848. 9 H. Hartshorne, Amer. Journ. of the Med. Sciences, Oct. 1848, p. 353. 10 Silliman's Journal, xxi. 406. '* Ibid. 12 Account of a new anaesthetic agent as a substitute for sulphuric ether in Surgery, Edinb. 1847. 200 CHLOROFORMUM. complete, and generally more persistent ; its inhalation more agree- able and pleasant ; and that being required in much less quantity, it is more portable and transmissible than sulphuric ether ; — that recovery is usually more speedy, leaving fewer unpleasant feelings ; and that it does not excite irritation of the bronchial tubes, is pleasant to the taste, and does not leave a disagreeable taint of the breath. As soon as the discovery was promulgated by Dr. Simpson, the inhalation of chloroform was largely employed in all cases in which the inhalation of ether had previously been directed. Experiments were made by numerous observers, — by Dr. Simpson 1 himself, Dr. Snow, 2 M. Sedillot, 3 Mr. Wakley, jun., 4 Mr. Gruby, 5 MM. Dumeril and Demarquay, M. Amussat, 6 M. Gerdy, 7 M. Jobert, 8 Mr. F. Sibson, 9 M. Coze, 10 and others, to determine its physiological action ; from all of which it appears, that whilst chloroform is a much more potent agent than sulphuric ether, its action as an anaesthetic is essentially the same ; MM. Dumeril and Demarquay in their experiments on animals state, that ether and chloroform are rapidly fatal, when inhaled in very large quantity. Dogs were destroyed in thirty-five or forty-five minutes, and even in less time, by chloroform. When the inhalation of chloroform, like that of ether, is carried beyond a certain point, it is capable of producing death ; and if not to this extent, convulsions and profound insensibility. Certain persons appear, too, peculiarly susceptible to its influence, so that disagreeable, and even danger- ous phenomena may present themselves, when least expeeted. Many such cases have been recorded ; — the disagreeable effects being chiefly, — vomiting, especially when the inhalation has been used soon after eating ; headache, continuing for several hours ; hysteric or tetanic convulsions, and formidable depression of the heart's action. The ordinary effects are described by Dr. Chris- tison 11 as follows: — When inhaled in the dose of twenty or thirty minims from a handkerchief, it speedily occasions whizzing and pulsation in the head ; a change in the apparent colour of objects ; pleasurable ideas and visions; loss of consciousness, or a semi- conscious state, and either soft sleep, or tendency to laughter and jocularity, or propensity to incoherent talking, or boisterous tur- bulence ; and when this state passes off, which happens in five or six minutes at most, there is little or no recollection of what has passed, and no remembrance of pain, even although pain may have I Monthly Journal of Med. Science, Dec. 1847. 3 Lancet, Feb. 12, 1848, and May 13, 1848. 3 Comptes rendus, p. 802. * Ibid. 5 Bulletin des Academies. 6 Comptes rendus, Nov. 29, 1847. II Comptes rendus, p. 803. 8 Ibid. p. 806. See, also, Amer. Journ. of the Med. Sciences, July, 1848, p. 227. 9 Lond. Med. Caz., Feb. 1848. 10 Bouchardat, Annuaire de Therapeutique. pour 1850, p. 38. 11 Dispensatory,| Amer. edit, by R. E. Griffith, p. 975, Philad. 1848. See, also, a let- ter from Dr. Christison to M. Dumas, in Bouchardat, Annuaire de Therapeutique, pour 1849, p. 76. CHLOROFORMUM. 201 been expressed. These phenomena closely resemble in nature and variety the effects of the inhalation of nitrous oxide gas. The effect on the heart's action is variable. The most frequent devia- tion, witnessed by Dr. Christison, is, some increase in the frequency and diminution in the force of the pulse; but often no distinct change takes place, and occasionally the pulse is strengthened. When a dose of a fluidram or more is inhaled in the same man- ner, the most frequent effect is the rapid induction of coma, with complete relaxation of the muscles; slow and often stertorous breathing; upturning and fixing of the eyes, and total insensibility to agents which cause, in ordinary circumstances, the most acute suffering. The pupils are variously affected, but always contractile. Frothing at the mouth is not unusual. Slight convulsive twitches of the face and limbs are more rare. The insensibility may begin in fifteen seconds, and is rarely postponed beyond two minutes, if the chloroform be skilfully applied. It continues usually between five and ten minutes, but sometimes for two hours, if the inhala- tion has been kept up for some time by renewing the chloroform on the handkerchief. Sometimes quiet sleep succeeds; more generally a drowsy, dreamy state, but not unfrequently rapid, complete con- sciousness and activity. In general, no recollection is retained of any occurrence during the state of insensibility. For the most part, there is no remarkable subsequent effect ; no lassitude ; no headache; no sickness; no loss of appetite; but occasionally there is a little weariness or sickness. Such is the statement of one who is partial to the administration of chloroform. He admits, however, that other results have been observed, which he regards as anomalies, depending upon consti- tutional peculiarities or impurities in the chloroform. t "I have witnessed," he remarks, "violent tetanic spasm twice in the healthy state ; and once in delirium tremens, but without any ill conse- quence : hysteric agitations, contortions, and screaming, have also been witnessed, but without any ultimate harm ; and during both of these affections there has been no recollection afterwards of any uneasiness. Sickness and vomiting have sometimes occurred, chiefly, according to my observation, when "the remedy w T as used too continuously so as greatly to obstruct the breathing. Relaxa- tion of the sphincters is an untoward accident, which is not so frequent as might be expected. The only really formidable affec- tion is sinking of the pulse, as in the case adverted to above ; and this seems a rare occurrence." It is undoubted, however, that unpleasant and even alarming phenomena have been produced by it in the experience of Mr. Beales, 1 Mr. R. Stewart, 2 Mr. W. W. Gull, 3 Dr. Mitchell, 4 Dr. 1 Lond. Med. Gaz., Dec. 24, 1847. 2 ibid. Jar]> 184a 3 Ibid> Dec# 1847# 4 Ibid. Jan. 1848, from Dublin Med. Press, 202 CHLOROFORMUM. Nevins, 1 Dr. Reed, 2 Mr. Tomes, Dr. Webster, 3 (insanity induced,) Dr. John Snow, 4 Dr. C. H. Cragin, 5 M. Michon, 6 Delarue, 7 and others, and fatal cases ascribed to its deleterious agency have been recorded by Mr. Meggison, 8 Dr. R. Jamieson, 9 Mr. Robinson, 10 M. Gorre, 11 Dr. Anderson, 12 M. Robert, 13 R. O. Johnston, 14 M. Confevron, 15 and others. 16 According to M. Gruby, during the inspiration of chloroform, the arterial blood retains its florid hue, and if, under asphyxia, it assumes the dark venous character, the red colour is speedily restored ; yet by others 17 a highly venous appearance of the blood issuing from the arteries has been noticed; and M. Robin 18 ascribes the anaesthesia induced by it and ether to their preventing the com- plete conversion of venous into arterial blood. Like ether, chlo- roform is capable of inducing local anaesthesia, 19 by dipping the part in it, or applying it externally by means of lint, — a fact, which was noticed before it was employed as an anaesthetic in the way of inhalation, and led to its use as a local agent by Mr. Tuson and others. Its influence in deadening the sensibility of a part has been recorded also by M. Gruby, 20 Mr. Nunnely, 21 Dr. Simp- son, 22 Mr. Spry, 23 M. Jules Roux, 24 Mr. Higginson 25 and others. No sooner were the anaesthetic properties promulgated by Prof. Simpson than it was employed in all the cases in which the inhala- tion of ether had been prescribed. It w 7 as given in the various Neuroses. In I Lond. Med. Gazette, Mar. .1848. 2 Lancet, April 29, 1848. 8 Lond. Med. Gazette, Jan. 1850, and Psychological Journal, April, 1850. 4 Edin. Med. and Surg. Journal, cited in Amer. Journ. of the Med. Sciences, July, 1850, p. 169. 8 Med. Examiner. April, 1848, p. 223. 6 Archives Generates de Medecine, Juillet, 1850, p. 370. 'Ibid. Sept. 1850, p. 105. 8 Med. Times, Feb. 5, 1848. 9 Lond. Med. Gaz., Feb. 26, 1848. 10 Medical Times, cited in Ranking's Half-yearly Abstract, Amer. edit. viii. 220, Philad. 1848. II Lancet, July 4, 1848. See a fatal case, occurring in Cincinnati, in Western Lan- cet, Mar. 1848; and another at Hyderabad, in Scinde, in ibid., July 22, 1848. n Ibid. 13 Cited in Medical Times, July 22, 1848. 14 Provincial Medical and Surgical Journal, July 26, 1848. 14 Cited in Lancet, Nov. 17, 1849. 16 Lond. Med. Gazette, Jan.- 1849. See, on the injurious and fatal effects of chloroform, J. C. Warren, Amer. Journ. of the Med. Sciences, April, 1849, p. 379; and Effects of Chloroform and of strong Chloric Ether, as narcotic agents, Boston, 1849; Dr. Snow and others, in Amer. Journal of the Med. Sciences, July, 1849, pp. 274-278; also, a Dis- cussion before the Academy of Medicine of Paris, on the action of Chloroform, by MM. Malgaigne, Amussat and Guerin, cited in Med. Times, Nov. 25, and Dec. 2, 1848, and Lancet, Feb. 2, 1849; and in Bouchardat, Annuaire de Therapeutique, pour 1849, p. 90. 11 Provincial Med and Surg. Journ., Feb. 9, 1848. 18 Archives Generales de Medecine, Fevrier, 1850, p. 238. 19 Boston Med. and Surg. Journal, April, 1848. 20 Lond. Med. Gazette, Dec. 24, 1847. 21 Provincial Medical and Surgical Journal, June 28, 1848. 23 Monthly Journal of Med. Science, 1847-48, p. 451. 93 Provincial Medical and Surgical Journal, Aug. 28, 1848. M Gazette des Hopitaux, 7 Nov., 1848. 2* Lond. Med. Gazette, Jan. 1849. CHLOROFORMUM. 203 Tetanus, successful cases were recorded by Mr. Geo. Sloman, 1 Mr. R. L. Baker 3 and Dr. E. H. Clarke. 3 M. Forget 4 and M.Jules Roux 5 refer to seven cases of cure, against six of want of success. Dr. C. A. Worthington 6 has reported a case in which it afforded great relief, but did not prevent the fatal termination. Hydrophobia. One case of this almost intractable malady has been recorded in which it was successful; and others 7 in which it greatly relieved the intense suffering from the spasms; but on the other hand, in a case by Mr. S. B. Denton 8 it augmented them. A case of hydrophobic mania was treated happily with it by Mr. R. Y. Ackerley; 9 and one of presumed hydrophobia, under the care of Professor Jackson 10 of Philadelphia, is reported as having been cured by it. Dr. Jackson inclines to the belief that the case was one of true hydrophobia ; but the published details do not lead the author to the same conclusion. In Neuralgia, it was prescribed w 7 ith advantage, by Dr. Protheroe Smith, Mr. Sibson 11 Dr. D. Brainard, 12 and others; and in Chorea, by Mr. Harris 13 and Mr. Sibson. 14 In delirium tremens, by Dr. P. Smith; and it was used with great success in inducing sleep, by Dr. Joseph Parrish 15 and Dr. Whiting. 18 Insanity. Dr. M'Gavin 17 and Dr. E. B. Moore' 8 found it an excellent sedative and hypnotic; and in sick headache, Dr. P„ Smith prescribed it with advantage. It was also given with great benefit in typhus, as a sedative and hypnotic, by Dr.Fairbrother, 19 in Asthma, by Mr. Chandler, 20 Mr. Greenhalgh, 21 and Dr. Cra- gin; 22 in Hooping cough, by Dr. Protheroe Smith; in Colic, by the same gentleman, and by Dr. Cragin; 23 in Nephritic colic, by Drs. Bowditch and A. Stille; 24 in 1 Provincial Med. and Surg. Journ., Sept. 5, 1849. 2 Ibid., May 31, 1848, and Lancet, June 3, 1848. 3 Amer. Journ. of the Med. Sciences, July, 1849, p. 75. 4 Cited in Canstatt und Eisenmann's Jahresbericht, u. s. w. ira Jahre, 1849, v, 190, Erlangen, 1850, I 5 Revue Medico-Chirurg. Nov. 1848, cited in Bouchardat,Annuaire de Therapeutique, pour 1849, p. 101. 6 Provinc. Med. and Sur^. Journ., April 19, 1848. I Rankings Half Yearly Abstract, &c, viii. 212, Amer. edit., Philad. 1848, and T. T. Smiley, Med. Examiner, April, 1848, p. 223. 8 Provincial Med. and Surg. Journ., Oct. 31, 1849. 9 Lancet, July 29, 1848. 10 Transactions of the College of Physicians of Philadelphia for January and April, 1849. » London Med. Gazette, March 31, 1848. 13 North- Western Med. and Surg. Journal, Sept. 1849. 23 Lancet, June 3, 1848. 14 London Med. Gaz., Feb. 4, 1848. 15 New Jersey Medical Reporter, July, 1848. 16 Ohio Med. and Surg. Journ,, March, 1849, See, also, Zeitschrift filr die Gesammt. Medicin, April, 1850, No. 4, S, 553, II Report of Montrose Asylum, 1848, cited in Monthly Journal of Med. Sci., Oct. 1848. 18 Boston Med. and Surg. Journal, April 4, 1849. 19 Lancet, Jan. 28, 1848. M Provinc. Med. and Surg. Journal, Jan. 29, 1848. 21 Lancet, Dec. 4, 1847. <*> Medical Examiner, April, 1848, p. 227. 9J Ibid. 24 Transactions of the College of Physicians of Philadelphia, vol. ii. No. 6. 204 CHLOROFORMUM. Biliary calculus, by Dr. P. Smith; in Dysmenorrhea, by the same gentleman, and by Drs. J. H. Bennett 1 and Dr. Withers; 2 in Bronchitis, by Mr. Brown; 3 in Cholera morbus, it has been employed successfully by Mr. Brady and Mr. Plummer; 4 and in Cholera, by Dr. James Hill, Dr. Ferguson, 5 and Dr. A. Bour- nonville. R With others, however, as Dr. W. Robertson, 7 it has only succeeded in relieving the distressing cramps. Lastly, in Feigned diseases, it has been used in the way of detection ; but the same objections apply to it as to other anesthetics. (See page 71.) In regard to the employment of the inhalation of chloroform as an anaesthetic in surgical operations, the same remarks are appli- cable as were made on sulphuric ether. Wherever a powerful anaesthetic, anodyne and relaxant was needed, chloroform has been had recourse to, and the highest testimonials have been brought forward in its favour by the most distinguished surgeons of all countries. On this side the Atlantic, ether inhalation is, perhaps, more employed, and is generally considered safer; but there are many who prefer chloroform. 8 In obstetrical practice it has been largely administered; and the same objections have been urged against its employment in a natural process, as in the case of sulphuric ether. 9 Since its first introduction by Dr. Simpson, it has been extensively used in Edinburgh, to subdue the sufferings of childbearing; and it is impossible to extol any agent more highly than it has been. " Its effect," says Dr. Christison, 10 " is perfect, and may be maintained uninterruptedly for many hours, without influencing the frequency or force of the uterine contractions, and without any eventual harm. It is only when the deepest coma, with suffocative stertor, is brought on, that the uterine contractions are apt to be arrested for a time; — a property which may be taken advantage of to facilitate the operation of turning." From a careful and dispassionate inquiry into its effects in such cases, Dr. Murphy 11 is of opinion, that it does not interfere with 1 Lancet, Feb. 19, 1848. 2 Western Journal of Med. and Surg., Feb. 1849. 3 Lancet, Dec. 4, 1S47. 4 London Med. Gazette, Sept. 16, 1848. 5 Dublin Med. Press, Nov. 8 and 18, 1848. 6 Medical Examiner, Aug. 1849. * Monthly Journal of Med. Science, Dec. 1848. I On the Value of Anaesthetics, and especially of Chloroform in Surgery. See Sur- gical Experience of Chloroform, by James Miller, F.R.S.E. Edinburgh, 1848. Prof. Lizars, Med. Gazette, June 8, 1849, and the Reports of the Committees on Surgery in Transactions of the American Medical Association, vols. Land hi. Philad. 1848-50. s See page 72, and Banking's Half-yearly Abstract, vii. 252. American edition. Philad. 1848, for the views of Drs. Ranking, Simpson, Roland, Tyler, Smith, and others; and Ibid. viii. 241. Philad. 1849. 10 Dispensatory, edit. cit. p. 976. Philad. 1848. II Chloroform in the Practice of Midwifery, cited in Ranking, loc, cit., and Monthly Journal of Medical Science, Dec. 1849. CHLOROFORMUM. 205 the parturient action of the uterus, unless given in large and un- necessary doses ; — that it causes greater relaxation of the passages and perineum, and a greater secretion from the mucous membrane of the vagina; subdues nervous irritation, caused by severe pain; restores nervous energy ; secures the patient perfect repose for some hours after delivery, — and that its injurious effects, when an ordinary dose is given, seem to be dependent upon constitutional peculiarities or improper management. Its value in natural labour and operative midwifery has been deposed to by numerous observers; — by Mr. Brown, 1 Dr.Nevins, 3 Messrs. Clifford, Fearn, Wilson, M. Richet, 3 Dr. Protheroe Smith, 4 and by Drs. Keith, Moir, Malcolm, Thompson, Purdie, Cumming, and numerous others, cited by Dr. Simpson, 5 as well as by Dr. Denham, 6 Dr. Henry Bennett, 7 Dr. Geo. N. Burwell, 8 Dr. J. P. White, 9 Dr. Channing, 10 Dr. C. H. Cragin," Dr. Lindsly, 13 Dr. Beatty, 13 Dr. Trask, 14 and others. In labours complicated with puerperal convulsions, good effects have resulted from it in the practice of Mr. W. J. White, 15 Mr. Fearn, 16 Mr. Clifton, Dr. J. P. White, 17 Dr. Channing, 18 Dr. S. N. Harris, 19 Dr. Harding, 30 Dr. Keith, 21 and others. Dr. Ranking 22 has recently remarked, that if he may judge from the tenor of numerous private communications, there seems to be a growing indisposition, in England at least, to the employment of anaesthetics in natural labour, although he is not prepared to say, that the trouble attending the use of the agent has not some- thing to do with the objection. In instrumental and other forms of complicated labour, he believes they are still much employed by the leading accoucheurs of England; whilst, in Scotland, the withholding of them, even in natural labour, is almost the excep- » Lancet, Dec. 4, 1847. 2 London Med. Gazette, March, 1848. 3 Ranking's Half-yearly Abstract, vii. 255. Philad. 1848. * Lancet, Nov. 27, 1847. 8 Monthly Journal of Med. Science, October, 1848; and Ranking, op. cit., viii. 242. Philada. 1849. « Dublin Quart. Journal of Med. Science, Aug. 1849. 7 London Journal of Med., March, 1850. 8 Buffalo Med. Journal, Nov. 1848. 9 Ibid. Sept. 1848. 10 Dr. Parkman, Amer. Joum. of Med. Sci., July, 1849, p. 41. 11 Medical Examiner, April, 1848, p. 228. 12 Ibid. June, 1848, p. 340; and Report of the Committee of Obstetrics, Dr. Lindsly Chairman, in Trans of the Amer. Med. Association, i. 228, Philada. 1848, and Sup- plement, containing the favourable Testimony of Prof Channing, Dr. E. J. Marsh, Dr. J. C. Bennett, Dr. M. B, Wright, Dr. Moultrie, Dr. Gross, Dr. Jas. Stewart, &c; also, Rrport of the same Committee, Dr. Gilman, Chairman, in Transactions, &c, ii. 24 L Philad. 1849. 13 Dublin Quart. Journal of Med. Science, Aug. 1850, p. 341. * 4 Amer. Journal of the Med. Sciences, July, 1850, p. 341. 15 Lancet, March. 1848. Ie Lond. Medical Gazette, Feb. 11, 1848. " Buffalo Med. Journal, Sept., 1848. 18 A Treatise on Etherization in Childbirth, Boston, 1848. 19 Charleston Med. Journal, Sept., 1848. 20 Boston Med and Surg. Journal, Feb. 21, 1849. 21 Monthly Journal of Med. Science, August, 1850. 22 Half-yearly Abstract, &c, x. 266, Amer. edit Phila. 1850. 14 206 CHLOROFORMUM. tion. Dr. Rigby is satisfied, that a sufficient immunity from suf- fering may be attained without annihilating consciousness, and advises, that not more than ten or fifteen drops should be used at a time, by which the patient may have the sensations of pain much mitigated, and, at the same time, be perfectly conscious of its occurrence; and a similar view is entertained by Professor Lindsly, 1 of Washington, and by Professor T. E. Beatty, 2 of Dub- lin. It would appear, from the observations of Drs. Murphy and Beatty, that the first effect of a good dose of chloroform is to arrest uterine action for a short time, so that if the pains be slow and feeble, they may be more certainly interfered with; and to obviate this result, Dr. Beatty 3 associates with it ergot, which he has found to answer a valuable purpose. MODE OF ADMINISTRATION. The dose in which Mr. Tuson administers chloroform is from one to four or five drops; but others go as high as a tea-spoonful, diluted with water, or sugar and water, or mucilage. In neural- gic affections it appears to have given the greatest relief in the form of liniment, composed of linimentum saponis seu lini- mentum camphoras, f ^ij., chloroform, f gj., to be carefully rubbed over the affected part; or the chloroform may be applied by means of a rag wetted with it. As a wash, injection, and gargle, Mr. Tuson prescribed it di- luted with water, in the proportion of one or two drams to the pint; but as an application to the sound skin, it is generally used undiluted — being applied by means of lint or soft rags, covered with oiled silk to prevent evaporation. When employed un- diluted, it ought to be pure, as, according to Mialhe and others, when it contains absolute alcohol it acquires caustic properties, and excoriates the surface with which it is made to come in con- tact. Dr. Hayward, 4 indeed, ascribes such properties to the chlo- roform itself. The dose for inhalation is a fluidram at a time, which must be renewed in two minutes, if the desired effect be not induced. According to Dr. Christison, 5 there seems to be no limit to the safe repetition of it. Dr. Simpson has used eight fluidounces in thirteen hours, in a case of labour. The patient, he says, ex- periences least annoyance, and is least apt to show a precursory stage of excitement, when a full dose is used at once. Professor S. Jackson 6 has related the case of a lady, labouring under stricture of the upper portion of the rectum, with convulsions and peculiar spasms, who, by gradually increasing the quantity as the effects i Medical Examiner, June, 1848, p. 340. 2 Dublin Quarterly Journal of Med. Science, Aug. 1850, p. 6. 3 Ibid. p. 8. 4 Remarks on the Comparative Value of the different Anaesthetic Agents. Bost. 1850 6 Dispensatory, American edit., by R. E. Griffith, p. 977. Philad. 1848. 6 Transactions of the College of Physicians of Philadelphia, vol. ii. No. 6. CHLOROFORMUM. 207 diminished, inhaled, in the course of an evening, two ounces; then two ounces more, and another ounce in the course of the night — making five ounces, from 5 o'clock, p. m. until 10 o'clock the next morning. Dr. Jackson, having been sent for in consequence of the mother's alarm at the quantity of chloroform used, found her with a feeble pulse, diminished temperature of the body, and considerable mental excitement. She remained cold and nearly pulseless for forty-eight hours, when the effects disappeared. As in the case of the inhalation of sulphuric ether, various forms of apparatus have been invented for the inhalation of chloroform, some of which have been figured in another work. 1 They are all, however, admitted to be unnecessary. A small muslin or silk handkerchief, twisted into a hollow cone, or into the form of a bird's nest, moistened with chloroform, and held near the nose or mouth of the patient, is the arrangement adopted by Dr. Simpson, and most operators. In this way, a due admixture of atmospheric air may be insured, and the risk of apnosa avoided. When the effect produced is greater than is desired, the patient should be placed in the horizontal posture ; cold air be fanned across the face, and cold water be dashed or poured over the forehead and head. Ammonia may be inhaled; and, in more urgent cases, it has been advised, that the physician should blow into the mouth of the pa- tient for the purpose of artificial respiration, if no apparatus be at hand. It has been suggested, too, that it would not be an idle provision to have an electro-magnetic machine in operation. As soon as the patient is able to swallow, stimulants may be adminis- tered internally ; but under the apprehension that the respiration might otherwise be farther embarrassed, 2 it has been recommended that they should not be given until he has revived in some measure. 3 Like ether, chloroform vapour has been administered per anum by Pirogoff, Bromme, Korner, and Seifert. 4 Under the names concentrated chloric ether, and strong chloric ether, a compound of pure chloroform and nearly ab- solute alcohol, composed of one-third of the former to two-thirds of the latter has been employed by Dr. J. C.Warren 5 and others; but Dr. Bache 6 has properly suggested that, as the name chloric ether was originally applied by Dr. T. Thomson to the " Dutch liquid," or " chloride of olefiant gas," it would be well to abandon the appellation for either chloroform or its union with alcohol. Correct names, as he remarks, for the latter combination would 1 General Therapeutics and Mat. Med, 4th edit. i. 386, Philad. 1850. 2 C. H. Cragin, Med. Examiner, April, 1848, p. 227. 3 Christison, Dispensatory, p. 977. 4 Canstatt und Eisenmann's Jahresbericht, u. s. w. im Jahre 1849, v. 190, Erlansren, 1850, s Effects of Chloroform and of strong Chloric Ethsr, as narcotic agents. Boston, 1849. 6 The Dispensatory of the United States of America, 8th edit. p. 1245. Philad. 1849. 208 CHLOROFORMUM. be either alcoholic solution of chloroform, or tincture of chloro- form. By Dr. Warren, and others, this preparation has been regarded as safer than chloroform, and more agreeable than sulphuric ether; but if the unpleasant effects of chloroform be owing, as has been supposed by some, to its not being pure, it is not easy to see how the chloric ether can be safer than chloroform. 1 The preparation sold in London and elsewhere under the name "chloric ether," is said to be a weak tincture of chloroform, of variable quantity, con- taining at most but 16 or 18 per cent, of chloroform, and at times not more than 5 or 6 per cent. According to a Report of the Standing Committee on Surgery of the American Medical Association, of which Dr. Mussey was chairman, 2 there are two kinds of chloric ether — the chloric ether of commerce, consisting of one part of chloroform to fifteen of alcohol; the other, more concentrated, composed of chloroform one part, and alcohol nine parts — the latter, the one employed for anaesthetic purposes. It is a much weaker article than those above mentioned. Cases of the successful use of chloric ether, as an anaesthetic in surgical operations, are given by Dr. Warren; 3 and Dr. Channing 4 employed it successfully in obstetric practice. Dr. Hayward, 5 however, states that he cannot divest himself of the belief, that chloric ether is an unsafe anaesthetic, when he con- siders that it is simply chloroform diluted with alcohol. " It is true," he remarks, "that as far as we know, no fatal effects have hitherto followed its inhalation; but it is also true, that it has as yet been used to a very limited extent, and in all the cases in which it has been exhibited, that have come to my knowledge, it has been managed with great caution and judgment. But I fear, that if it be used with the same freedom that sulphuric ether is, we shall soon have to record some very different results. We cannot feel confident that it will always be confided to skilful hands only, nor by any means certain that death, when not looked for, may not follow its exhibition." When it comes in contact with the unprotected skin, it acts upon it — Dr. Hayward says — in the same manner as chloroform. He thinks, too, that it is more apt to induce disagreeable encepha- lic disorder than ether. ' Hayward, Remarks on the Comparative Value of different Anaesthetic Agents. Bos- ton, 1850. 2 The Transactions of the American Med. Association, iii. 323, Philad. 1850; and Amer. Journ. of the Med. Sciences, April, 1849, p. 379. 3 Op. cit. and Transactions of the Amer. Med. Association, iii. 385. 4 A Treatise on Etherization in Childbirth, illustrated by five hundred and eighty-one cases, Boston, 1848; and Dr. S. Parkman, Amer. Journ. of the Medical Sciences, July. J 849, p. 42. 6 Remarks on the Comparative Value of the different Anaesthetic Agents. Boston, 1850. CHLOROFORMUM. 209 A compound ether has also been employed, which consists of a solution of chloroform in sulphuric ether. It was formed on the suggestion that ether alone is too slow and uncertain, whilst chlo- roform itself is too rapid and hazardous in its effects ; and hence, the union of the two, it was conceived, might act more gradually and safely. Under its influence, amputations were performed by Dr. Cox at the Bellevue Hospital with favourable results. 1 Sulphuric ether, chloroform, and chloric ether, and compound ether are the anaesthetics most frequently employed ; and it may be interesting to state the preferences of different practitioners for one or other of them, as enumerated in the Report of the Standing Committee on Surgery of the American Medical Association, of which Dr. Mussey, of Cincinnati, was chairman. 2 Dr. Hayward, of Boston, expresses a strong preference for sulphuric ether. It is preferred, too, by Dr. Horner, of Philadelphia. Dr. J. C. War- ren, and his son, Dr. John Mason Warren, Professor Knight, of Yale College, and Dr. A. L. Pierson, of Salem, Massachusetts, employ chloric ether exclusively. Dr. D. M. Reese, of the Belle- vue Hospital, New York, uses a mixture of one part of chloroform with two parts of sulphuric ether, by weight; and when the pa- tient is less impressible, chloroform alone. Dr. Pope, of St. Louis, employs either chloroform alone or in combination with ether. Dr. Brainard, of Chicago, uses pure ether, or three parts of ether to one of chloroform. Dr. Washington L. Atlee, two parts of ether to one of chloroform, liquid measure. Dr. Howard, of Co- lumbus, Ohio ; Dr. Xwitchell, of New Hampshire ; Dr. Eve, of Augusta, Georgia, now of Louisville; Dr. Gross, of Louisville, now of New York; Dr. Shipman, of Syracuse, New York; Dr. Hamilton, of Buffalo, and Dr. Mussey, prefer chloroform ; and the last gentleman remarks, that were he to employ any other anae- sthetic than simple chloroform, he would select the mixture of it with ether — one measure to two, as employed by Dr. Atlee; as from several trials he has made, he thinks the pulse is rather better sustained than under chloroform alone. It appears then that each of these anaesthetics has its advocates; and, perhaps, under careful management no decided preference need exist. The vapours of sundry other substances — of chlorohydric and nitric ethers, of bisulphuret of carbon, of chloride of olefiant gas, of benzin, aldehyde, light coal tar naphtha? &c. &c, 1 Charming, a Treatise on Etherization in Childbirth, p. 30. Boston, 1848. 2 Transactions of the American Medical Association, iii. 323. Philad. 1850. 3 Professor Simpson, Monthly Journal of Medical Science, April, 1848. Bouchardat, Annuaire de Therapeutique pour 1849, p. 107— 11 1. H. J. Bigelow, Transactions of the Amer. Med. Association, i.197, Philad. 1848; and Report of the Committee on Surgery, Dr. N. R. Smith, chairman, Ibid. vol. 2, p. 213. Philad. 1849. 210 CHONDRUS. have been inhaled, and produced anaesthetic effects analogous to those of ether and chloroform, but they are not employed. 1 LIX. CHONDRUS. Synonymes. Fucus Crispus seu Irlandicus, Lichen Carrageen, Chondrus Crispus seu Polymorphus, Sphaerococcus Crispus, Ulva Crispa, Irish Moss, Carrageen, Carragaheen or Corigeen Moss. French. Mousse d ; Ir]ande, Mousse Perlee. German. Krauser Tang, Seetang, Carragaheenm oos, Ir- ian d i s c h Moos, Irlandisch Perl-oder Seemoos, Geperl- tes Seemoos, Krauser Knorpeltang. Although Carrageen or Irish moss has long been used in Ireland, it was but little employed in other parts of Europe, or in this country, until -within the last few years. Of late, it has been used precisely in those cases in which Lichen Islandicus or Iceland moss has been deemed appropriate. In Germany, the first trials were made with it in the year 1833, by Von Grafe of Berlin, and the results were given to the world in his report for that year, 3 of the Clinical, Surgical and Ophthalmic Institute, attached to the Frederick William University. Chondrus, which belongs to the Natural Family Algae, exists in the Atlantic Ocean, on the coasts of England, Ireland, western France, Spain, and Portugal, and as far as the tropics. It is also said to be a native of the United States. It is met with more abundantly, however, in Ireland, especially in Clare, where it is used by the poor as an article of diet. It is thrown on the shore by the waves, and is gathered at the time of the ebb. 3 Irish moss, when fresh, is of a purple-brown or purple-red colour, and somewhat resembles Iceland moss; but when dried, as we meet with it in commerce, it is mostly yellowish or dirty white, but intermixed with purplish-red particles, and resembles laminae of horn : it is crisped, translucent, and frequently contains small shells, calcareous concretions, and grains of sand. It has not much taste; the smell seems to betray iodine, which, however, has not been detected in it. When the moss is chewed, it feels like so much cartilage, but, by the moisture and warmth of the mouth, it soon loses its brittleness. It contains a little chloride of sodium. 4 The jelly obtained from it is transparent and colourless, its 1 Amer. Joum. of the Med. Sciences, April, 1849, p. 528. Nunnele)^, Provincial Med. and Surg. Joum. March 7, J 849. 2 Bericht Uber das klinisr.he chir. augen'arztliche Institut. der k. Friedr. Wilh. Univers. fur d. J. 1833. Berl. 1834. 3 Pereira, Elements of Materia Medica and Therapeutics, ii. 874. Lond. 1842; or 2d Amer. edit., by Carson. Philad. 184G. * E. Grafe in Art. Fucus. Encyclop'ad. Worterb.dermedicinischen Wissenschaft. xjii. S.l. Berlin, 1835. 'CHONDRUS. 211 taste is by no means disagreeable; it keeps several days, and is not converted by muriatic acid into mucus, like the jelly which is obtained from land plants. It exists in the proportion of 79.1 per cent., and has been considered to consist of pectin in large proportion, and starch; but Dr. Pereira 1 esteems it a peculiar principle, and gives it the name Carrageenin. It is easy of di- gestion, is readily borne by weak and irritable stomachs, and ex- erts a soothing influence on the air-passages and the intestinal canal. In order to obtain it, the moss is cut small, carefully cleared from impurities, boiled with the selected vehicle, and strained. Von Grafe obtained from nine ounces of milk boiled with half a dram of the moss, five ounces of jelly ; and as much from a dram and a half of the moss and twelve ounces of water. The formula, commonly used by him, is given below. To this jelly may be added any dietetic or remedial agent, which may be considered indicated in the particular case. 2 Chondrus is in the secondary list of the Pharmacopoeia of the United States, — cetraria in the primary; but the assignment ap- pears to be arbitrary, as one is perhaps as valuable an agent as the other. 3 EFFECTS ON THE ECONOMY. Chondrus is used in the affections that are considered to be benefited by Iceland moss. As a diet, it is given in consumptive cases, and wherever there is erethism in the respiratory or di- gestive apparatus. It is sometimes prescribed in diarrhoea, along with astringent or other remedies. The jelly has been ad- vised as a diet in scrofulous cases. Von Grafe affirms, that he has often found it serviceable in hoarseness, dry spasmodic cough, consumption, diarrhoea, and dysentery, in the intestinal pain which remains after inflammation and ulceration of these parts, and after poison has been taken; in diseases ac- companied by much emaciation, and in the prostration en- suing on serious diseases and operations. In similar affections it has been extolled by Hufeland. 4 On the other hand, Heyfelder affirms, that he, and many physicians of his acquaintance, have used the moss without either good or evil results in phthisis, as well as in erethism of the respiratory and digestive organs; and Riecke 5 remarks, that as it makes a very agreeable jelly, when boiled with milk, and with the addition of a little of the aqua lau- rocerasi, it may do for cases where we must prescribe " ut fecisse aliquid videamur." The truth is, that it can render no more service than other substances that contain a similar principle; and, 1 Op. cit. 2 L. Feuchtwanger, in Philad. Journ. of Pharm. vi. 204. Philad. 1833-4. 3 See the author's General Therapeutics and Mat. Med., 4th edit. i. 253. Philad. 1850. 4 Hufeland und Osann's Journ. der practisch. Heilkund. B. 77, St. 5, p. 135. & Die neuern Arzneirnittel. Stuttgart, 1837, S. 235. 212 CIMICIFUGA. accordingly, but, few prescribe it with any other view than as a demulcent and nutritious aliment in cases where such is needed. MODE OF ADMINISTRATION. Decoctum chondri. Decoction of Irish moss. R. Chondri (elect, et eoncis.) £ss. Adde Lact. Tecent. f ^ix. Coq. ad remanent, colatur. f gv. Sacchar. gss. ad ^j. Aq. amygdal. amar. concentr. ^j. To be taken in the course of the day. Von Grdfe. R. Chondr. (elect, et eoncis.) giss. Coq. cum aq. font, f ^xij. ad remanent, colat. f ^v. Syrup, rubi idaei f ^iss. ad f ^ij. Aq. amygd. amar. concentr. ^j. To be used through the day. When employed as diet, Von Grafe allows from ten to eighteen ounces of the jelly in the day. R. Chondr. (elect, et eoncis.) gss. Coque cum aq. font. q. s. ad reman, f t ^vj. Colatur. adde Sodse phosphat. £iss. Syrup opii f gij. ad f giij. Dose. — A spoonful every two hours in cases of haemoptysis, between the attacks. Clarus. R. Lactis f gxxiv. Chondr. (elect, et eoncis.) 9iv. Sacch. §j. Cinnam. cont. 7}]. Coque per minut. x. leni igne ; filtr. et exprime. BSral. R. Chondr. (elect, et eoncis.) gij. Coque cum lactis Oj. ad consist, gelatin. Tere cum Sacch. %\j. Amygdal. amar. No. 2. To be used in the course of the day, and daily. Hufeland. LX. CIMICIF'UGA. Synonymes. Cimicifuga Racemosa seu Serpentaria, Actaea Racemosa, Macrotrys Racemosa, Black Snake-root, Cohosh, Bugbane, Cohort. French. Actee, Herbe Saint Christophe. German. Traubenformiges Christophskraut, Schwa rze Klapperschlangenwurzel. This plant is a native of the United States, growing in shady and rocky woods from Canada to Florida. Sexual System, Polyandria Di-Pentagynia ; Natural Order, Ranunculaceae. The root is the part used in medicine. It yields its virtues to CIMICIFUGA. 213 boiling water, and was found by Mr. Tilghman, of Philadelphia. to contain gum, starch, sugar, resin, wax, fatty matter, tannic and gallic acids, a black colouring matter, a green colouring matter, lignin, and salts of potassa, lime, magnesia, and iron. 1 EFFECTS ON THE ECONOMY. Cimicifuga belongs to the class of acro-narcotics. Until re- cently, it is said to have been employed chiefly in domestic prac- tice, as a remedy in rheumatism, dropsy, hysteria, and in va- rious affections of the lungs, especially such as resemble con- sumption. 3 It is noticed here, however, chiefly in consequence of the encomiums that have been passed upon it, of late, as a remedy in chorea. Several cases of this disease, reported by Dr. Jesse Young to have been cured, were published some years ago; and at the same time it was stated, that Dr* Physick had known it prove successful in many instances. 3 Dr. Wood 4 also states, that he administered it in a case of chorea, which rapidly reco- vered under its use, after the failure of purgatives and metallic tonics. He also remarks, that he had derived the happiest effects from it in a case of convulsions, occurring periodically, and con- nected with uterine disorder. Dr. T. S. Kirkbride, 5 has pub- lished some cases of success, obtained in the same disease, from its administration, after free purging had been employed. In one successful case, in a girl, nine years old, whose mental faculties were much disordered, and who had lost nearly all power over both her left extremities, — there being, at the same time, irregularity of the bowels, headache, and pain frequently shooting down the left arm, cups were applied to the back of the head and neck once; stimulating pediluvia were prescribed, with friction with salt over the surface of the body, and she was mode- rately purged every day for a week before the Cimicifuga was begun with. Dr. Kirkbride refers to a very intractable case, that fell under the care of Dr. Otto, and that yielded ultimately to this drug. He always purges before he has recourse to it, and general frictions with salt or the flesh brush, and pustulation with croton oil over the spine, he believes to be of much value in chronic cases. Dr. Beadle of New York treated a case success- fully in a girl eighteen years of age. There was considerable gastric derangement, with suppression of the catamenia, for nearly five months, from pregnancy. She was put upon the use of Cimicifuga, five grains of the powder being given every three ' Journal of Philadelphia College of Pharmacy, vi. 20; and Wood, in Dispensatory of the United States, by Wood and Bache, Art. Cimicifuga. 2 F. J. Garden, Amer. Med. Recorder, Oct. 1823. 3 Amer. Journ. of the Med. Sciences, ix. 310. 4 Op. citat. 5 American Journal of the Medical Sciences, February, 1840, p. 289. 8 New York Journal of Medicine and Surgery, July, 1840, p. 191. See also C. C. Hildreth, Amer. Journ. of the Med. Science, Jan- 1843, p. 61; and F. J. Garden, Ibid, p. 247. 214 CIMICIFUGA. hours, and no other remedy except an occasional dose of sulphate of magnesia. There was little improvement in her condition during the day, for nearly a week, after which she improved rapidly and was well in three weeks. The medicine produced no sensible effect. Allusion has been made to the employment of Cirnicifuga in popular practice, in cases of rheumatism. Like other narcotico- acrids, when pushed so as to produce catharsis, and even slight narcosis, it may unquestionably be of service in acute forms of the disease. 1 Dr. F. 1ST. Johnson has, at different times, selected more than twenty cases of acute rheumatism, including the se- verest forms, and treated them with cirnicifuga for the purpose of testing its powers in that disease. The results were in the highest degree satisfactory, " every vestige of the disease disappearing in from two to eight or ten days, without inducing any sensible evacuation, or leaving behind a single bad symptom." These trials were repeated by Dr. Johnson, Dr. N. S. Davis, and others, until they had no more doubt of the efficacy of cirnicifuga in the early stages of acute rheumatism than they had of the power of vacci- nation as a preventive of variola! Dr. Johnson found the most acute and severe cases yield to its influence not only more speedily, but more perfectly, and with less danger of metastasis to other organs, than to any other form of treatment. 2 The author has always classed it among sedatives ; and the observations of Dr. Davis are in favour of this. In some parts of the country, cirnicifuga has become a very popular remedy in coughs ; and Dr. E. G. Wheeler 3 affirms, that he has found it useful in several cases of severe and protracted cough ; especially in the chronic cough or bronchitis of old peo- ple. Dr. Wheeler states farther, that by some eminent physi- cians, it has been thought to be a good substitute for ergot in parturition, being dissimilar, however, in its mode of action, — relaxing the parts, and thereby rendering labour short and easy. This, however, requires confirmation. It has been advised by Dr. C. C. Hildreth 4 in " acute phthisis, uncomplicated with much inflammation in the vesicular structure, or pulmonary mucous or serous membranes ;" who states, that he has " often seen the most prompt action of the decoction alone, in throwing off febrile excitement or the hectic paroxysm, allaying cough, reducing the rapidity and force of the pulse, and inducing gentle perspiration." "In those intercurrent congestions and 1 E. A. Anderson, and Alexander Vedder, in American Medical Intelligencer, vol. ii. p. 296, Philadelphia, 1839. Also, Boston Medical and Surgical Journal, Oct. 2, 1839, p. 126. a Report of the Committee on Indigenous Botany; Dr. N. S. Davis, Chairman; in Transactions of Amer. Med. Association, i , 353, Philad., 1848. 3 Boston Med. and Surg. Journal. Sept. 4, 1839, p. 65. 4 Amer. Journ. of the Med. Sciences, Oct. 1842, p. 288. CINCHONIA. 215 inflammations, so frequent in the second and third stages of phthisis, from atmospheric exposures," he states, that he has "often seen the same happy influence exerted ;" but the testimony in regard to its beneficial action in these cases is certainly wanting in precision. 1 MODE OF ADMINISTRATION. The dried root of cimicifuga may be given in powder. Dr. Kirkbride administered it in the dose of a tea-spoonful; and Dr. Wheeler in the dose of 5j. from three to five times a day. Dr. Davis recommends it in the dose of from thirty to sixty drops of the tincture, or twenty grains of the powder repeated every two hours " until its effects are manifest." It is most commonly 3 however, given in the form of the Dccoctum cimicifugSB. Decoction of black snake-root. R. Cimicifug. contus. ^j. Coque paulisper in Aquae Oj. Dose. — One or two fluidounces — two to four table-spoonfuls — several times a day. Tinctnra cimicifuga?. Tincture of black snake-root. R. Cimicifug. contus. ^iv. Alcohol. (.835,) Oj. Dose. — Twenty drops three or four times a day. An idea pre- vails, that the stronger the alcohol the better is the preparation ; but this may be questioned. LXI. CINCHONIA. Synonymes. Cinchonina, Cinchoninum, Cinchonin ; Cinchonine. French. Cinchonine. German. Cinchonin. Although Duncan, of Edinburgh, Reuss, of Moscow, and Gomez, 2 of Lisbon, had endeavoured to separate the active prin- ciple of the cinchonas, and had given the term cinchonine to a resinous extract obtained in their investigations, the honour of discovering both cinchonia and quinia, and of applying them to practical purposes, belongs to the French chemists — Pelletier and Caventou. 3 Cinchonia is commonly obtained from the gray or pale varieties 1 See the author's General Therapeutics and Mat. Med., 4th edit. ii. 196. Philad.1850. 2 Richter's Specielle Therapie, B.x. S. 325, Berlin, 1828; and Magendie's Forraulaire. 3 Annates de Chimie et de Physique, xv. 289 and 337. 216 CINCHONIA. of cinchona; the yellow furnishing the quinia, and the red both cinchonia and quinia. It is an alkaloid strikingly analogous to quinia in its chemical and medical relations, but is not as much used. METHOD OF PREPARING. Cinchonia is obtained by boiling cinchona in alcohol, until it loses all its bitterness; the alcoholic solution is then evaporated to dryness in a water bath; the extract, thus obtained, is dissolved in boiling water, strongly acidulated with muriatic acid; an excess of calcined magnesia is added, which, after a few minutes' boiling, will fix all the red colouring matter, and render the liquid clear. When cold, the liquid is filtered, and the magnesian pre- cipitate washed with cold water; it is then dried in a stove, and all the bitterness separated by repeated digestions in boiling alcohol; the alcoholic liquors are mixed, and the cinchonia crys- tallizes as the fluid cools. Cinchonia, thus obtained, still contains a green fatty matter, which may be separated by solution in a very weak acid. If the acid be too strong, it will dissolve a part of the fatty matter, and the intended object will thus be defeated. 1 Cinchonia may also be obtained by treating pulverized pale cinchona by weak sulphuric acid, precipitating the solution by means of lime in excess; collecting the precipitate on a filter, washing, and treating it, after drying, with boiling alcohol. 2 Cinchona is white, translucent, crystallizing in needles ; requiring, for its solution, 700 parts of cold water, according to Magendie; according to others, 2500 parts of boiling water. On account of its very sparing solubility in water it has but a slightly bitter taste. In alcohol, it is readily soluble, and the solution is extremely bitter, as well as the salts formed by its union with acids, which resemble the salts of quinia. It does not dissolve readily in fixed or vola- tile oils, or in ether. At a certain temperature, it volatilizes; a great part, indeed, is destroyed by the operation, yet a sensible portion escapes the decomposing power of the caloric. In medicine, pure cinchonia, as well as the sulphate and acetate, is prescribed. The sulphate is soluble in 54 parts of water, and in 6.5 parts of alcohol (s. g. .815:) it is not soluble in ether. It forms crystals and tastes bitter. The acetate, on the other hand, does not crystallize; and is less soluble in water than the sulphate; but an excess of acid facilitates the solution. EFFECTS ON THE ECONOMY. It is not necessary to say much on the application of cinchonia and its preparations to disease, as they have been almost wholly superseded by quinia and its salts. It is a weaker article, and 1 Magendie, Formulaire, &c. 2 Pharmacop6e Universelle, L 414, Paris, 1828.] CINCHONIA. 217 therefore requires to be given in larger closes ; Magendie and Git- termann assert that it has been found ineffective as an antiperiodic. Bally, 1 Chomel, 3 Mariana, 3 Wutzer, 4 and others, however, have exhibited it successfully. 5 Dufresne 6 frequently prescribed it, and he assigns it this claim to preference, that it is almost tasteless, or at least that the bitter taste is but tardily developed ; and that it need not be given in combination with acids, as the acid contained in the gastric secretions will render it soluble. 7 He gave it in intermit tents, during the apyrexia,in the quantity of from six to twenty grains, and found it of marked use in the cases of gastral- gia with formation of acid, which are so often met with in young females, and are not unfrequently associated with leucorrhcea, hypochondriasis, melancholy, &c. MODE OF ADMINISTRATION. The following formulae have been recommended, but, as before remarked, they are rarely used, the preparations of quinia being now almost universally prescribed. Sympns cinchonis. Syrup of cinchonia, R. Cinchonise sulphat. gr. xlviii. Syrup Oj. M. Used in the same cases as the Syrupus quinia ; a table-spoon- ful for a dose. Magendie, Vinum cinchonise. Wine of cinchonia. $L Cinchoniae sulphat. gr. xviij. Vini Maderens. Oij. M. Magendie. Tinctura cinchonioe. R. CinchonisB sulphat. gr. ix. Alcohol (34° or s. g. -847,) f gj. M. Magendie. Magendie recommends, that this tincture should be used for preparing, extemporaneously, wine of cinchonia, by adding two ounces of the tincture to a pint of Madeira wine. 1 Nouv. Biblioth. Medicate, ix. 189. -_ 2 Nouv. Joum. de Medecine, Mars, 1821. 3 Osservaz. sulla Pratica del Solfato de Cinconina, &c. 4 Rust und Casper's K rit. Repert. B. xxi. and Bulletin des Sciences Medic. Sept. 1827. * Art. Cinchonine, in Merat and de Lens, Diet, de Mat. Med. s Bibliotheque Universelle, Mai, 1831. p. 89. 1 See, also, Ganz, in Bulletino delle Scienze Mediche di Bologna, Agosto et Settembre. 1836, p. 121, 218 CODEIA. Boli cinchoniff, Boluses' of cinchonia. Boli antifebriles. Febrifuge boluses. R. Cinchonise sulphat. gr. iij. Micas panis, Mellis, Glycyrrhiz. aa. q. s. ut fiat bolus. Dose. — One, every two hours. Brera? Mistnra cinchonise. Mixture of cinchonia. R. CinchonisB sulphat. gr. vi. ad xlviij. Potassee acetat. Sacchar. aa. ^ss. Solve in Aquae anthemid. §vj. Dose.— A table-spoonful every two hours, in intermit tents. Sundelin. For the iodide and other preparations of cinchonia, see the cor- responding preparations of Quinia. LXII. CODEIA. Synonymes. Codeina, Codeinum ; Papaverinum, Codeine. French. Codeine. German. Kodein. Although opium had been repeatedly examined by the chemists, and certain of its active constituents separated from it, it was not until within the last twenty years, that the article, whose name is at the head of this paragraph, had been obtained from it. It was discovered by Robiquet in 1832, 2 and as it has been exhibited as a therapeutical agent, it requires notice. METHOD OF PREPARING. According to Winkler, 3 this new alkaloid may be prepared in the following manner. Morphia is first thrown down from a solu- tion of opium, made in the cold, by means of ammonia; the me- conic acid is precipitated by the chloride of calcium; for the re- moval of the colouring matter, the fluid is then treated with the extract or subacetale of lead; and the extract of lead, contained in the fluid poured off from the precipitates, is afterwards decom- posed by sulphuric acid; the fluid, separated from the sulphate 1 Ricettario Clinico di Brera. Padov. 1825. 2 Journal dc Pharmacie, xix. 91 and 162. Paris, 1833. 3 Buchner's Report, xlv. p. 459, cited in Journal de Pharmacie, xxi. 251. Paris, 1835. CODEIA. 219 of lead, is now treated with an excess of caustic alkali; the mix- ture is exposed to the air until the excess of free alkali has at- tracted carbonic acid from it: it is then agitated and digested with ether, and left to evaporate spontaneously, after which a yellow- ish, highly transparent, but not crystalline compound remains, which forms with muriatic acid a crystalline salt, and resembles exactly the codeia of Robiquet. Merck 1 procures codeia in a very simple manner. He treats morphia, precipitated by soda, with cold alcohol ; the spirituous tincture is carefully saturated with sulphuric acid; the alcohol drawn off, and the residue treated with cold water as long as it is turbid ; it is then filtered, and the filtered liquid evaporated un- til it has the consistence of syrup: on cooling, ether is poured over it in a large flask; caustic alkali is added in excess, and the whole strongly agitated. The ethereal mixture is then so sa- turated, that codeia crystallizes from it in a few hours. By eva- porating the ether, and treating the residue with alcohol, the co- deia is obtained, by degrees, wholly pure, and separated from an oily matter, which is a great obstacle to crystallization. Codeia, according to Pelletier, consists of 31 parts of carbon; 40 parts of hydrogen; 5 parts of oxygen, and 2 of nitrogen. It is an alkaloid, soluble in water, alcohol and ether; but not so in al- kaline solutions. It unites readily with acids, and, with the chlo- rohydric especially, forms a salt, which crystallizes with great fa- cility. When the crystals of codeia are heated on a plate of pla- tinum, they burn with a flame without leaving any residue. Heated in a tube, they melt at about 150° centigrade; and, if al- lowed to cool immediately, form a crystalline mass; if, however, the heat be continued, the oleaginous fluid rises along the sides of the tube, appearing to shun the heat; but it does not volatilize. When dissolved in water, codeia communicates to it decidedly al- kaline properties. 1000 parts of water at 60° Fahrenheit, dis- solve 12-6 parts of it; the same quantity at 100°, 37 parts, and at 212°, 58-8 parts. If more codeia be added to boiling water than can be taken up, the surplus melts, and forms, like meconin, an oleaginous layer on the bottom of the vessel. This aqueous solution, by careful refrigeration, affords a translucent and uncom- monly well defined metal. Tincture of galls forms a copious precipitate with a solution of codeia, in which respect, the latter differs essentially from morphia, as it does in many other of its properties, — as in being soluble in ether, but insoluble in a solution of potassa ; in not decomposing iodic acid, nor forming a red com- pound with nitric acid ; whilst it is not precipitated from the dilute solution of its salts by means of ammonia. 2 1 Journal de Pharmacia, cited in American Journal of Pharmacy, new series, i. 171 Philad. 1835. 2 Ballard and Garrod, Elements of Mat. Med. and Therap. p. 169. Lond. 1845. 220 CODEIA. EFFECTS ON THE ECONOMY. As morphia does not represent the whole of the activity of opium, Robiquet concluded, that other substances might concur therewith, and he conjectured that codeia might be one of them. Under this idea, Kunkel 1 instituted experiments with it on rabbits and dogs, from which he obtained the following results. First. Codeia dif- fers from morphia in this — that it does not, like the latter, paralyze the lower extremities. Secondly. It appears to exert a power- fully excitant action. It occasions convulsions of the limbs, and muscles of the neck, and when it produces death, this seems to be owing to its action on the cerebellum and medulla oblongata; twice, he noticed S3 r mptoms of backward progression under its use, and those parts after death were found turgid with blood. To judge from the condition of the heart and lungs, it affects likewise the circulatory organs. It occasions inflammation of the tissues, with which it comes in immediate contact. Its action is more ener- getic, when introduced into the areolar membrane, than into the stomach. It seems, also, to exhibit a special action on the urinary organs, for animals to w T hich it is given never evacuate their bladder as long as they are under its influence. Thirdly. Co- deia differs from the watery extract of opium, in not paralyzing the hinder extremities ; but it approximates it in this, that it acts, as has been said, more powerfully when introduced into the areolar membrane than into the stomach, and accelerates respira- tion and circulation. Kunkel, however, remarks upon the results of his experiments, that they demand repeated trials for confirma- tion, as he was only able to experiment with a very small quan- tity of the substance. Robiquet observes that Kunkel's experi- ments have led to the inference, that when codeia is combined with acids, it loses much of its efficacy — the very opposite, by the way, to the inferences of Magendie. Barbier 2 has taken considerable pains to fix the value of codeia as a remedial agent. He prescribed it in the dose of one or two grains in a syrup, prepared with the aqueous solution of the alka- loid, of such strength that a table-spoonful of half an ounce con- tained one grain of codeia. In his opinion, it exerts a peculiar agency on the nerves of the ganglionic system, whilst it appears to possess but little influence on the hemispheres of the brain, and to make no impression upon the spinal marrow. In the epigas- tric region, he remarks, its agency is powerfully manifested; and here in the centre of the ganglionic system, its effects may be investigated, and their extent and magnitude appreciated. If a spoonful, or, at an interval of from one to two hours, two spoonfuls of syrup of codeia be administered to one affected with the symptoms to be described immediately, it will be found, • Journal de Chimie Medicate, ix. 223. 3 Gazette Medicate, 8 Mars, 1834. CODEIA. 221 that it exhibits a considerable and remarkable effect upon the economy. If the person complains of pain in the epigastric re- gion, beneath the lower extremity of the sternum, and stretching to the sides and back; and if, with these symptoms, there is com- bined a feeling of heat, with indescribable anxiety, marked debili- ty, paleness, decided alteration of the features, a sense of painful traction sometimes on one side, at others on the other, of the epi- gastric region, with tendency to syncope, frequent sighing, de- spondency, and more or less sensibility to pressure in the epigas- tric region, &c, Barbier considers the seat of the disease to be the epigastric nervous plexus; and in such cases, he says, he has found no remedy superior to syrup of codeia. He has observed it afford decided relief, where the coats of the stomach were manifestly in a state of degeneration. A common effect of codeia is sleep : w T hich is never accompanied by heaviness of the head, nor by de- termination of blood to the brain. When the persons awake from the sleep produced by it, the countenance is bright and lively, and there is a tendency to laughter. Barbier was led to believe, that it does not affect the nervous cords connected with the ver- tebral portions of the centre of the nervous system. In his obser- vations at the hospital of Amiens, he often noticed the neuralgic affection of the abdomen above mentioned to be accompanied by pains in the head, loins, and limbs, and whilst codeia relieved the abdominal uneasiness, it left the others untouched, — a singular cir- cumstance, if true, but requiring fresh observation before we can esteem it to be established. He remarks farther, that almost all the patients who were benefited by codeia had used laudanum un- successfully. Codeia, he adds, occasions no manifest change in the circulation and respiration: it does not disturb the digestive function; seems merely to diminish the feeling of hunger, and oc- casions no constipation. During its use, itching of the surface is frequently experienced. When applied to the skin, it induces no striking phenomena. When placed, in the quantity of two grains, on a blistered surface, it excites a painful sensation of burning, without any other change, — the neuralgic pains, for the removal of which it may have been thus employed, not appearing to be modified by it. Dr. W. Gregory made experiments upon himself and some of his pupils with nitrate of codeia. None of them experienced any effect from a dose of three grains and under; from four to six grains, however, occasioned striking symptoms — quickness of pulse, sense of heat in the head and face, remarkable excitement, like that following the use of intoxicating liquors; agreeable, and apparently permanent, stimulation, accompanied by considerable itching, which began at the head and extended over the whole body. To this succeeded, in the course of a few hours, a dis- agreeable sense of relaxation, with nausea, and often vomiting. 15 222 CODEIA. None of the experimenters felt the slightest inclination to sleep, until after the feeling of relaxation. Riecke 1 thinks that these ex- periments confirm Kunkel's observations, that codeia loses its efficacy when combined with acids. In the year 1834, M. Martin Solon, at one of the sittings of the Academie Royale de Medecine, when the experiments of Barbier with codeia were the subject of discussion, confirmed his views regarding its soporific property. It appeared to him to allay the cough of the consumptive. He remarked, however, that he had not observed the effects on the ganglionic nervous system, which Barbier had witnessed. Magendie 2 took a grain of codeia, dissolved it in a little water, and injected it into the jugular vein of a middle-sized dog, which w T as immediately thrown into profound sleep — readily broken, however, by any strong noise made in the vicinity of the animal ; but the interruption was of brief duration, — sleep soon recurring. This condition persisted for several hours without being accom- panied by any unpleasant symptoms. The effect was not the same with the muriate of codeia: a single grain of this salt, introduced in the same manner into the organism, suddenly induced deep sleep; but, after the animal had slept five or six hours, it died. Several similar experiments afforded a like result. Magendie ad- ministered codeia in the Hotel Dieu to different patients. He found that one grain, given once or twice, succeeded, in many cases, in inducing a quiet and soft sleep, to which no confusion succeeded the next day, as is commonly the case with morphia. As respects intensity of action, he compares one grain of codeia with half a grain of morphia. Two grains often excited nausea, and even vomiting. Magendie found the muriate to be decidedly stronger than pure codeia. Two grains commonly induced, be- sides sleep, vertigo, nausea, and even vomiting ; but this dose suc- ceeded like a charm, in cases of neuralgia faciei and in sciatica, that had resisted the most valued agents. 3 Dr. Miranda, of the Havana, has published* the results of his experience with codeia in what he calls powerful nervous irrita- tions of the mucous membrane of the stomach, and he affirms, that he cured eleven cases by the syrup of codeia alone. He be- gan with a dram, night and morning, and gradually increased it to an ounce in the twenty-four hours. His success was so striking that he is induced to " regard the discovery of codeia to be fortu- nate for humanity, especially in climates like that of the Havana, in which gastrites are so multiplied." 1 Die neuem Arzncimittel, u. s. w. S. 1 If). Stottgart, 1837. 2 Fonnulaire pour la preparation et l'emploi de plusieurs nouveiux medicamens. Edit. 9me. Paris. 1836. * Gully's Translation of the 8th edit, of Magendie's Formulaire. Lond. 1835. * Journal de Pharmacie, xxiv. 145. Paris, 1838. COLCHICUM. 223 Sy ru p u s codeise. Syrup of codeia. This is directed by M. Cap 1 to be prepared in the following manner: — R. Codeise gr. xxiv. Aquae destillat. f giv. Sacchar. 3 viij. Reduce the codeia to an impalpable powder in a glass or por- celain mortar. Triturate with one-third of the water, allow it to settle and decant. Treat the residuum with another third of the water, and again with the remainder. Put the whole into a small mattrass, covering the opening with a piece of moistened parchment perforated with a pinhole. Heat in a water bath until the codeia has entirely disappeared. Remove the mattrass from the fire to add the sugar ; cover the opening again ; agitate, and put the vessel again in the bath, until the sugar is completely dissolved. Each ounce of the syrup contains two grains of codeia. M. Levrat, aine, 2 of Lyons, obtained excellent effects from the use of the syrup in the " ataxic form " of typhoid fever. He gave it to adults in the dose of two drams, and of one dram to a child. Muriate of Codeia has been used in this city, but it has not been found to possess any virtues which the salts of morphia do not; whilst its price has been enormous — as much, we are in- formed, as four dollars the dram. LXIII. COLCHICUM. Synonymes. Colchicum Autumnale, Meadow Saffron. French. Colchique, Tue-Chien ; Mort aux Chiens, Safran des Pres ; Safran Batard, VieilJotte. German. Herbstzeitlose , Zeitlose , Wiesensafran, Herbst- blume, Wilder Safran, Spin nblume. Meadow saffron is a well-known plant in the temperate parts of Europe, where it grows wild in moist meadows. It belongs to the Family ColchicaceaB: Melanthacese (Lindley;) and to Sexual System Hexandria Trigynia. It is avoided by cattle; and its active poisonous properties have been long known; fatal cases, indeed, still occur every now and then from its employment, not only in animals, but in consequence of its too free use in the treatment of gout. Reynolds, the inventor of the wine of Col- chicum, commonly called "Reynolds's Specific" is said to have killed himself by an overdose of it. A case is given of a man 1 Journal de Pharmacie, xxiii. 418. Paris, 1837. a Archives Generates de Medecine, Mai, 1847, p. 112. 224 COLCHICUM. who took, by mistake, an ounce and a half of the tincture, and died in forty-eight hours, after suffering much from vomit- ing, acute pain in the stomach, colic, purging, and delirium.' The cases of two children are also on record, who were poisoned by a handful of the seeds, and who died in the course of the day, death being preceded by violent vomiting and purging. Consi- derable redness of the mucous coat of the stomach and small in- testines was found: in other cases, no morbid appearance has been detected. 2 A fatal case has been published by Dr. Blumhardt, from the papers of Dr. Neubrandt. The patient, a man aged thirty-two, took, by mistake, a decoction made of a large table-spoonful of the seeds to three pints of water. He was soon afterwards attacked by vomiting, purging, and died two days afterwards under symp- toms of narcosis and endo-enteritis. Another fatal case, which was caused by the leaves, 3 is referred to in the same Journal; 4 and, more recently, one, from the administration of the tincture, has been published by Professor A. T. Thomson. 5 Colchicum is not of modern introduction. It is the Hermo- dactyl of the ancients. It had, however, almost wholly fallen into neglect, when its use was revived in Great Britain, in the first quarter of the present century, as an excellent agent in rheu- matic and gouty affections. That it is highly esteemed as a the- rapeutical agent, is shown by the number of officinal works into which it has been admitted: amongst others, the Pharmacopoeias of the United States, Austria, Amsterdam, and Anvers, and in the Batavian, Belgic, Brunswick, Danish, Dublin, Spanish, Edinburgh, Paris, Ferrara, Geneva, Hamburg, Hanoverian, London, Lisbon, Russian, Saxon, Swedish, and Wirtemberg. Several chemists have investigated the composition of the plant. Pelletier and Caventou believed, that they had found veratria in it; but, from the examinations of Geiger and Hesse, it appears that the alkaloid, discovered by those gentlemen, was not veratria, but a peculiar principle, colchicia or colchicine, which is found in every part of the plant; crystallizes in slender needles; is in- odorous, and of a very bitter, and, afterwards, biting taste. In- troduced into the nose, it does not occasion sneezing like veratria. It has a feeble alkaline reaction; but neutralizes acids completely, and forms with them crystallizable salts, which have also a bit- ter, pungent taste. It dissolves with tolerable facility in water. For therapeutical purposes, the root or bulb, (cormus,) as well 1 Edinb. Med. and Surg. Journal, xiv. 262. Q Christison on Poisons, 3d edit. p. 791. Edinb. 1836. 3 See a case of over-dose of Colchicum, by T. A. Henderson, in London Med. Gaz., Aug. 17. 1839, p . 763. 4 Medicinisches Correspondenzblalt, 1840, cited in Encyclographie des Sciences Medicales, Mai, 1840, p. 402. 5 London and Edinb. Monthly Journal of Med. Science, June, 1843, p. 537. COLCHICUM. 225 as the flowers and seeds, have been administered. The fresh root has a somewhat disagreeable smell, and a bitterish acrid taste. When chewed for any length of time, it excites the secretion of saliva and thirst; destroys the sense of feeling in the tongue; causes a sense of burning in the mouth and lips; constriction of the fauces, hiccup, violent pains in the abdomen, vomiting, diarrhoea, and discharge of blood upwards and downwards. By drying, the cormi lose somewhat of their efficacy. Dr. Houlton 1 recommends the following method to ensure their dry- ing spontaneously without being sliced. They are to be stripped of their loose, dry coats, and the bud or little bulb, the rudiment of the future plant, is to be carefully picked out. This part, ac- cording to him, has a high vital endow T ment; is very tenacious of life, and, unless removed, the cormi will not readily become dry: yet, when it is removed, and they are put in a dry place, they will dry without any trouble, and in a short time. The seeds have of late come much into use. They are inodo- rous, but of a very acrid taste. Their agency is like that of the bulb, and — some think — they are more equable in their effects. To ensure this, however, they must be gathered wholly ripe, when they first become entirely black. They have been highly recom- mended by Dr. Williams and others. The flowers are the mildest part of the plant. They have been successfully administered by several English physicians. EFFECTS ON THE ECONOMY IN HEALTH. In its effects, colchicum resembles digitalis in one thing, that it renders the pulse less frequent, 2 according to Thomson and Willis; but, in other, respects, Osann and Riecke 3 think it agrees more with squill. 4 In moderate doses, the different parts of the plant that have been mentioned act as diaphoretics, diuretics, and cathartics. On the digestive organs, they are conceived to pro- duce less debilitating effects than squill. Sir Everard Home ascribes much of the griping and nauseating effect which sometimes follows the use of the vinous and other tinc- tures of colchicum that have not been carefully filtered, to the sediment which forms in them, and which may be removed with- out injury to the desired effect of the medicine. 5 Sir C. Scuda- more, 6 however, found the sediment to be inert. Several experi- ments were made with colchicum on healthy individuals. In the first case, 160 drops of the vinous tincture of the seeds were taken 1 Pharmaceutical Transactions, July 1, 1844. 5 Art. Colchicum, Encyc. Worterb. der Med. Wissensch. viii. 136. Berlin, 1832. 3 Op. cit. S. 142. * See the author's General Therapeutics and Materia Medica, 4th edition, i. 290. Pfailada. 1850. 5 Brande's Dictionary of Materia Medica, p. 189. London, 1839. * Treatise on Gout, 3d edit. p. 513. 226 COLCHICUM. in 24 hours, by a young man aged 18; — the first dose being 50 drops, the last, 60. Seven copious evacuations were produced, with loss of appetite and debility for twenty-four hours. In the second case, a youth, 17 years old, took 170 drops in 9 hours, in doses of 70, 60, and 40 drops: nausea and vomiting, and six copious evacuations followed. Third case; a youth, aged lo, took 130 drops in 10 hours, in 4 doses; the first, of 40 drops, and, the last three, of 30; vomiting and only one evacuation were the result. Fourth case; a youth, aged 12, took 60 drops in two doses, after an interval of eight hours : nine copious watery evacuations were produced. Fifth case; a youth, aged 17, took 40 drops at bed- time, 30 drops next morning, and 30 drops seven hours after, — in all, 100 drops in 19 hours: vomiting and faintness, and five copious evacuations were the result. The same boy afterwards took 70 drops at one dose, which were followed by vomiting and headach, but not by purging. Sixth case; a boy, aged 10, took 80 drops in 24§ hours, in four doses, of 20, lo, 25, and 20 drops : great sickness and vomiting, and nine evacuations resulted. Dr. John Aldridge 1 states, that he has seen three cases in which profuse ptyalism followed the use of half a dram of the tincture of the seeds taken for some time thrice a day. In one of these cases at least, mercury had never been taken ; nor had the patient ever been salivated. They were' all cases of ophthalmia. EFFECTS ON THE ECONOMY IN DISEASE. The diseases in which colchicum is recommended, are as follows: In gouty and rheumatic cases, it has been supposed to be almost a specific. Numerous practitioners have testified to its valuable agency in such affections; among these, may be named Mr. Want, Dr. Johnson, Dr. Williams, Mr. Battley, Dr. Arm- strong, Sir Everard Home, Sir C. Scudamore, Mr. Haden, Dr. Copland, Dr. Graves, Sir Henry Halford, Dr. Wallis, Dr. Barlow, 2 Mr. W T igan, 3 Dr. Holland, 4 Dr. Gairdner, 5 Dr. Seymour, 6 and others in England; and Locher-Balber,' Kahleis, Gumpert, Plasse, Weber, Klokow, Biermann, &c, in Germany." Colchicum is pre- sumed to be the active ingredient of the celebrated gout remedy — Eau mtdicinale d' 'Husson — which has been considered to be formed of two ounces of colchicum root, macerated in eight ounces of sherry wine; the dose being from twenty to eighty drops. 1 Dublin Hospital Gazette, Oct. 1, 1S45; cited in Amer. Journal of the Medical Sciences, Jan. 1846, p. 2 15. 3 Art. Gout, in Cyclopaedia of Practical Medicine, Amer. edit. Philad. 1845. 3 Lancet and Med. Gaz., June 30, 1838. * Medical Notes and Reflections, 2d edit, p. 124, Lond. 1840. s On Gout; its History, its Causes, and its Cure. London, 1849. 6 Thoughts on the Nature and Treatment of several Severe Diseases of the Human Body, i. 93. London, 1847. 1 Riecke, Op. cit, and Richter's Specielle Therapie, x. 180. Berlin, 1828. COL CHI CUM. 227 Dr. R. B. Todd 1 considers colchicum to be chiefly applicable to the sthenic form of gout, which occurs in robust constitutions, and in the prime of life, and that it is almost inadmissible in per- sons advanced in years, who have had several attacks, and in whom the malady would seem to be too deeply rooted to be in- fluenced by the temporary administration of this remedy; and Dr. Seymour affirms, that " in gout, especially in gout originated from excess; in strong, violent, painful gout, it may be given not only without fear, in moderation, but with almost an absolute cer- tainty of relief, without any bad effects either immediately or remotely following its use." In acute rheumatism, as well as in various inflammatory affections, colchicum was proposed by the author's friend, Mr. Charles T. Haden, 3 as an excellent sedative to reduce excited organic action, which he conceived it capable of effecting to such an extent, that blood-letting might generally be rendered un- necessary in febrile and inflammatory disorders; 4 yet, in the very cases in which it was esteemed so appropriate by Mr. Haden and by Carminati, 5 it is regarded unadvisable by others. Thus, Riecke, 6 speaking of its use in acute rheumatism, says, that it was at one time given in that disease under the most opposite circumstances, but that it was soon found necessary to restrict its employment within, narrower limits, and to pretermit it when any considerable febrile condition existed. The author has often exhibited the different preparations of colchicum in gout, and, frequently, with decided advantage ; but very often it has failed altogether. In his own person, it has never appeared to prevent or to modify the paroxysm. In acute — and the same may be said of chronic — rheumatism, its advantages have not been by any means clearly marked in his experience: many .physicians, however, testify most strongly in its favour. Like other acro-narcotics, as the cimicifuga, when pushed to the extent of slightly affecting the system, as shown by nausea, with some cerebral confusion, it has, at times, effected a revulsion, which has broken in upon the morbid chain in acute rheumatism. A severe case, under the author's care, yielded rapidly to it when pushed to the extent of inducing painful diarrhoea, accompanied by distressing tenesmus. In this case, twenty-five drops of the tincture of the seed were given three times a day. When the bowels become affected, the remedy must be discontinued altoge- ther, or the quantity be diminished. By attending to these rules, Dr. Christison 7 affirms, that he has never had occasion to observe 1 Practical Remarks on Gout, Rheumatism, Fever, &c, p. 105. Lond. lb 43. 2 Op. cit p. 93. 3 Pract. Obs.on Colchicum Autumnale in Inflammatory Diseases. London, 1820. * See also Dr. Lewins, in Edinb. Med. and Surgical Journal, for April, 1837, or in Brit, and For. Med. Review, for Oct. 1837, p. 565. 5 Memor. dell' Instituto del Regno Lombardo-Venet. 1819. 8 Op. cit. S. 43. 1 Dispensatory, p. 355. Edinb. 1842. 228 C0LCH1CUM. any unpleasant effects from its use, or any symptoms which a dose of opium did not readily subdue. He adds, that he has never seen a case of rheumatism essentially benefited, till the patient suffered from colic and diarrhoea, on the one hand, or from frontal headach and giddiness, on the other. The ill success which some practitioners have encountered in using colchicum, he thinks,, may have arisen from inattention to this circumstance. In chronic rheumatism, it has exhibited less marked results; yet there is no agent, perhaps, which is so much employed in rheumatic cases in general. In none of these, according to most observers, need any sensible evacuation be produced by it, although some, it has been seen, have affirmed — and such is the result of the author's obser- vation — that it is more efficient when it evinces its influence upon the alimentary canal. 1 Such, too, is the experience of M. Monne- ret, 2 who found that the powerful revulsion on the bowels, caused by the tincture in the dose of one dram to four drams in the twenty-four hours, given in* one, two or four divided doses, was sufficient to suspend or remove the disease, — the improvement always coinciding with the diarrhoea; and Dr. Wigan 3 asserts, that he gives colchicum powder in rheumatic gout in the dose of eight grains every hour, until " active vomiting, profuse purging, or abundant perspiration takes place, or, at least, until the stomach can bear no more," and, when thus administered, he pronounces it to be "the most easily managed, the most universally applica- ble, the safest, and the most certain specific [?] in the whole compass of our opulent [London] pharmacopoeia." Yet, Dr. Upshur 4 has recently declared, that, in chronic rheumatism, he thinks he has sometimes derived great benefit from it, but, in the acute form, never. He adds, that it may be he has been " so un- fortunate as always to get hold of an inferior preparation," — a qualification which, however, applies equally to the results of his experience in the chronic form of the disease. Mr. Anthony White, 5 himself a sufferer from gout, relies ex- clusively on a combination of colchicum and calomel, according to the formula given hereafter. He is of opinion, that " the main object to be pursued towards the effectual cure of the gouty paroxysm, by the removal of its immediate cause, is the restora- tion of the natural functions of the liver, as indicated by a copious discharge of bile through the bowels." On the other hand, Dr. Gairdner 8 maintains, that colchicum never more effectually re- lieves the patient than when it acts silently and peacefully, with- out producing any evacuation whatever, or in any way disturbing the patient's comfort and ease. It has been demonstrated, by 1 See Wood and Bache's Dispensatory, Art. Colchicum; and Lewins, Op. citat. a Archives Generates de Med , Mar. 1844, cited in London Med. Gaz.. May, 1844. 3 London Med. Gaz. June 30, 18:18. 4 Medical Examiner, Oct 1850, p. 580. 1 London Medical Gazette, August 18, 1848. 6 Op. cit. COLCHICUM, 229 Drs. Douglas Maclagan, Chelius and Lewins, that it causes a more copious discharge of urea from the system, and Dr. Gairdner found, in repeated investigations, that the increase of urea was attended by a great diminution of the urates in the urine. The vinous tincture of the seeds has been extolled in the tetanus of warm climates, by Dr. W. G. Smith, 1 of Port-au- Prince. He begins with 3ss. and increases the dose every half hour, repeating it until emesis or catharsis has been produced. It is then discontinued. In dropsy, colchicnm was used of old with good results; and it has. been employed in modern times. Carminati gives the de- tails of a case of dropsy supervening on scarlatina, and Plasse, one of hydrothorax, in which it was advantageously prescribed. In such cases, it may be well to push the remedy until it affects the bowels. In chronic bronchitis, it has been given with ad- vantage by many physicians, and especially by Drs. Armstrong 2 and Hastings, 3 and Dr. Pereira 4 found it of great service in humoral asthma and other chronic bronchial affections, espe- cially when these complaints were accompanied with anasarcous swellings. By Drs. Eisenmann«and Ficinus, 5 the vinum colchici has been given in gonorrhoea. The latter prescribes from twenty- five to thirty drops three times a day, combined w T ith tinctura opii, low diet, the warm bath, &c. These means were attended with unprecedented success in the treatment of gonorrhoea and other inflammatory discharges from the urethra in the male, and from the vagina and uterus, in the female. By Ritton 6 it has been advised as an extremely efficacious remedy in leucorrhoza, in the dose of five grains of the powder three times a day; and in several spasmodic diseases it has been extolled by Raven. Tait 7 speaks in exalted terms of it in scar- latina — the dose, to children from four to six years of age, being three or four drops of the vinum colchici every three or four hours. Mr. Fosbroke advises it in ischuria; Elliotson saw favourable effects from it in obstinate prurigo; Bullock gave it in erysipelas; by Chisholm and Baumbach 8 it was exhibited success- fully against tape-wor?n, and Dr. Chapman 9 states that from ten drops of the tincture of the root repeated several times in the 1 American Journal of the Medical Sciences, for Nov. 1835, p. 66. 2 Pathology of Consumptive Diseases. London, 1822. 3 Inflammation of the Mucous Membrane of the Lungs, London, 1821. 4 Elements of Materia Medica, &c, ii. 947, London, 1843; or 2d Amer. edit, by Carson, Philad. 1846. 5 Casper's Wochenschrift, Aug. 26, 1848; cited in Lond. Med. Gazette. 6 Lancet, Aug. 2, 1844. 1 Amer. Journ. of the Medical Sciences, May, 1838, p. 205. 8 Rust's Magazin, B. xxi S. 270; and Osann, in Art. Colchicum, in Enc} T c. Wor- terb. der Medicin. Wissenschaft. B. viii. S. 136. Berlin, 1832. 9 Lectures on the more Important Diseases of the Thoracic and Abdominal Viscera, p. 2!J9. Philad. 1844. 230 COLCHICUM. twenty-four hours, and persisted in for some time, as much may be anticipated in functional constipation, with a view merely to the restoration of the lost susceptibility of the bowels, as from any thing else within his experience. He has rarely, indeed, seen it fail. Colchicum is sometimes applied externally as a liniment to rheumatic joints, in the form of the tincture of the seeds or bulb. 1 It has been recommended by Mr. Wansborough in gout f- two drams of the tincture of the seeds being added to f ^iv. of a spirit lotion. It is affirmed, however, that the local use of morphia had the same effect, 3 — the part being bathed in hot water for a minute, and then lint applied, spread w 7 ith simple cerate, on which about three grains of acetate of morphia were distributed. Mr. Laycock 4 has advised the tincture of the root as an exter- nal application in rheumatism^ alone or combined with tinctura camp horse. It was used in the author's Clinic at the Philadel- phia Hospital, and often with advantage ; but whether much, or any of the benefit was produced by the colchicum, he was unable to decide. MODE OF ADMINISTRATION. Colchicum is not so frequently given in substance, although it is often prescribed in this form. The dose of the powdered root is from three grains to ten, several times in the day. The offici- nal preparations of this country and Great Britain are : — acetum colchici (United States and London;) oxymel colchici (Dublin;) syrupus colchici (Edinburgh;) vinum colchici radicis (United States and London;) and extractum colchici aceticum (London;) than which, Dr. Holland 5 affirms, he knows no preparation more certain in effect, or better capable of fulfilling the peculiar pur- poses of the medicine. These are made from the bulb. The officinal preparations from the seeds are tinctura colchici seminis (United States and Dublin;) and vinum colchici seminis (United States.) The London Pharmacopoeia has likewise a spirit us seminis colchici ammoniatus or tinctura colchici composita, which is much used by the English physicians, and is formed by macerating tw 7 o ounces and a half of bruised colchi- cum seeds in a pint of aromatic spirit of ammonia. Mr. Bat- tley recommends an extractum colchici e succo bulborum re- center expresso, and such a preparation is in the Pharmacopoeia of Austria. The dose is two grains every two hours. Dr. A. T. Thomson recommends a saturated vinous tincture, made by macerating an ounce and a half of the driedbulb in twelve 1 Diet, de Matiere Medic, par MM. Merat and De Lens, ii. 361. Q Lancet. July 2!), 1837. 3 Ibid. Aug. 5, 1837. 4 London Medical Gazette. March 16, 1339, and June 8, 1839, p. 388. 5 Medical Notes and Reflections, 2d edition, p. 153. London, 1840. 5 Jourdan, Pharmacopee Universelle, i. 436. Paris, 1828. COLCHICUM. 231 ounces of white wine. From thirty to sixty minims are given to gouty patients when in pain. The dose of the powdered root or seed is, as w T as said, from three to ten grains; of the acetum colchici, from thirty minims to one fluidram; of the syrupus colchici, from one fluidram to half a fluidounce ; of the vinum colchici radicis, from fifteen minims to one and a half fiuidrams; and of the vinum colchici seminis from one to two fiuidrams. Dr. Copland 1 suggested the use of the fresh flowers in the form of vinegar, tincture, &c, as milder than the seeds or bulbs, and yet equally efficacious in rheumatic and other affections; but they are not employed. Haustus colchici et magnesise. R. Vin. rad. colchic. 9j. Magnesise 5ss. Mist, camphor, gx. M. Fiat haustus. To be taken twice a day in gout. Seymour. Mistura colchici. Mixture of colchicum. Scudamoreh mixture. R. Magnes. sulphat. gj. ad gij. Solve in Aquae menth. crisp, f ^x. Adde Acet. colchic. f 3J. ad f jfiss. Syrup, croc, f ^j. Magnes. gviij. M. To be well shaken. Three table-spoonfuls to be administered, so that from four to six evacuations may be produced in twenty- four hours. Given in paroxysms of gout. Sir C. Scudamore. Gnttae colchici composite. Compound drops of colchicum. R. Extract, aconit. 9j. ad gss. Solve in Vin. colchic. sem. f ^ss. M. Fifteen, twenty, thirty, or forty drops to be given three times a day. _ Weber. R. Tinctur. colchic. sem. guaiac. aa. f giij. M. Dose. — Thirty or forty drops three times a day in chronic rheu- matism. Blasius. R. Tinct. colchic. sem. digit, aa. f gij. Sp. sether. nitric, f gss. M. Dose. — Twenty drops, on sugar. Hildenbrand. 1 Lond. Med. Repos. 1823. 232 COLLODION. Pil nice colchici. Pills of colchicum. R. Colchic. pulv. gr. iij, Saponis q. s. ut fiat pilula. Dose. — Three daily, increasing the quantity to five or six. Ritton. Pilulec colcliici compositoe. Compound pills of colchicum. R. Extract, colchic. acet. gr. iij. Pulv. ipecac, corap. Ext. colocynth. comp. aa.gr. j— ij. M. et fiat pilula. In gout. Sir H. Halford. R. Ext. colchic. acet. Hydrarg. chlorid. mit. Aloes, aa. gr. j. Ipecac, pulv. gr. ij. M. Dose. — One every four hours in gout. Two or three are gene- rally enough " to produce a considerable disgorgement of the liver." This is assisted by one or two doses of compound decoction of aloes. A. White. Linimentum colchici et camphors. Liniment of colchicum and camphor. R. Tinctur. colchic. rad. ■ camphors, aa. partes aequales. M. haycock. LXIV. COLLO DION. Stnonfmes. — Collodium, Ethereal Solution of Gun Cotton. Professor Schonbein appears to have first shown the solubility of gun cotton in sulphuric ether. He states, that long before it was employed in this country, he had recommended for surgical use a fluid, which he termed, " liquor constringens " and u ether glue;" and that it had been employed in Switzerland three years previous to any notice of it in America. 1 Specimens of the solution were exhibited by Dr. C. F. Jackson before the Boston Society for Medical Improvement, in December, 1846, or January, 1847, to illustrate its use as a brilliant varnish. Soon afterwards, Dr. H. J. Bigelow 2 prepared a bottle of the solution according to Dr. Jackson's directions, and whilst employing it as a varnish, he accidentally smeared it on a fresh wound of the finger. The smarting that resulted drew his attention to the wound, and he immediately endeavoured to rub it off, but it had dried almost instantaneously, and remained on ; the smarting soon ceased, and 1 Lancet. Mar. 17, 1849. 3 Boston Medical and Surgical Journal. Mar. 22, 1848. COLLODION. 233 when the film was removed, union had taken place. Dr. Bigelow at once had recourse to it as a dressing for wounds, especially such as it is desirable to unite rapidly by the first intention. About the same time a young medical student, Mr. George P. Maynard, 1 of Boston, exhibited a similar liquid adhesive substance, which he had introduced as a substitute for the common adhesive plaster, over which it seemed to possess many advantages, and to be applicable to cases in which the latter is not; and in a letter to Dr. John D. Fisher, read before the Boston Society, Mr. Maynard 2 stated, that he had used the adhesive liquid, and seen it used by his preceptor, Dr. Whitney, in more than one hundred cases of surgery, some of them serious, — and in all successfully. Mr. May- nard appears to have first used it surgically in January, 1847 : and it was, in consequence, known for some time under the name of " Maynard'' 's adhesive liquid ;" but, subsequently, it received the name Collodion — from xo\\a, ' glue;' — by which it is now known. METHOD OF PREPARING. The formula generally adopted for the preparation of collodion is that of M. Mialhe. The plan recommended by Mr. Maynard was to treat cotton with nitric and sulphuric acids ; washing the substance thoroughly, and afterwards dissolving it inpure^/- phuric ether. Several French chemists, on repeating the process, failed to procure the cotton in a state in which it could be dissolved by ether, when M. Mialhe 3 ascertained, after many trials, that it was much more readily procured by using a mixture of nitrate of potassa and sulphuric acid. M. Mialhe's process is as follows : — Take of finely powdered nitrate of potassa 40 parts by weight ; concentrated sulphuric acid 60 parts, carded cotton, two parts. Mix the nitric with the sulphuric acid in a porcelain vessel ; add the cotton, and agitate the mass for three minutes by the aid of two glass rods. Wash the cotton, without first pressing it, in a large quantity of water, and when all acidity is removed, as indi- cated by litmus paper, press it firmly in a cloth. Pull it out into a loose mass, and dry it in a stove at a moderate heat. The compound, thus obtained, is not pure fulminating cotton — French, fulmicoton: it always retains a small quantity of sulphuric acid ; is less inflammable than gun cotton, and leaves a carbonaceous residue after explosion ; but it possesses, in a remarkable degree, solubility in ether, especially when mixed with a little alcohol. The collodion is made of this prepared cotton, 8 parts by weight ; rectified sulphuric ether, 125 parts ; and alcohol, 8 parts. The cotton is put with the ether into a well-stopped bottle, and the mixture is shaken for some minutes. The alcohol is added by 1 Amer. Journal of the Medical Sciences, April, 1848. 2 Boston Medical and Surgical Journal, Mar. 29, 1848. 3 Lond. Med. Gazette, cited in Amer. Journ. of Pharmacy, Jan., 1849, p. 42. 234 COLLODION. degrees, and the mixture is shaken until it acquires a syrupy con- sistence. It maybe then passed through a cloth, the residue be strongly pressed, and the liquid kept in a well-secured bottle. Other modes of preparing it are given by Mr. J.B.Edwards, 1 and by Messrs. Charles S. Rand 2 and Edward Parrish. 3 Gun cotton will also dissolve in equal parts of ether and alcohol, and form as adhesive a solution as that in ether alone. It of course dries more slowly, and whilst it may not be as well adapted for holding the edges of incised wounds together as the latter, it may be preferable in certain cases, — as an application to abraded surfaces, for example. Collodion has been used extensively by the surgeon as a reten- tive adhesive compound in all cases of solution of continuity, — either applied directly to the part, by being brushed over with a camel's hair pencil, or spread on strips of cotton. On ulcers and abraded surfaces — as in superficial burns it acts as an excitant; the ether evaporates, and a film is left, which protects them against the irritating and desiccative influence of the air. 4 It was sug- gested in burns by Dr. Payne, dentist, of Montreal ; and Dr. Craw- ford 5 of that city employed it successfully, and since then its utility- has been confirmed by others. 6 M. Briquet 7 used it successfully in a case of erysipelas of the abdomen; and Dr. J. W. Freer, 5 of Illi- nois, in an epidemic erysipelas, which prevailed there in the spring of 1839, applied it, by means of a feather, over the affected part. By Mr. Erasmus Wilson 9 it was prescribed in various cutaneous diseases, and with advantage, — for example, in chronic ery- thema of the face, intertrigo, chapped nipples and chapped hands ; herpes labialis, h. prxpulialis, and h. zoster; lichen agrius ; lupus non exedens, and l.exedens; acne vulgaris, and several affections of the sebiparous organs. In these cases, it has the same action as in burns ; and besides by its contraction, during the evaporation of the solvent, pressure is exerted on the part, which may be of essential service. As elsewhere remarked by the author, 10 in cases of acne and follicular affections of the skin in general, he has seen advantage from it. Occasionally, it has induced an inflammatory condition of the follicles, and at first seemed to aggravate the affection; but, subsequently, good has resulted from the modified nutrition induced. As a protect- 1 Lond. Pharmaceut. Journ.: cited in Amer. Journ. of Pharmacy, July, 1840, p. 233. ' 9 Amer. Journ. of Pharmacy, July, 184!). p. 209. 3 Ibid. October, 1849, p. 299. * For a summary of the surgical and other cases in which it had been until that time employed, see Bigelow and Maynard, op. cit., and Lond. Journ. of Medicine, Feb., 1849; or Rankings Half-yearly Abstract, Amer. edit, ix. 100, Philad., 1849. 'British Amer. Journ., Aug. 1848. s Lambert, Gazette Mcdicale de Lyon; cited in Bouchardat, Annuaire de Thera- peutique, pour 18 0. p. 241; and Liman in Casper's Wochenschrift, Juli 27, 1850. cited in Keller und Tiedemann's Nord Amerikanischer Monatsbericht fur Natur— und Heil- kunde, S. 188, Nov. 1850. 1 Bulletin de Therapeutique, xxxviii., 322 ; cited in Brit, and For. Medico-chirurg.. July, 1850, p. 275. * North Western Medical and Surgical Journal, Jan., 1850. 9 Lancet, Nov., 1848. 10 General Therapeutics and Mat. Med., 4th edit., i. 497, Philad., 1850. COLLODION. JoD ing, supporting and compressing agent, it appears to have been applied with advantage by M. Caballero 1 over a large aneurismal tumour of the subclavian artery; and Dr. Brainard 2 used it with advantage for the cure of erectile tumours (ncevi) without opera- tion. Dr. John Evans, 3 disheartened by the general want of suc- cess in preventing suppuration in mastitis, and satisfied that the most prominent indication of cure is to overcome the freedom with which blood is sent into the mamma, and by compression cause the absorption of the effused plasma, employed a coating of collodion to obtain the benefit of its contraction; and he affirms, that in no Case, except one, had the slightest suppuration supervened. In every one, the relief was prompt, and no inconvenience resulted in any, except the slight smarting caused by its application. Mr. Wilson, as well as others, found that the film left by the eva- poration of the solvent is liable to crack from want of elasti- city, and consequently to peel off, a defect which is remedied by combining a certain portion of oil with it : by this means, the film is sufficiently elastic to follow the motion of the part to which it is applied, without separating into flakes. A farther improve- ment was considered to be effected by giving the solution a flesh colour. The coloured solution has been called collodium tindum. Dr. Simpson 4 employed it with perfect success in some cases of painful fissures at the base of the nipple. Having brought to- gether the edges, he applied the collodion, which formed a protec- tion against all irritating influences, and permitted the child to suck. The healing process took place rapidly. Equally good effects in cases of sore nipple were obtained by Mr. Brown. 5 Dr. T. R. Mitchell 6 considers it superior in ulceration of the os and cervix uteri to nitrate of silver. It forms an artificial cover- ing to the ulcer, and permits the healing process to go on beneath. In cases of simple abrasion, three applications have proved suffi- cient; in more obstinate cases, he has employed caustics first, and then covered the eschar with collodion, and has in this way cured extensive ulcers in half the time required by other methods. He has likewise found it beneficial in inflammation of the vagina without ulceration. In cases of chancres, which have become clean, and are in process of reparation, H. Lippert has seen the cicatrization rapidly effected by the application of collodion, seve- ral times a day, by means of a camel's hair pencil. 7 In bleeding from leech bites, the hemorrhage was restrained by Mr. Tucker, 8 by compresses of lint dipped in collodion, and it 1 Wahu, Annuaire de Medeine et de Chirurgie pratiques, pour 1850, p. 215. 2 North Western Medical and Surgical Journal. Sept., 18491 3 Ibid., Sept., 1850. * Monthly Journal of Med. Science, July, 1849. 5 Lancet, Dec. 24, 1848. 6 Dublin Med. Press, Oct. 4, 1848. 7 Lancet, Dec. 9, 1848. 'Casper's Wochenschrift, 10 Febr.. 1850, No. 7, cited in Keller und Tiedemann, Op. cit., Dec, 1850, p. 221. 236 COLLODION. succeeded also with Mr. R. T. Wylde. 1 Dr. W. H. Ranking- ap- plied it advantageously with the same view in the incisions made in cupping. By Dr. Muirhead 3 it was employed with great benefit in bed sores: and by Dr. W. H. Ranking 1 it has been suggested as a valuable application to the face for the purpose of excluding the air, and preventing pitting in variola. Asa stopping for teeth, it was used by Mr. Ancell, and by Mr. J. Robinson, 5 dentist ; the latter of whom affirms, that he has frequently applied collodion in severe cases of toothache, arising from exposure of the nerve, with perfect success, where no persuasion could induce the patient to submit to extraction. By M. Hairion it has been employed to glue the eyelids to- gether, where it has been desirable, as in keratitis and conjuncti- vitis, to protect the inflamed surface from the contact of air, to prevent the movements of the eyelids over it, or to retain topical applications in contact with it. He usually applies it to the eyelids of one eye, and afterwards, if both eyes are diseased, to the other. The adhesion never continues longer than forty-eight hours. A little space may be left at the angle of the eye for the discharges from the inflamed surface to escape. In perverted states of the eyelids — as trichiasis, districhiasis, entropion, ectropion, &c, the ease wilh which the desired rectification can be secured renders it, M. Hairion considers, a most valuable palliative and even curative agent. In pharmacy, collodion has been employed as a coating for pills. The pill is placed on the point of a needle and dipped in the solution. M. Durden 7 employs one of the specific gravity .810, and two immersions are sufficient. Pills of # aloes and colo- cynth, thus coated, can be taken without the slightest taste of those nauseous articles being perceived. Cantharidal Collodion, Collodium vesicans seu canthari- dale ; French, Collodium cantharidal. Under this name, a vesi- cating agent has been proposed by M. Ilisch, 8 of St. Petersburg. It is prepared by exhausting, by the method of displacement, a pound of cantharides coarsely powdered, with a pound of sulphuric ether and three ounces of acetic ether. In this manner, a satu- rated solution of cantharides is obtained. In two ounces of this solution twenty-five grains of cotton powder are dissolved. It may be preserved unchanged in well-stopped bottles. 9 1 Lancet, Jan. 6, 1849. "Ibid., January 13, 1849. 3 Ibid.. Jan. 27. 1S49. « Op. cit. 5 Lancet, Dec. 30, 1848. •L'Union Medieale, Nov. 29 & 31 ; cited in Brit, and For. Medico-chirurg. Rev. July, 1649. : Bouchardat, Annuaire de Therapeutique, pour 1850, p. 243. * Canstatt und Eisemnann's Jahresbericht iiber die Fortschritte in der Heilkunde im Jahre IS4!>. S. 178. Erlangen, 1850, and Pharmaceutical Journal, Mar. 1, 1850, cited in Amer. Journ. of Pharmacy, July. 1850, p. 229. 9 Bouchardat, Annuaire de Therapeutique, pour 1850, p 101. COMPRESSIO. 237 Mr. Charles S. Rand, 1 of Philadelphia, who has made many experiments with this preparation, confirms the statements of M. Ilisch in its favour. Some improvements, he thinks, might be made in his formula. The proportion of cantharides is unneces- sarily large, a tincture made with double the amount of ether being found to vesicate with equal power. In employing M. Ilisch's preparation, it is sufficient to paint the part with a camel's hair pencil dipped in it; and if, after desiccation, which takes place in less than a minute, it appears that the skin is not entirely covered, the operation must be repeated. A more certain and rapid action is obtained, if the part be covered with a little lard or simple cerate. No longer time is required for the blister to be produced than in the case of the Emplastrum cantha- rides; and it has the advantage of not being disturbed by the movements of the patient. According to Mr. Rand, the contraction induced by it, as in the case of simple collodion, is a serious objection, — owing to its not only causing pain in the sensitive vesicated surface, but retarding the necessary action; but the addition of Venice turpentine to the amount of about one per cent, effectually obviates this, " and renders the preparation perfect." When the blister is formed, the film of collodion loosens, and, curling at the edges, may, by a slight effort, be detached without rupturing the membrane beneath., If it be simply painted upon the skin, and the ether be allowed to evaporate, vesication does not take place sooner than with the officinal plaster; but if immediately on its application a piece of oiled silk be bound upon the part, and suffered to remain an hour, so as to prevent rapid desiccation, a blister will be formed in three hours, sometimes more quickly ; and in one instance it formed in one hour. 2 The cantharidal collodion has been frequently employed, and has met with much favour. LXV. COMPRESSIO. Synonymes. Compression, Methodical Compression. German. Druck. This valuable method of modifying the condition of the capil- lary or intermediate system of vessels, and, through it, the function of nutrition, has become more extensively employed in the treat- ment of disease. As a sorbefacient, in various hypertrophies and dropsies, anasarca, ascites, ovarian dropsy, 3 chronic hydrocephalus, 4 1 Amer, Journ. of Pharmacy, Jan., 1850, p. 20. 2 Rand, Op. cit. 3 Mr. Isaac Brown, London Lancet, May 9, 1844, and April 5, 1845. 4 Hirsch, Casper's Wochenschrift, cited in Provincial Med. and Surg. Journ. April 29, 1843. Engelmann, cited from Gaz. Med. de Paris, Jan. 28, 1843, in Amer. Journ. oi the Med. Sciences, Oct. 1843, p. 458. 16 238 COMPRESSIO. &c, it has long been used wherever its agency was applicable, am' its effects have been decided. 1 Of late years, it has been proposed in inflammatory and other affections, in which it had been pre- viously esteemed inapplicable. Upwards of twenty years ago, it was highly recommended in rheumatic affections, by Dr. William Balfour, 3 of Edinburgh; and numerous cases were brought for- ward by him, and by others, to attest its efficacy. Since then, it has been advised by Guerin, 3 in the cases of phlegmonous erysipe- las of the extremities; by Velpeau, 4 in severe burns, and phlebitis, and in inflammation of the synovial apparatus ; 5 and Mr. James Allan 5 has related three cases of phlegmasia benefited by a simi- lar treatment — two were of erysipelas of the low 7 er extremities, and one of the face. In these, compression w T as of speedy and per- manent benefit — the pain caused by it being very transient. He states, moreover, that he has found the bandage of very great ser- vice in removing the pain and swelling of joints affected with acute rheumatism, after the more active degree of inflammation had passed away. In cases of external inflammation, compression acts probably in two ways, — first, by diminishing the circulation in the interme- diate system of vessels concerned in the pathological condition ; and, secondly, by restoring tone to the over-dilated vessels ; for it is in erysipelatous affections, in which this form of hyperemia more especially exists, that it has been found of greatest advantage. Numerous cases of erysipelas of the extremities have been treated by the author by compression, and with great benefit. He is con- stantly, also, in the habit of employing compression, under the cir- cumstances mentioned by Mr. Allan, in arthritic affections attended with great effusion, and with the most satisfactory results. From an observation of the good effects resulting from com- pression in analogous cases, it occurred to Dr. Fricke, 7 of Ham- burg, that it might be employed with advantage in cases of orchitis or swelled testicle (hernia humor alis ;) which is frequently very tedious, and requires means that are by no means easy of applica- tion. He, accordingly, had recourse to it, and the result w T as sa- tisfactory: he found, that " the disease could be removed by it in a simple, easy, and surprisingly rapid way." Dr. Fricke was not, 1 Clinique M^dicale de l'Hopital Neckar, p. 247. Paris, 1835; or the authors transla- tion in American Medical Library, first year. See, also, the author's General Therapeu- tics,^ 228, Philad. 1S36; or his General Therap. and Mat. Med. 4th edit. ii. 285, Philad. 1850; likewise, Morelli, Annali Universali di Medicin. Marzo, 1840, cited in Brit, and For. Med. Rev. Jan. 1841, p. 237. 3 A new mode of curing Rheumatism and Sprains without Debilitating. Edinb. IS 17. 3 Journ. Analvt. i. 90. 4 Ibid, and Bulletin General de Therapeutique, No. 16, Aoi\t 30, 1836. 5 Nouv. Bib. Med. Aout, 1826; and Merat and De Lens, Dict.de Mat Med., art, Compression. 6 British Annals of Medicine, Jan. 27, 1837 = 1 Zeitschrift filr die gesammt. Medicin. B. i. H. 1, Hamburg, 1836. See, also, Brit, and For. Med. Rev. for July, 1836, p. 253. COMPRESSIO. 239 however, the first to employ compression in this disease. It would seem, that as long ago as the year 1803, it was used at the Pennsylvania Hospital, by Dr. Physick, and by Dr. Hartshorne. 1 Dr. Fricke is of opinion, that, generally speaking, compression may be employed in every kind of inflammatory engorgement of the testicle, whatever may have been its cause, and at all stages of the disease. In many cases, the pain was, at first, in some degree, increased ; and in some, especially when applied too tightly, it in- duced great suffering; but this never continued long — the patient, in a short time, finding himself so much relieved as to be able to leave his bed and walk about the room. In many cases of recent origin, a single application of the compression was sufficient; but when the disease was of longer duration, say from three to eight days, it was found necessary to repeat it two or three times. Swelling of the spermatic cord, if not very considerable, did not contra-indicate its use; nor did other coexistent local affections, as buboes, ulcers, &c. When a general febrile state accompanied the orchitis, compression was found to be the best means for removing it, where the vascular action was not too considerable; although, in extremely rare cases, such a state was the effect of the com- pression itself. When the pain was very severe, it was generally owing to the compression having been too strong, and the same was the case with certain signs of gastric derangement, that occa- sionally supervened. In these cases, it was necessary to suspend the remedy until the derangement was removed by the use of an emetic, or the application of a poultice to the stomach. Such cases were, however, extremely unfrequent. The good effects exhibited themselves very soon after its employment, and the speedy abatement of the pain was always the surest sign of its effi- cacy. If it continued for some hours in any considerable degree, a general disorder of the system might be looked for to explain the failure of success. In the summer of 1835, Dr. Fricke treated, in this manner, seventeen cases. Of these were cured, in one day, one; in three days, four; in four days, two; in five days, three; in nine days, one: and in ten days, two. The last three were severe and unfa- vourable cases. For the purpose of compression, he employed sticking plaster, made very adhesive, but not of too irritating ma- terials, and spread on strips of linen, of the breadth of the thumb. No preparatory measures, as leeches, cataplasms, &c, are required. In slighter cases, the patient may stand before the surgeon, lean- ing against the wall, or he may sit on the edge of a bed or sofa, so that the scrotum may hang freely down. If the scrotum and neighbouring parts are much covered with hair, it must be removed ; but, generally speaking, this is unnecessary. 1 American Journal of the Med. Sciences, Jan. 1342, p. 258. 240 COMPRESSIO. The following is the method adopted by Dr. Fricke for apply- ing the compression : — The surgeon takes the scrotum in one hand, and separates the diseased from the sound testicle; whilst, with the other, he gently stretches the skin of the scrotum over the former. The spermatic cord is isolated in the same manner. If the swelling of the testicle be considerable, it must be held by an assistant. The surgeon now applies the first strip over the isolated spermatic cord, about a finger's breadth above the testicle,, holding the end of the strip with his thumb, and passing it round the cord. He proceeds in the same manner wdth the second strip, which must cover the former either in part or altogether. The first part of the process must be carefully done ; the strips must compress the cord closely; for this purpose, the cord must be kept approximated to the skin, which must be tightly stretched over it; otherwise, when the other extremity of the testicle is com- pressed, the upper end will be apt to slip upwards through the loose rings of adhesive plaster, which will not only occasion pain, but render the whole operation abortive. In this manner, the surgeon proceeds, applying strip after strip, the last always lying- over its precursor by a third of its width, until the thickest part of the testicle, where it begins rapidly to decrease in diameter, is reached. The mode of procedure is now changed — the surgeon lays hold of the part of the testicle already covered, and passes his strips longitudinally from above downwards over the lower portion of the testicle. In this w T ay, the rest of the testicle is closely enveloped and compressed. The proper degree of com- pression will be indicated, in most cases, by the speedy disappear- ance of the pain which had previously existed. When both testi- cles are affected, they must both be included in the circular strap- ping — the testicle already covered serving as a point of support for the other, as there is not room enough for the application of the circular strips over the second, in the same way as over the first. In some cases, w T here the skin is irritable, ulcerations take place: small slits may then be cut in the plaster, and a Goulard lotion be applied. Generally speaking, the patient may leave his bed immediately after the strapping has been attached, and walk about the room; and, w^here the inflammation has not been great., he may even attend to light labour out of doors. When the strap- ping becomes loose, it may have to be reapplied, but often one ap- plication is sufficient. In orchitis, caused by blow 7 s or pressure, compression is re- garded by Dr. Fricke as the best agent. If the inflammation runs very high, he usually applies leeches, in the first instance, and keeps on poultices for a day or two ; but, in slighter cases, he lias recourse immediately to compression. The principal advan- tages which he considers this mode of treating orchitis has over others, are : First. The speedy removal of the pain ; Secondly. COMPRESSIO. 241 The quick removal of the disease itself; Thirdly. The simplicity of the plan, and the slight trouble given thereby to the patient; Fourthly. Its small expense: and, Fifthly. The comparatively slight care and attendance required on the part of the surgeon. The last two points, as he properly remarks, are of considerable importance in hospital practice. Since this plan of treating orchitis was suggested by Fricke, it has been successfully employed by our hospital and other surgeons, although it has been by no means extensively adopted. Several cases, too, have been mentioned by M. Dechange, 1 of Liege, formerly chef declini que chirurgicale at the Hopital deBaviere. Of twelve cases of acute orchitis, thus treated, three were cured in three days; and the remainder before the seventh day. Mr. Langston Parker 2 has also extolled this remedy, not only in ordi- nary swelled testicle, but in chronic or subacute inflammation of the testes, whether dependent on syphilitic causes or not; and a more recent writer 3 affirms, that he has adopted the practice in many cases, and can speak most unequivocally in its praise. It may be employed, he remarks, in very acute forms ; and he has seen several instances, w>here the patients had not lain in bed an hour, "whilst under the ordinary antiphlogistic treatment they would have been confined from ten days to a fortnight." Methodical compression has been employed with advantage in mammary abscess ,by MM. Trousseau and Contour. 4 They found it frequently produce a cure when used at the commencement of the inflammation; relieve the pain when suppuration w T as esta- blished; and of great service after the abscess was emptied. The compression was made by means of strips of diachylon plaster, an inch broad, and several feet long, carried round the body, so as to produce regular compression of the whole breast. 5 M. Brachet, of Lyons, 6 has reported four cases of spermator- rhoea treated by compression of the prostate gland. He states, that pressure cannot be employed indiscriminately in every case; often, by removing the cause we can cure the disease ; but he thinks it will succeed in all cases of atony produced by venereal ex- cesses, onanism or blennorrhagia. The effects produced by compression are, in his opinion, of two kinds. In the first place it keeps the seminal fluid in its reservoirs, which are thus accustomed to its contact and enabled to retain it longer ; and in the second place, it modifies the condition of the urethra, prostate, and semi- nal excretory ducts. The bandage is composed of a w^aist-band 1 Bulletin Medical Beige, A out, 1838, p. 218. 3 London Lancet, July 25, 1840, p. 640. See also, J. Dixon, Lond. Lancet, Dec. 5, 1840. 3 Brit, and For. Med. Rev., Oct/1840, p. 393. 1 Journal des Conn a i nances Med. Chirurg., Fevrier, 1841. See, also, J. Bell, Lond. Med. Gaz., or Med. Intelligencer, Dec. 1841, p. 121. 5 See. also, Littre, Journal des Connaiss. Med. Chirurg., Janvier. 1S41. e Medical Times, May 24, 1845. 242 COMPRESSIO. of leather, the extremities of which unite on the abdomen : from its centre behind a strap descends, which, on reaching the genital organs, bifurcates, and is finally buckled in front to the cincture. On the descending strap a small cushion is placed opposite the part on which pressure has to be made. Dr. Batchelder, 1 of Utica, affirms, that he has been in the habit of using compression of the perineeum as a remedy in this affection for upwards of twenty years. Compression of the arteries, as an antiphlogistic agent, has been revived by Goyrand, Malapert, and others ; the object being to prevent the afflux of blood to a part labouring under hyperemia. The origin of this idea has been a matter of con- troversy; 2 but, as Dezeimeris 3 has remarked, it certainly is not due to the gentlemen who have engaged in it. Blaud compressed the carotid in brain fever; Autenrieth did the same, before Blaud, in cases of convulsions. Earl, in epilepsy; Livingston and Kellie, in rheumatism; Ludlow, in gout; and Parry, of Bath, half a century earlier, employed compression of the vessels in different diseases, with the clearest appreciation of its modus operandi. Compression of the carotids has been used by M. Strohlin 4 in hysteric convulsions, and has almost always succeeded in modi- fying the form of the attack. He used it in two cases of epilepsy with similar success. Compression of the carotids at the com- mencement of the paroxysm always caused them to cease in a minute afterwards. M. Allier 5 has published a case of intermittent neuralgia of the lobe of the right ear, cured by compression of the primitive carotid of the same side: half an hour before the paroxysm, the compression was exerted, with interruptions of five minutes every quarter of an hour. He has, also, reported a case of neuralgia of the orhito-frontal nerve; and, subsequently, of the nervus pudendus superior, respectively cured by compression of the carotid, and abdominal aorta. The compression of the carotid of the affected side was continued the whole forenoon, with pauses of five minutes every quarter of an hour. For the pudic neuralgia, the abdominal aorta was compressed for the space of three quar- ters of an hour: the neuralgia, in both instances, gradually ceased. M. Dufresne 6 has published a case of hemicrania and facial neuralgia of the right side, cured by the same means. Compres- sion of the right primitive carotid for ten seconds occasioned in- stantaneous disappearance of the pain, which returned in one minute after the removal of the pressure. Compression of the 1 New York Medical and Surgical Reporter, cited in St. Louis Med. and Surg. Journ., June, 1846, p. 43. 2 Gazette Medicate de Paris, No. 46, IS Nov., 1837, anl No. 47. a Ibid. * Archives General, de Medecine, Mars, 1811. 6 L'Experience, No. 16, 20 Jan., 1838. 6 Ibid. No. cxxviii. Dec. 1339. COMPRESSIO. 243 same vessel for twelve seconds also caused immediate cessation of the pain, but it shifted to the posterior part of the head. This pain ceased with the removal of the pressure, and in two minutes after- wards the original pain reappeared on the right side. When graduated compression was made on the same vessel for thirty seconds, the pain, as before, moved to the posterior and left part of the skull. M. Dufresne then pressed on the left carotid, and, increasing the force as he diminished that on the right side, the posterior pain disappeared, and no return of either had taken place ten minutes afterwards. The patient slept well and made no complaint of pain in the morning. The employment of compression of the epigastrium to arrest hiccup was recommended by Bordeu, but it had fallen into obli- vion. It has been revived, however, and was suggested to M. Rostan 1 by an old physician of Paris, whose wife was subject to attacks of hysteria, during which she suffered from incessant hiccup, and in which he had observed, that she experienced re- markable relief from strong compression on the epigastrium with the hand. Since then, M. Rostan has employed it in many cases of the same kind, and constantly with good effect, whatever might have been the cause of the hiccup. To render the pressure con- stant, he has employed a pad with a truss-spring as a substitute for the hand ; and M. Boyer 2 has recorded three cases of painful and obstinate hiccup instantly relieved by the same means. Compression of the abdominal aorta has been revived by M. Baudelocque, and many others, with the view of arresting uterine heyiiorrhage occurring in labour, as well as the hemorrhage which follows wounds of the arteries of the inferior half of the body? In a case of uterine hemorrhage, detailed by Dr. Ebrenreich,* external compression by the hand on the abdomen, which is the only way of acting on the aorta when any obstacle exists to the introduction of the hand into the uterus, was tried without suc- cess, owing to the thickness of the abdominal parietes. The he- morrhage was, however, completely controlled by introducing the entire right hand into the uterus, and making forcible pressure . with the ringers in a conical shape on the aorta immediately above its bifurcation. Many similar cases have been published and re- ferred to by M. Piedagnel, in a memoir communicated to the Socitte Medicate d? Emulation, of Paris, on which an excellent report was read by MM. Velpeau and Briere de Boismont, giving a history of the process. It is necessary at times that the com- pression should be continued for a considerable period, even for an 1 La Lancette FranQaise, 20 Fevr. 1847. 2 Revue M6dico-Chirurg. Juillet, 1847. 3 See an account of Baudelocque's views, by J. C. Christophers, in Lancet, July 20, 1 839, p. 599. l iMedicinische Zeitung, No. xxxvii. 1339, cited in British and Foreign Medical Re- view, July, 1840. p. 274. 244 COMPRESSIO. hour or two, should the case seem to require it. The gentlemen last cited advise that it should be associated with ergot. 1 The mode adopted by M. Seutin 2 for compressing the aorta in such cases is as follows. The woman is to be placed on a ho- rizontal plane, with the head and shoulders raised, and the thighs flexed upon the pelvis, in order to relax the abdominal muscles as much as possible, and to avoid mechanical engorgement of the uterine vessels. The surgeon, placed on the right side of the patient, uses the left hand to compress the vessel, keeping the right dis- engaged for any other purpose which the case may demand. The intestines being pushed on one side by gentle manipulation, the three fingers of the left hand are pressed firmly and deeply be- hind and to the left of the uterus, nearly on a level with the um- bilicus. By this plan, the aortic pulsations will be evident, and farther pressure is then to be made in a direction downwards and backwards. In order that the operator may not be too much fa- tigued by continued exertion, his hand may be compressed by those of an assistant. Lastly : M. Allier 3 employed compression of both carotids in a case of hydrophobia at the commencement of an attack; imme- diately, the convulsion ceased, and the patient became apparently exanimate. The family were alarmed, and would not permit a repetition of the experiment. The case ended fatally. In paroxysmal diseases, the ratio medendi of compression is not the same as in inflammatory diseases. In the latter, the flow of blood towards the inflamed part is prevented by the compres- sion of the arterial vessels proceeding to it; but when compression is exerted on the vessels in neuralgia and congenerous diseases, the new impression caused by the resulting irregularity in the circulation, and the modification in the nervous functions induced thereby, break in upon the morbid catenation like the different agents that are classed under the head of antispasmodics, of which class we have elsewhere endeavoured to show — what, by the way, is not now contested by any eminent therapeutist — that we have none that can be regarded in any other light than as indirect agents. 4 1 La Lancette Franoaise, 12 Mai, 1840. 2 Bullet.de l'Acad. Med. Beige, cited in Ranking's Abstract, pt. 1, p. 180. Amer. edit New York, 1845. s L'Experience, No. xvi., 20 Jam:., 1838. ' See the author's General Therapeutics, p. 350 ; or his General Therapeutics and Mat. Med. 4th edit. i. 395. Philad. 1850. CONTRA-IRRITATIO. — AMMONIATED COUNTER-IRRITANTS. 245 LXVI. CONTRA-IRRITATIO. Synonymes. Counter-irritation ; Counter-action. French. "Contre-irritation. German. Gegenreizung. It is not the object of the author to enter into an explanation of the therapeutical application of counter-irritants, or revellents in general : this he has done at considerable length elsewhere ; x but to refer to some agents not mentioned in the body of this work, to which attention has been revived, or first directed, of late years more especially. AMMONIATED COUNTER-IRRITANTS. Gondret's ammoniacal ointment; Granville's counter-irritants — Antidynous 3 counter-irritants— Raspail's counter-irri- tant. Ammonia has long been used in different formulas for exciting rubefaction and vesication of the citfaneous surface. When two parts of liquid ammonia are united with one part of suet, and one of oil of sweet almonds, the mixture forms the Pommade ammo- niacale of Gondret, which has been used for a long time to excite a speedy revulsion in cases of chronic affections of the brain, incipi- ent cataract, amaurosis, 2, &c, as well as to cauterize the integu- ments deeply. 4 To the advantages of this preparation, as well as of derivation in various diseases, M. Gondret has called the atten- tion of practitioners in an ex professo treatise. 5 The formula, given above, is that of the French Codex; but, according to M. Trousseau, 6 it is much too hard for use, unless the weather is warm. He proposes two different formulas, — one for summer, and the other for winter. In the former, he di- rects three parts of lard, one of suet, and four of liquor ammonice; in the latter, equal parts of lard, and liquor ammonice. M. Gondret has communicated to M. Miquel a formula for his Pommade, which differs from that of the Codex, and accord- ing to him, succeeds much better. It is as follows : — Take of lard, 32 parts: oil of sweet almonds, 2 parts. Melt by a gentle ■ General Therapeutic?, p. 333 ; or General Therapeutics and Mat. Med. ii. 217. 9 A term coined by Dr. Granville. It ought to be "Antodynous," from avn, li against," and cSuvrj, "pain." 3 Bouchardat, Annuaire de Therapeutique pour 1844, p. 215, Paris, 1844, and Lis- franc, Ibid. 845, p. 1255, Paris, 1845. 4 Considerations sur l'emploi du feu en medecine, suivies de Fexpos6 d'un moyen epis- pastique propre a suppleer la cauterisation, et a remplacer 1'usage des cantharides. Paris* 1819; and iN'ouv. Bihlioth.Med. hi. 441, Paris, 1828. 5 Traite theorique et pratique dela Derivation contre les affections les pluscommunes, en general, telle que la Plethore, l'lnfiammation, l'Hemorrhagie, &c. Paris, 1837. 6 Journ. des Connaiss. Med., cited in Medico- Chirurgical Review. July, 1840, and Trousseau and Pidoux, Traite de Therapeutique, &c, 3eme 6dit. i. 366. Paris, 1S47. 246 CONTRA-IRRITATIO. — AMMONIATED COUNTER-IRRITANTS. heat ; and add liquid ammonia at 25°, 17 parts, stirring until it becomes cold. 1 Since the appearance of M. Gondret's treatise, Dr. Granville 2 has published one on counter irritation, which gave rise to much attention on both sides of the Atlantic, — partly in conse- quence of the strong encomiums he passed on certain counter- irritant applications employed by him; and still more in conse- quence of the mystery which he threw around them, by keeping their preparation a secret, until the united voice of the profession had expressed the mingled feelings of surprise, indignation, and regret, which such conduct on the part of an individual, holding an elevated position in the ranks of the profession, naturally en- gendered. It is due, however, to Dr. Granville to remark, that on subsequently publishing his formulae, he stated, that he ad- dressed his work to the public to impress all with the value of the agency, but that it would have been unwise in him to give precise formulae to those who could not estimate the proper proportions of the ingredients ; that every physician can apportion them ; and that he had never concealed, the formulas from his friends, and always intended to give them to the world. 3 Dr. Granville describes two sorts of ammoniated lotions, of different degrees of power, which are prepared in the following manner: Each kind of lotion consists of three ingredients: — 1st. The strongest liquor of ammonia, A. 2d. Distilled spirit of rosemary, B. 3d. Spirit of camphor, C. These are made as follows : — A. The strongest Liquor of Ammonia. — Saturate a given quantity of distilled water, contained in a glass receiver surrounded by ice, with ammoniacal gas obtained in the usual way from a mixture of equal parts of muriate of ammonia and recently slacked lime, both reduced to a fine powder. The water may be made to take up nearly 800 times its bulk of ammoniated gas under the circumstances described; its specific gravity will then be about .8/2, and 100 parts of it will contain thirty-three parts of real ammonia, according to Sir H. Davy's tables. This solution of am- monia will, therefore, be more than three times the strength of the liquor ammonia of the Pharmacopoeia of London, 100 parts of which, at a specific gravity of .960, contain only ten parts of real ammonia. Dr. Granville, therefore, called this "liquor ammoniae fortissimus." The liquor ammoniae fortior of the last United States' Pharmacopoeia (1842,) which is of the specific gravity .882, is of sufficient strength. 1 Bouchardat, Op. cit. 1845. p 254. 9 Counter-irritation, its Principles and Practice, illustrated by one hundred Cases of the most painful and important Diseases effectually cured by External Applications. Lon- don. 1838; or Araer. Med. Lib. edition. Philad. 1833, 3 Lond. Lancet, Oct. 27, 1838. CONTRA-IRRITATIO. — AMMONIATED COUNTER-IRRITANTS. 247 B. Distilled Spirit of Rosemary. — Take two pounds of the tips or small leaves of fresh rosemary, and eight pints of alcohol; leave the whole in infusion for twenty-four hours in a well co- vered vessel, and after adding as much water as will just prevent the empyreumatie smell, distil over seven pints. The Pharmaco- poeias of London and the United States direct the essential oil of rosemary to be distilled with alcohol to form the spirit of rose- mary. Such a preparation Dr. Granville found unsuited for his purpose. C. Spirit of Camphor. — To four ounces of pure camphor add two pints of alcohol, so as to dissolve the camphor, and filter. The three ingredients, thus prepared, should be kept always ready at hand, in well-stoppered glass bottles, so as to be able to make, extemporaneously, a counter-irritating lotion of any requisite strength, according to the nature of the case. But, for ordinary purposes, Dr. Granville advises that both a milder and a stronger ammoniated lotion should be kept prepared for use. Lotio ammoniata mitior. Milder ammoniated lotion. Assuming the quantity of lotion desired to be divided into eight parts, the proportion of the ingredients will stand thus: — A — four-eighths. B — three -eighths. C — one-eighth, or as follows: — R. Liq. amraon. fort, f ^ j. Spirit, rosmarin. f gvj. Tinct. camphor, f gij. M. lotio ammoniata fortior. Stronger ammoniated lotion. If the quantity desired be also divided into eight parts, then the proportion of the ingredients will run as follows: — A — five-eighths. B— two-eighths. C — one-eighth, or as fol- lows : — R. Liq. ammon. fort. fgx. Spirit, rosmar. f 5SS. Tmct. camph. f gij. M. Although the changes of proportion may be deemed trifling, yet the strength of this lotion is such, that Dr. Granville never employs it, except in cases of apoplexy, and for the purpose of cauterization. Directions for Mixing the Ingredients — A and B are gradually mixed together. The mixture becomes opalescent and somewhat turbid, and a peculiar, highly agreeable, ethereal smell is given out, different from the individual odour of either ingredient, although the extreme pungency of the ammonia is still discerni- 243 CONTRA-IRRITATIO. AMMONIATED COUNTER-IRRITANTS. ble. " I have strong reasons to believe," says Dr. Granville, "that, at this point of the operation, some particular change takes place, which imparts to the mixture of the two ingredients some of its valuable peculiarities as a counter-irritant described in my work; but what that change is, it is not my business to enter upon in this place: suffice it to say, that in a great number of experi- ments made with the ingredients separately (for each of them acts as a counter-irritant on the skin,) and with them combined, the effects were uniformly different; those in the former case being found unequal to the production of those complete results which I trust I have justly promised to the profession. Ammonia alone (how- ever strong) w 7 ill not give rise to the effects I have described, though it has often stopped internal pain, and produced small blisters ; but never has it succeeded in almost immediately pro- ducing a full vesication, as I have seldom failed to produce with the two ingredients mixed together, particularly after the third ingredient had been added." Before, however, the third ingre- dient is so added, it is desirable to clear the previous mixture, by the addition of a small quantity of alcohol, and to set the w r hole in a cool place. All the various precautions here mentioned may., upon an emergency, be dispensed with, when an immediate action is required, either to arrest pain or relieve deep-seated inflamma- tion. But for the more delicate uses, particularly for instanta- neous vesication, Dr. Granville recommends, that the preparations should be obtained in the manner specified. The lotion must always be kept in bottles with a glass stopper. M. Raspail 1 has recommended the following lotion, the effects of which, he says, are often instantaneous in relieving intolerable headach: R. Liquor, ammon. p. 100. Aquae destillat. p. 900. Sodii chlorid. purif. p. 20. Camphor, p. 2. Essent. rosar. q. s. The whole to be mixed cold. A piece of linen is to be steeped in this solution, and applied over the part of the head which is the seat of pain, care being taken tjiat none of the fluid passes into the eyes. EFFECTS ON THE ECONOMY IN HEALTH. The various counter-irritants, described above, act essentially in the same manner; differing only in. the intensity of the counter- irritation which they induce. In all, liquor ammonise is the main effective ingredient. The stronger of Granville's lotions is a powerful agent. It gives rise, in a few minutes, to vesication over the whole surface to which it is applied; almost as rapidly, indeed, as if boiling water were placed upon the part. 1 L'Esperience, 24 Juillet, 1840. COXTRA-IRRITATIO. — AMMONIATED COUNTER-IRRITANTS. 249 It need scarcely be said, that the strength of these lotions may be regulated so as to produce either full vesication, or simply rubefaction, by varying the quantity of liquor ammonise. The mode of applying these liquid counter-irritants is, as in the case of Oleum Sine/pis — first to impregnate with them a piece of cotton or linen, folded six or seven times, or a piece of thick or coarse flannel ; and then lay either of these on the spot, pressing with the hand, at the same time, very steadily and firmly on the compress, over which there should be placed a thick towel, doubled several times, so that not only the evaporation of the lotion may be impeded, but the hand employed in pressing the application to the part may not suffer from direct or indirect con- tact with the liquid. Care must be taken that the ammonia does not reach the eyes or nose. 1 As a general rule, the application should seldom be kept on longer than from one to six or eight minutes; and, Dr. Granville affirms, it has often happened to him to find, that less than a minute was sufficient to produce the de- sired alleviation of pain and spasm. But, in order to excite the higher degrees of counter-irritation, vesication and cauterization, as many as ten or twelve minutes may be necessary. EFFECTS ON THE ECONOMY IN DISEASE. There can be no doubt that the ammoniated counter-irritants are valuable agents in all those diseases which are capable of being benefited by a sudden and powerful revulsion. It is chiefly, as elsewhere stated, 2 when the diseased action has been prolonged for a considerable period, and in affections which belong to the neuralgic class, that rapid revulsions are productive of the most marked advantage. When the disease is of an acute character — as in the different phlegmasia — revellents which are more pro- longed in their action, are — as a general rule — preferable. It is in the first class of affections, chiefly, that his lotions are extolled by Dr. Granville; he urges the importance of the sudden vesica- tion effected by them in the treatment of many serious disorders; and alflrms that they arrest " nervous and muscular pain almost immediately, provided it does not depend on structural disease." 3 There is perhaps no agent — he remarks — except boiling water, which can, in the space of between three and ten minutes, give rise to as ample a vesication. But, as powerful and effective a revulsion can be accomplished by the actual cautery in various forms, and especially in that of the moxa. This we say from observation; and it is a result to which just theory would lead us. The ammoniated lotions are, however, devoid of 1 Granville, Op. cit., Amer. edit, p, 39. 2 General Therapeutics, p. 341; and General Therapeutics and Materia Medica. 4th edit., ii. 22!. Philad, 1850. 3 Lancet, Oct. 27, 1838. 250 CONTRA-IRRITATIO. — AMMONIATED COUNTER-IRRITANTS. the painful mental impression, which the dread of actual fire occa- sions; although we doubt not that, in many of the cases above referred to, such mental impression may exert an important agency in the cure. Dr. Granville gives the following, not very classically arranged, list of diseases, which, in the course of nine years, have appeared to him to be benefited by his counter-irritants. DISEASES. A. Principally affecting the Nervous System. 1. Acute neuralgia £ permanent j Tic douloureux - o Yitus's Dance. 3. Convulsions I D i u , • , 3 ( Hysterics. 4. Cramp. 5. Brow-ague. 6. Tetanus or Loch-jaw. 7. Highly acute toot hack. 8. Nervous headach. B. Principally affecting the Muscles and Tendinous Tissues. 9. Rheumatism. 10. Lumbago. 11. Swelled and highly painful articulations. C. Principally affecting the Circulation. 12. Headach from fulness of blood in the head. 13. Congestions and sudden attacks of blood in the head. 14. Sore-throat. .- v , . n C a. of the trachea and bronchia, ) rp „>• „ + „ 15. Larlv innam-} ? f ,, , , .-, ■ ,' f 1 ending to d .. J & , mation J r .-, ■ , & . , • ,- J i consumption C. c. of the heart and pericardium. ) F D. Diseases of a mixed character. . a c 7 . C a. affecting the heart. 16. Suppressed gout £ fc> affectin | the stomach> 17. Genuine gout. 18. Parylitic debility. E. Accidental, Mechanical and Cutaneous Derangements. 19. Violent sprains. 20. Pimples. 21. Biles. 22. Ringworm. Dr. Granville does not affirm that all these disorders, and their modifications, have yielded to the ammoniated counter-irritants: or that the counter-irritants were always the sole agents employed . On the contrary, a few of them, he says, on particular occasions; resisted that agency; others were only momentarily benefited; and a few more required the simultaneous employment of ordi- nary internal remedies to assist in, and complete the cure. Among the exceptions to the general rule of success, he enumerates C0NTRA-IRR1TATI0. — FIRING. 251 chronic tic douloureux; chronic rheumatism of long standing; epilepsy dependent on organic mischief in the encephalon, or any part of the spinal apparatus; and rheumatic gout, in persons whose constitutions had been completely shaken by that disorder, or by any other previous disease, although, even in this case, some good was obtained from using the ammoniated counter-irritants. The second and fourth of these disorders are of the number that require, in addition to the ammoniated applications, an appropriate internal treatment. The other two Dr. Granville has found to be only partially relieved, but never cured, by counter-irritating lotions. 1 In many of the disorders, referred to by Dr. Granville in the table given above, the ammoniated counter-irritants have been employed, both in public and private in this country. They have been largely used by the author, and their effect in nervous and spasmodic diseases, in neuralgic and deep-seated rheumatic vains, has, at times, been very striking. Severe pains have yielded rapidly, as described by Dr. Granville; hypersemiae of particular organs have been diverted elsewhere, especially after blood-letting and sedatives had been premised; and, in short, whenever revellents, sudden and rapid in their action, have been demanded, ammoniated counter-irritants have effected every thing that similar powerful revellents were capable of accomplishing, — but no more. The author has been in the habit of having re- course to the moxa in congenerous affections, and with equally satisfactory results. There is one objection, too, that applies to the use of these strong lotions: — the sloughs and sores induced by them are often considerable, and remarkably difficult to heal. This, it is true, may be partly prevented, by being careful that the application is not too long continued ; but, with the greatest caution, these results will, at times, supervene. When such is the case, simple dressings, with emollient poultices, will be found the best applications. Not long ago, Dr. Corrigan, 3 of Dublin, strongly recommended a mode of producing counter-irritation as an admirable remedy in lumbago and analogous affections in other parts of the body. It consists in a species of " firing" performed by an iron instrument which is very portable, and consists of a thick iron wire shank, about two inches long, inserted in a small wooden handle, having on its extremity, which is slightly curved, a disc or button of iron, a quarter of an inch thick, and half an inch in diameter, the whole instrument being only six inches in length. The face of the disc for application is quite flat. The only other portion of apparatus required is a small glass spirit lamp, so small that it can be carried in the waistcoat pocket. To use the instrument, the 1 Op. cit, p. 29. a Dublin Hospital Gazette, March, 1846, 252 CORTEX ADSTRINGENS BRASILIENSIS. lamp must be lighted, and the button held over the flame, keep- ing the forefinger of the hand holding the instrument at the dis- tance of about half an inch from the button. As soon as the finger feels uncomfortably hot, the instrument is ready for use, and the time required for heating it to this degree is only about a quarter of a minute. It is applied as quickly as possible, the skin being tapped successively at intervals of half an inch over the affected part as lightly and 'as rapidly as possible; care being taken to bring the flat surface of the disc in contact with the skin. In this way, the process of firing a whole limb, or the loins, making about one hundred applications, does not occupy a minute, and once heating the lamp suffices. The iron is never rendered red hot; it is very little hotter than boiling water, and an eschar is never made by it, and rarely a blister. The pain produced by its application is so slight, that, according to Dr. Corrigan, some of the resident clinical clerks in the hospital preferred it, in their own cases, when suffering under local muscular rheumatism* to any other method of counter-irritation, — it being, in their opinion, the least troublesome, most rapid, least painful and most effectual. In sprains of the muscles of the back and other parts, and in sciatica, he has seen it render valuable service, as well as in neuralgia of the fifth pair, and in paralysis of the portio dura. Even delicate females, he says, will not object to its fre- quent repetition, when required. The method of Dr. Corrigan has been extensively tried by Dr. M'Cormack, 1 who has reported very favourably in regard to its powers, and by others. LX VII. CORTEX ADSTRIN'GENS BRASILIENSIS. Synonymes. Cortex adstringens Brasiliensis verus ? Cortex adstringens veruSj Astringent Bark of Brazil. German. Adstringirende Brasilianische Rinde. This bark was introduced into Germany, in the year 1818, by Schimmelbusch, a merchant, who carried it from Brazil, where it had long been used internally, as well as externally, as an ex- cellent astringent. 2 According to Von Martius, 3 it is the bark of Acacia jurema, but this is not certainly determined. 4 Oesterlen 5 assigns it to mimosa (acacia) cochliacarpa seu virginalis. Merrem G affirms, that the genuine bark is in more or less flat pieces; at times, in half, or complete rolls, from four to twelve 1 Lancet, Jan. 5, 1847. 2 Yon Schlectendal, in Encvclop. Worterb. der Medicin. Wissenschaft. B. viii. S. 538. Berlin, 1822. 3 Reise, ii. 788. 4 Riecke, Die neuern Arzneimittel, S. 146. 5 Handbueh der HeilmitteUehre, S. 484. Tubing. 1S45. 6 Ueber den Cortex adstringens Brasiliensis. Koln, 1828. CORTEX ADSTRINGENS BRASILIENSIS. 253 laches long; from an inch to two inches and a half broad, and from one to four lines thick ; these are more frequently straight than crooked. The bark may be separated into two parts; an outer, which is rough, and an inner rind, of a smooth, fibrous cha- racter : the two are but loosely connected together. The outer bark is of a grayish-brown colour, traversed by longitudinal and transverse furrows, having, here and there, white and grayish- white crusty growths, covered with a foliated lichen. The inner bark is of a dark-red brown, on its outer surface, and, after the outer bark has been separated, is somewhat smooth: on the inner side, it is of a bright reddish-brown, and, probably owing to the laceration of the woody splinters, somewhat fibrous. The younger bark is smooth in the fracture, and of a dull splendour. The older bark, which is thicker, is unequal, and may often be sepa- rated into fibrous layers, which are readily lacerable. When chewed, it has a tolerably strong, astringent, somewhat bitter and disagreeable taste, but it does not excite nausea, nor leave any arriere-gout. It has scarcely any smell. In its chemical rela- tions, it resembles rhatany. 1 Merrem, who made numerous experiments with the bark, af- firms, that, whilst it possesses the properties of astringents in general, and to a high degree, it is rather sedative than exciting ; agrees with the digestive organs, and aids the peristaltic action. He employed it, first, with more or less success, in hemorrhage — in epistaxis, hemoptysis, and metrorrhagia; and Gunther 2 found it very efficacious in profuse menstruation arising from atony of the uterus. Secondly ; in mucous discharges, as leucorrhcea, blen- norrhcea, &c. Thirdly; in inflammatory and exanthematous affections — as cynanche, urticaria, and in periodical erysipelas of the face. Fourthly; in nervous diseases, especially when asso- ciated with disturbance of the menstrual function, and leucorrhcea : and, fifthly, in weakness and catarrhs of the genital organs, bladder and rectum. The Indians consider, that the bark affects especially the generative apparatus, and, from the experiments of Merrem, it would seem, that its agency is more particularly ex- erted in cases of leucorrhcea ; and in many, after cinchona had been administered without effect. 3 MODE OF ADMINISTRATION. Merrem prescribed it in various forms. He gave the powder in doses of from Bj. to 5ss., three or four times a day, mixed with water. It appeared to him to act most beneficially in cases of mucous discharges unaccompanied by disorder of the digestive 1 See the analysis by Hofrath Trommsdorff, in Brando?, Arehiv., B. xxxlii. S. 260 ; and Dierbach, in Heidelberg. Annalen, B. x. H. 3, S. 357. Heidelb. 1834. 3 In Harless Rein-Westphal. Jahrbuch, B. viii. St. 1, S. 72; and Brandes *\rchiv Band, xi. S. 200. 3 Osann, in Encyc. Worterbuch der Medicin. Wissensoh. viii. 541. 17 254 CORYLUS ROSTRATA, functions ; and he found that the powder was better borne by some than the decoction, which is singular, as the woody matter is more apt, in such cases, to disagree. He rarely gave it combined with aromatics, and never found the combination of use. To form the decoction, an ounce of the coarsely poivdered bark was boilet: with sixteen ounces of water, down to f ^ viij.; and to this an ounce of syrup was added. The dose was from one to two spoon- fuls every two hours. Merrem also prepared an extract, and a tincture, in the same manner as these preparations are made of cinchona ; of the former, he took from one to two drams, dissolved it in six ounces of an aromatic water, and added ^ss. of syrup. Of the mixture, a spoonful was given every hour. Externally, the decoction was injected three times a day in hucorrhcea and blennorrhcea ; or, in the former disease, a sponge imbued with the decoction was introduced, and kept there for some time. It has been applied, also, as an astringent to ulcers. Mistura corticis Brasiliensis adstringentis. Mixture of the astringent bark of Brazil. R. Decoct, cort. adstring. Brasil. f ^vij. Copaib. cum vitelli ovi q. s. subact. Tinct. ferri pomati, aa f gij. Syrup, balsam, f ^j. M. Dose. — A spoonful every two hours, in obstinate gonorrhoea and leucorrhcea. Merrem. R. Cort. adstring. Brasil. ^ss. Coqne cum aquae fontan. q. s. Sub fin. coction. adde Sabin. ^ss. Colaturae f ^ viij. adde Syrup, aurant. cort. f ^j. Dose. — A spoonful every hour in cancer of the uterus, and in the hemorrhage thence arising. Merrem. LXVIII. CORYLUS ROSTRATA. Synonyme. Beaked Hazel. Beaked hazel is a shrub two or three feet high; Natural Order, Amentaceae; Suborder, Cupuliferse; Sexual System. Moncecia Polyandria; which grows in the mountainous regions of North America. The nut which it produces is of an ovate shape, surrounded by a coriaceous and scaly involucre or cupula, termi- nating in a tube an inch and a half long, covered with short and thick bristles, very similar to those of mucuna or cowhage. 1 1 Duhamel, Amer. Journal of Pharmacy, Jan. 1843. CREASOTUM. 255 EFFECTS ON THE ECONOMY. The short, stiff bristles have been found to possess similar an- thelmintic virtues with mucuna, and to be equal to it in all re- spects. Mr. Duhamel states, that Dr. Heubener, of Bethlehem, Pennsylvania, from whom he obtained the specimen described by him, had employed it in cases of worms, and was much pleased with it. MODE OF ADMINISTRATION. It may be given, like mucuna, in syrup, molasses or other con- sistent vehicle, and in the same doses. LXIX. CREASOTUM. Synonymes. Creasoton, Creosoton, Creosotum, Kreosoton, Kreosotum, Oxy hydro-carburet um ex oleo pyroxilico paratum, Creosote, Creasote, Kreosote, Kreasote. French. Creosote. German. Kreosot. • This substance was first discovered, several years ago, by Rei- chenbach, of Blansko, and is extensively employed as a therapeu- tical agent. Its marked chemical properties suggested, that it might be possessed of a decided influence on the economy, ajid ! numerous experiments were immediately instituted to test the ac- curacy of the notion. These were of the most opposite character; and it is not surprising, as in every similar case, that there should have been great discrepancy in the results, and in the opinions deduced therefrom. There can be no doubt, however, that crea- sote forms a valuable addition to the list of our remedial agents. METHOD OF PREPARING. The process given by Koene, 1 is esteemed one of the best for preparing it on a large scale, — almost the only way in which it is formed: we, consequently, meet with it only in commerce. Hence it is in the Materia Medica list of the Pharmacopoeia of the United States (1842,)— not amongst the preparations. Tar, derived from pit-coal, is distilled in a retort provided with a long tube having a large mouth. Under this is placed a receiver. The oil, which comes over first, swims on water; and it is neces- sary to remove, from time to time, the products of the distillation, until an oil is obtained, which sinks in water. When this is the case, the product is collected. The heavy oil, obtained during the distillation, condenses not only in the receiver, but in the tube of 1 Annates Je Chimie et de Physique, Juillet. 1835. See Cormack on Creasote, p. 3G, Lond. 1836; or the Araer. edit, in American Medical Library; also. Turner's Chemistry. 5th edit. p. 872, and Christison, Dispensatory, p. 374, Edinb. 1842. 256 CilEASOTUM. the retort, where it unites with the naphthalin, forming a buty- raceous substance. By applying a gentle heat, the mass drops into the receiver. The product is now allowed to remain in a cool place for some hours, after which it is pressed. The expressed naphthalin still contains oil, which is separated by heating it w T ith its own weight of acetic acid, until it melts. After allowing it to cool, the crystallized naphtha is pressed, and the acid adhering to the creasote is saturated with carbonate of potassa. The creasote is now 7 to be shaken for a quarter of an hour with phosphoric acid, — the proportions being half an ounce of the acid to twenty ounces of the oil. The mixture ought then to be agitated with its bulk of water, and afterwards be distilled with a graduated heat, care being taken to separate the oil which floats on the surface. The rectified oil is now to be dissolved in its own volume of a hot solution of caustic potassa, s. g. 1.120. When it has been allowed to cool for half an hour, the supernatant oil is removed, and the heavy oil again treated with caustic potassa, only a fourth part of the solution being, however, employed this time. On uniting the solutions of potassa, a slight excess of diluted phosphoric acid is added, and the free creasote, which floats on the surface, is sepa- rated. It is a^ain rectified : and the first product, which is chiefly water, being rejected, the creasote comes over pure. M. Koene recommends the substance, thus prepared, to be preserved in bot- tles covered with blnck paper. A protracted and complex process, like the above, necessarily makes the drug expensive, especially as the quantity obtained is but small. M. Koene procured by it ten drams from thirty-two ounces of tar. M. Lem^re, one of the first Parisian pharmaciens who made pure creasote, obtained from eight hundred pounds of tar about six pounds of creasote. Reichenbach generally prepared it from the tar of the beech by six distillations; dissolving it afterwards in a solution of caustic po- tassa three times, and setting it free successively by sulphuric acid. 1 Giordano 2 has recommended the following simplified mode for obtaining it. Distil wood tar from the willow, at an elevated temperature, from a tinned copper retort, until the residue has the consistence of soft pitch. Re-distil the liquor passed over till its residue resembles the former. The liquor, neutralized by carbon- ate of potassa, or lime-water, is re-distilled till all the oil of crea- sote has passed over. The oil is dissolved in caustic potassa, from 1 For an account of this and other products of the destructive distillation of vegetal/!* matter, see Cormack, Op. cit. Reichenbaeh's observations and experiments are contained in a'work entitled ' ; Das Kreosot in chemischer, physischer and medicinischer Bi bun?, von Dr. K. Reichenbach, u. s w. zweite mit Nachtragen und Zusatzen Srhweigger-Seidcl verm. A usgabe. Leipz. 1835;" see, also, Annalcs de Chimie, liii. 325. Paris, 1833. 2 Annali di Medicina, Aprile, 1835, cited in Brit, and For. Med. Rev. July. 1836. p. 233. For the process of Calderini, see Edinb. Med. and Surg. Journ. for Oct. 1834. CREASOTUM. 257 which, after simmering a little in a porcelain vessel, and cooling, the eupione, which floats, is easily separated. The same opera- tion is repeated with the eupione, to remove all the oil that is united with it. The saponaceous liquor, treated with dilute sul- phuric acid, is distilled into water, from which the creasote is separated, and the water saturated with creasote is kept for exter- nal use, or re-distilled for a concentrated acetic acid of a pungent and most agreeable odour. Gozzi 1 has given the following sim- ple method of procedure: Distil tar into a cylindrical vessel, half full of water. Pour off the watery liquid at the top; add to the heavier liquid at the bottom sulphuric acid diluted with half its weight of water; heat the mixture till it boils; expose the super- natant creasote for three days to the air, stirring it frequently; and distil the product thrice for thorough purification. Creasote is a colourless, transparent fluid. Its refractive power is very great, and in angular glass vessels it is beautifully irides- cent. Its odour is penetrating, and disagreeable, but not offen- sive : many compare it to that of castor. It adheres to every thing, and is somewhat permanent. Its taste at first is very burning and caustic to the tongue; but on admixture with the saliva, it becomes somewhat sweetish. It has an oleaginous feel, and is of about the consistence of oil of almonds. Its specific gravity, at 68° Fahr., is stated by Reichenbach to be 1.037; but Dr. Christison 2 affirms that he has never found it lower than 1.065, or higher than 1.067. The fact is, of course, of interest in relation to its adulterations. It boils at 397°, and at — 17° does not congeal. When placed on paper, it forms a greasy spot, which, however, disappears after a while, and can be removed by the application of a heated body without any residue. It is a non-conductor of electricity. With water at 68°, it unites in two different proportions — one of the combinations consisting of I J of creasote and 100 of water; the other of 10 parts of water and 100 parts of creasote. The taste of the first mixture — creasote water — is very burning at first, and afterwards sweetish, like that of pure creasote, but of course weak- er. A drop of creasote in 10,000 parts of water produces a marked impression on the tongue, and has a smoky smell. Lit- mus and turmeric paper are not in the least changed by it ; so that it has neither an acid nor an alkaline reaction. At both poles of the galvanic battery, it furnishes numerous and striking combina- tions. It does not possess the property of the ordinary empyreu- matic oils, of becoming yellow and inspissated. It dissolves iodine, phosphorus, and sulphur. Acetic acid at 1.070, and alco- hol, dissolve it in all proportions, and with the latter it is often adul- terated. 3 Ether and petroleum likewise combine with it in all 1 Journal de Chimie Medicale, cited in American Journal of Pharmacy, Jan. 1839, p. 339. / 2 Dispensatory, p. 374, Edinb. 1842. 3 Journal de Chim. Med. and Amer. Journal of Pharmacy, July, 1841, p. 112. ZOO CREASOTUM. proportions. With potassa, it forms two or three combinations, one of which crystallizes. Resins and resinous bodies either de- compose creasote, or it decomposes them. With balsams, fixed and volatile oils, camphor, and the vegetable alkaloids, it unites readily. It coagulates albumen, and its antiseptic property is most remarkable, whence its name, from xptas, ' flesh,' and ou^u, 'I preserve' — orw^p, ' preserver.' Fresh meat, placed in creasote water for half an hour or an hour, and then taken out and dried, may be exposed to the heat of the sun without undergoing putre- faction. Nay, when flesh has begun to be putrid, the process ceases after it has been washed with creasote water, and if su tiered to remain immersed in it for an hour, it does not subsequently pu- trefy. There can be but little doubt, consequently, that creasote is the main antiseptic and conservative principle of pyroligneous acid and tar water. From the experiments made by Reichenbach to determine the exact components of the flesh on which the crea- sote acts, he arrived at the following results. It unites with the albumen of the blood in the flesh, which it coagulates, and with the red particles without acting on the fleshy fibre, which serves merely as the frame-work for the coagulated matters; and it is well known that dried albumen does not putrefy, but becomes hard, brittle, and transparent. EFFECTS ON THE ECONOMY IN HEALTH. Reichenbach has properly remarked, that the excessive burn- ing pain in the tongue, which creasote causes, must have at once suggested it to be a poisonous substance. It w T as soon found that plants, sprinkled with creasote water, died ; that fish placed in it were convulsed ; and that small animals, as wasps and flies, died when touched with the pure article. If a small quantity of it be spread upon the hand, and washed off a minute afterwards, the place is found to present a white appearance, but without pain or inflammation. In the course of a few days, the place becomes dry, and the cuticle desquamates. When creasote is applied to a part where the epidermis is deficient, or to a wound, instantane- ously an extremely violent burning pain is experienced, which continues for eight or ten minutes; but if the part be carefully washed, it gradually ceases. The cause of this is conceived to be the property which creasote possesses of coagulating albumen ; and, where blood is flowing, of arresting it. If the rapid disturbance which it excites, affects important organs, death results sooner or later, according to their importance in the economy: relief, how- ever, may be afforded by those substances that dissolve coagulated albumen, as caustic alkalies, acetic acid, &c. It is probable, how- ever, that the poisonous properties result from its acrid character. To appreciate the physiological effects of creasote, experiments have been undertaken by many individuals. Miguet gave a CB.EASOTUM. 259 voung dog, for eight days, an ounce a clay of distilled water con- taining four drops of creasote, without any effect. When, how- ever, he doubled the dose, nausea, languor, subsultus tendinum, and tremors occurred, followed, in the course of a few days, by marked emaciation. On discontinuing the creasote, the functions gradually resumed their pristine condition, and the animal reco- vered its flesh. To another dog, he gave at once two. drams in half an ounce of water, and immediately thereafter great prostra- tion of the muscular system ensued — vertigo, fixed eyes, stupor, dyspnoea, accumulation of mucus in the air passages, spasmodic cough, discharge of large quantities of foamy saliva, with vomit- ing of a milky matter, although the animal had taken nothing of the kind. After two hours' suffering, it died of convul- sions. The body was immediately opened : all the tissues, except the liver, exhaled a strong smell of creasote; and the whole of the mucous membrane of the intestinal canal was inflamed. The mat- ters contained in the stomach coagulated when placed in contact with albumen. When heated, they yielded a thick smoke, and a marked smell of creasote. In the heart and large vessels, the blood was more firmly coagulated than usual: the lungs were gorged with blood ; in the brain there was no evidence either of congestion or hemorrhage. In another dog, into whose carotid equal portions of water and creasote were injected, death resulted with similar phenomena, but more rapidly. The precise quantity of creasote used in this experiment is not stated. Simon, in his experiments, found that when ten drops of crea- sote, diluted, were injected into a vein, scarcel} 1 - any effect resulted. Reiter and Miiller, who likewise made experiments on animals, agree with Simon as to the result of injections of creasote into the veins; no special symptoms were induced by it, but this ap- peared to be owing to the blood being instantaneously coagulated by it, which not only prevented the farther progress of the crea- sote, but also of the blood ; hence, no evil consequences resulted ; and, it is probable, as Riecke has suggested, 1 that the weaker the solution of creasote, within certain limits, the greater may be its effect on the mass of blood. Corneliani, 2 an Italian physician, has also instituted a series of experiments with creasote on lambs, rabbits, &c. All these ani- mals bore small doses of creasote — however unwillingly it might be taken — without any remarkable results, and without loss of appetite. Large doses, however, immediately occasioned general torpor, sudden inclination to pass the urine, paralysis — especially of the lower extremities — with or without convulsions, and fre- quently the ejection of a bloody foam. When the doses were 1 Die neuern Arzneimittel, u. s. w. S. 153. s Giornale delle Scienze Medico-Chirurgiche, No. 8, Febrajo, 1835; cited in Brit, and For. Med. Review, p. 265, Jan. 1836. 260 CREASOTUM. large, and it was but little diluted, death took place in a few minutes, and on examination, the inner lining of the stomach was generally found corroded, yet not so constantly as to allow of death being ascribed to that circumstance. It followed, farther, from his experiments, that pure creasote applied to a denuded nerve, or injected only in small quantities into a vein, may occa- sion death suddenly; and that the application of the creasote to extensive wounded surfaces in the same animals maybe ultimately followed by fatal consequences. Where a very large dose of creo- sote was administered, immediate death was produced without organic lesion. In the trials made with it by Dr. Elliotson 1 he found no action produced upon the bowels ; but it sometimes augmented the quantity of urine. He once saw it, in the dose of a minim three times a day, cause micturition nine times in an hour. In another case, in doses of three minims, it produced severe strangury. According to Simon, when applied to the muscles, it destroys the surface like caustic. Muller and Reiter, in their experiments,, found, that it speedily rendered the muscular fibres of a dirty- whitish appearance, and readily lacerable. When applied to the fresh blood of the hog, it converted the colour in an instant to an ashy-gray ; after which it became black and quickly coagulated. Mixed either pure or diluted with blood, it thickens it; the mix- ture assumes a brown-red colour, and is found studded with small white points, which are nothing more than coagulated albumen. On exposing the coagulum to the air, it assumes a yellowish-red colour. Reich, on the other hand, who appears to have made many experiments with creasote, both in internal and external diseases, affirms, that he has never observed any caustic effect from it : from which assertion, as Riecke has remarked, 3 the only inference to be deduced is, that he must always have applied it largely diluted. Fremanger likewise asserts, that when pure creasote is applied to the epidermis, it does not destroy it; but merely occasions more or less redness of the skin. When applied to a suppu- rating surface, it caused, instantaneously, the formation of a white pellicle, owing to its coagulating the albumen contained in the secretions from the wound. Adventitious tissues, with which it is brought in contact, are destroyed by it. When placed between the lips of a wound, it prevents healing by the first intention, by coagulating the albumen; and, consequently, it may be employed in all cases where it is desirable to prevent the growing together of parts. Fremanger is, indeed, disposed to refer all its efficacy to the action which it exerts on albumen. Its long continued use often occasions an inflammatory condi- tion which, as Dr. J. L. Da Luz 3 observes, has nothing in com- 1 Medico-Chirurg. Transac. vol. xix. Lond. 1835. * Op. cit. S. 154. 3 Journal da Sociedade das Sciencas Medicas de Lisboa, torn. v. Lisboa, 1837; re- viewed in Zeitschrift fur die gesamtnte Medicin. Oct. 1838, S. 224. CREASOTUM. 261 mon with the disease for the cure of which it may have been prescribed. In a case of porrigo favosa, treated with it by the author, febrile irritation supervened, and the head was covered by an artificial eruption, which induced, however, a new action in the system of nutrition of the scalp, and, after its subsidence, the porrigo was cured. Dr. Cormack, of Edinburgh, instituted various experiments on the lower animals to test its physiological effects. 1 In three experiments, about twenty-five drops of pure creasote were in- jected into the venous system of dogs. All the animals died. In every case of poisoning by it, which he has observed, Dr. Cor- mack found the following to be the symptoms. — Its first delete- rious action was a powerful one of sedation on the heart ; the vital energies of that organ seeming to be instantaneously para- lyzed. In some instances, 'hurried and sonorous respiration went on for more than a minute after the heart had ceased to beat. In general, one or two convulsions, resembling the tetanic, preceded death; and, almost invariably before expiring, the animal uttered one or more shrill cries. In every instance the atony of the heart immediately after death was very striking. From other experiments it appears, that when it is injected into the arteries the deleterious effects are of a much milder cha- racter, and if the dose be not large, the animal may experience but little inconvenience, — a circumstance which proves the im- portance of a thorough admixture with the blood before the poi- sonous article reaches the heart ; such admixture not taking place to the necessary extent, when the poison is injected into the veins, but being readily effected when injected into the arteries, and con- sequently distributed through the system of nutrition. When taken for any length of time, the urine acquires a black- ish hue, and in some cases creasote may be recognised in it. 2 EFFECTS ON THE ECONOMY IN DISEASE. Creasote has been administered in various diseases; the follow- ing may be esteemed a summary of the chief therapeutical expe- riments made with it. Hemorrhage. — The discovery of creasote happened at a time when the Acqua Binelli enjoyed more confidence as a styptic than it does now ; and the fancied probability, that the nostrum was indebted to creasote for its properties, gave rise to many ex- periments with the latter in cases of hemorrhage. One of the first, who instituted experiments with it on rabbits, was G. Simon. Not being able to obtain any striking results from the Acqua Binelli, he tried creasote, pure, as well as in the form of creasote water, and of an emulsion prepared with gum Arabic; and from the results 1 Op. cit. p. 66. 2 Maeleod, in Med. Gaz. xvi. 599, and xvii. 653. 262 CREASOTUM. of these he was led to affirm, that although creasote occasioned the coagulation of the albumen of the blood, it acted no better as a styptic than cold water. With the Acqua Binelli he was not able to coagulate albumen. The rapid separation of the albumen in the form of a reddish-gray coagulum under the influence of creasote, he found to be of no advantage, as the mass remained soft and pulpy ; and the wound in the vessel would not close, but was immediately opened by the stream of blood. Neither did he esteem it adapted for arresting trifling hemorrhages; for, when very much diluted, it was still too exciting to the injured parts, and greatly delayed their union. This, indeed, might, he thinks, be expected from the fact, that pure creasote, when placed on the skin for ten or twenty minutes, induces superficial inflammation. The experiments of other physicians have been decidedly more favour- able. Muller and Reiter, 1 for example, in theirs, found that creasote was far more efficacious than the Acqua Binelli; for, when the latter was prescribed, it was always necessary to have recourse to other agents, before the hemorrhage was arrested. In their experiments on dogs, they found the hemorrhage from a divided crural vein quickly cease, when a compress of cotton wetted with creasote w T as placed on the vessel with a moderate degree of pressure. Three days afterwards, the crural artery was exposed on the same dog, and divided; but it was afterwards necessary to tie it, as the creasote, in consequence of the excessive hemorrhage, could not be brought into immediate contact with the vessel, but merely acted on the superficial layer of blood, and therefore did not arrest the hemorrhage. The crural artery of a young and tolerably strong dog was cut a short distance above its division, compression being at the same time exerted upon the trunk. The artery did not bleed. Nine minutes afterwards, a compress of cotton soaked in creasote was applied immediately to the divided extremity of the artery, with some degree of pressure. When the compress was removed, the bleeding was entirely arrested, and the wounded surface was dry, and had an ashy-gray hue. In an old dog, hemorrhage from a divided crural artery was arrested by the same means, but not so speedily. When the artery was examined, it was found to be wholly closed, having a navel-like depression at the extremity, which disappeared when the vessel was pressed upon, and ultimately became conical. Within the vessel there was a conical coagulum, which could be readily de- tached; and for the space of a line, the artery appeared inflamed through its coats. In arteries that had been divided for a longer time, the union was likewise complete ; but there was this differ- ence, that the inflammation at the end of the vessel had disappeared, 1 Schmidt's Jahrbuch. cited in Encyclojrraphie des Sciences Medicales, Mars, 1837. See, also, Burdach, -Median. Zeitung. Jahrganp;. 1840, No. 31, cited in Lond. and Edinb. Monthly Journal of Med. Science, May, 1642. CREASOTUM. 263 and a pointed fibrous caruncle was observed in the vessel, which was doubtless the fibrinous portion of the previous coagulum. From their experiments, Miiller and Reiter were led to con- firm the haemastatic properties of creasole, both when the hemor- rhage occurs from veins and from arteries. The arteries divided were of considerable size, larger than the radial artery of an adult male. They consider pressure indispensable to occasion the erea- sote to act immediately on the artery ; and the arrest of the hemor- rhage, they ascribe, not alone to the coagulation of the blood, but to the contraction of the arteries. In parenchymatous hemor- rhage, creasote water was generally sufficient; as well as in tole- rably extensive wounds of the surface. Horing, also, obtained satisfactory results from his experiments on animals. He ex- posed, on an old cat, the crural artery and vein of the right side ; made a small incision into the latter, and pressed upon it to stop the copious flow which ensued : he then applied over the wound, for two minutes, a small compress of lint, wetted with a solution of creasote — two drops to one hundred of water — and the bleeding ceased. The artery was now opened, and a similar compress placed upon it with the same result. Two days afterwards, a se- cond experiment was made of the same kind, except that, owing.to the struggles of the animal, a larger opening was made into the crural artery. In this case, it was necessary to apply the com- press for four minutes before the hemorrhage ceased. In another cat, a large transvefse incision was made into the inner surface of the right thigh, above the middle, by which muscles, arteries, veins, and nerves were divided. Two large compresses of lint, wetted with a solution of creasote, were then pressed on the parts for five minutes, and the bleeding entirely cea'sed. The like re- sult was obtained in the case of an old horse, whose jugular vein was opened. But the creasote solution did not succeed in wholly arresting the hemorrhage in the same horse, when an opening was made into the crural vein and artery. To these experiments on animals may be added some that were instituted on the human subject, which testify, more or less, to the efficacy of creasote as a haemastatic. Hahn applied it in some insignificant cases, but saw no better effect from it than from cold water. Most found it speedily arrest slight hemorrhage from small vessels. Horing applied it successfully in cases of epistaxis, which had obstinately resisted other agents, — two plugs of lint, dipped in a solution of creasote, being inserted in the nostrils, after which the hemorrhage soon ceased/ Fichtdauer employed it with equally advantageous results in violent bleeding j r om leech bites, after several haemastatics had been used in vain ; and Hey- felder extols it for arresting hemorrhage from large wounded sur- faces. Berthelot differs with Fremanger and Simon, who affirm that union by the first intention is prevented by it. The results 264 CREASOTUM. of his observation were opposite. Miguet applied it success- fully as a haemostatic in fresh wounds on man and animals. Both pure creasote and a solution of it were, however, unsuccess- fully used by Bardili in hemorrhage from the arteria tibialis pos- tica, which he ascribed to the blood having lost its albumen, owing to the excessive discharge. Reich and HaufF found injections with creasote water useful in hcemorrhagia uteri. Schneider had a case of hemorrhage that had continued for seven hours in a man eighty years old, which proceeded from the gums of the tipper jaw; the blood oozing as from the pores of a sponge. He directed the man to take as much creasote water into his mouth as he was able; and after three repetitions the hemorrhage ceased, and did not recur. Kohler 1 endeavoured to test the haemastatic operation upon himself. He made an incision in his forearm an inch long, and three or four lines deep, to which he applied creasote water. A lancinating pain was felt in the wound, but no other sensible effect. A drop of pure creasote was now let fall between the lips of the wound: this was followed by a sensation of burning and drawing; for a moment coagulated flakes of a whitish-gray colour covered the wound, and there was a temporary cessation to the flow: it soon, however, recurred. After a time, the hemorrhage ceased ; but not sooner— Kohler thinks — than if cold water had been applied. The feeling of burning and drawing continued, however, for some time ; the edges of the wound were somewhat swollen, and cedematous, and, in about four flours, were covered with a yellowish-brown lymph; but there seemed to be no delay in the cicatrization. In a case of lithotomy, it was found impossible to arrest the hemorrhage by any of the usual means, and no particular vessel could be discovered from which the blood flowed. The patient was at last reduced to the lowest ebb, from the continued loss of blood, and had already lost consciousness, when a sponge, dipped in pure creasote, .was introduced into the wound, and pressed against the bleeding parts for an instant or two. The hemorrhage was immediately arrested. No particular pain was experienced ; no unpleasant symptoms occurred ; thin eschars were thrown off, and the patient recovered. 2 J. L. da Luz 3 found it an excellent styptic in capillary hemorrhage; but in he- morrhage from great vessels it did not prevent a recurrence of the bleeding. In hemoptysis, its internal use has been found beneficial. Santini 4 prescribed it in a desperate case with com- plete success, and with Schmalz it was equally effective; on the other hand, it was of little avail in Guitti's hands. In hcema- 1 Neue Wissenschafilich. Annalen, u. s. w. B. i. H. 3. S. 235. Berlin, 1835. : Daser, Edinb. .Medical and Surgical Journal, Oct. 1841. 3 Op. cif. * Gaz?tta Terapeutica
  • $, "divine," and otf^, "odour." The taste of the leaves is aromatic; somewhat pungent; and, in the opinion of Buchner, resembles that of peppermint ; without any parti- 294 DIOSMA. cular bitterness, yet disagreeable. According to the analysis of Buchner, Brandes, and Cadet, the most important constituents appear to be a volatile oil of a greenish-yellow colour, a peculiar principle — diosmin, and a semi-resinous substance. Diosmin is a very tenacious adhesive matter, similar to Peruvian balsam, and can be drawn out in fine threads. It has the same smell as the leaves, only somewhat weaker; the taste is pungent and bitter. The semi-resinous matter has a resinous lustre; is of a dark brown colour, becomes fluid when heated, and burns with a flame. Its odour is not remarkable; taste, somewhat pungent and sourish. 1 EFFECTS ON THE ECONOMY IN HEALTH. The Hottentots have long used the leaves of several varieties of diosma both internally and externally; but they give the prefe- rence to diosma crenata. Through them its virtues became known to the European settlers. It was first brought to the no- tice of British practitioners by the notorious Richard Reece, who is more known for the part he took in the farce of Joanna South- cote than for any thing else. In Germany, it was chiefly promul- gated by Jobst, who published an extract from Reece's obser- vations in the Repertorium of Buchner. 2 Bardili instituted ex- periments for testing its action on the healthy organism. It first acts — he says — as an excitant on the stomach, whence arises a feeling of increased heat in that organ, and the appetite becomes augmented : from the stomach, the excitement spreads to the vas- cular system ; the heat of the body is increased ; the pulse becomes more frequent, and the transpiration is favoured. It acts, like- wise, on the urinary secretion; the urine is separated in larger quantity, contains flocculi, deposits a purulent (?) sediment, and exhales an aromatic odour. On the digestive function, it seems to produce somewhat of a constipating effect. Bardili thinks, that he has also witnessed some narcotic operation in his experi- ments. The same results were produced by diosma on animals. EFFECTS ON THE ECONOMY IN DISEASE. The inhabitants of the Cape administer this agent as a sto- machic, and the Dutch physicians give it with success in indiges- tion. It is said also to have afforded essential service in chronic cases of rheumatism and gout. Autenrieth extols it in rheuma- tic pains, which have had their foundation in repelled itch (?) ; and its utility in chronic rheumatism has been confirmed by numerous others. It has been extolled, moreover, in hematuria, calculous pains, and in irritated and suppurative conditions of 1 Journal de Chimie Medicate, iii. 13, and Journal de Pharraacie, xiii. 106. a Band- xxii. S. 51. DIOSMA. 295 the bladder, urethra, and prostate. The author has repeatedly administered it, but has observed no other effects than those of a moderate excitant diuretic and tonic. Reece says he found it efficacious in incontinence of urine, and in catarrhus vesica; and he gave it — united with tincture of cubebs — in spasmodic stricture of the urethra, gonorrhoea, swelling of the prostate, and impotence. At the Cape of Good Hope, buchu leaves are often applied ex- ternally, in the form of liniment and baths, as well as of fomen- tations and cataplasms, in luxations and rheumatic pains, — and in wounds, especially the contused. It may be remarked, that this — like almost every similar re- medy — has been given in cholera; and, as the Riga physicians assert, frequently with favourable results. MODE OF ADMINISTRATION. The dose of the powder is 3ij. in the day: this, at least, is the common dose at the Cape. The infusion necessarily contains more of the volatile oil than the decoction; but, on the other hand, the latter has more of the diosmin : as respects their action, how- ever, there is not much difference. A vinegar, oxymel, liniment, extract, and tincture of diosma have been advised. The London, Edinburgh, Dublin, and United States Pharmaco- poeias have an Lntusum Diosma (Jss. of the leaves to Oss. of water, Pharm. U. S.;) dose, f §iss : and the Dublin, a Tinctura Buchu (§ij. of the leaves to Oj. of proof spirit;) dose, f £ij. or f giij, Infusum diosmse compositum. Compound infusion of buchu. R. Diosm. Uvae ursi aa. jf ss. Aq. bullient. Oss. Digere leni calore in vase clauso per semihoram. Colaturse adde Syrup, seneg. f jfss. Dose. — One or two spoonfuls every two hours in blennorrhcea, and in atony and paralysis of the bladder. Clarus. -R. Infus. diosmas f ^vij. Tinct. diosmse, Cubebee, aa. f §Ss. M. Dose. — Two table spoonfuls three times a day. This formula is recommended by Dr. Joy 1 " in chronic diseases of the prostate, bladder, kidneys, gravel, &c," as if the pathological condition to be rectified were, in all these cases, identical ! 1 Tweedie's Library of Medicine, v. 311. London, 1840; or 2d American edit. vol. iii. Philad. 1842. 296 ELECTRO-MAGNETISMUS. ELECTRICITAS, see GALVANISMUS. LXXIV. ELECTRO-MAGNETISMUS. Synontmes. Electro-magnetism, Magnetic Electricity. Electro-magnetism has been introduced amongst therapeutical agencies as adapted for the same cases as electricity and gal- vanism. Various forms of apparatus have been designed; coil machines, and magneto-electric machines: 1 but, perhaps, as Dr. Pereira has remarked, 2 the most convenient, simple, and powerful is the magneto-electric machine of Mr. E. M. Clarke, of London; which consists of a battery of six curved permanent magnets, and an intensity armature, around whose cylinders 1500 yards of fine insulated copper wire are coiled. The ends of this wire commu- nicate respectively with a pair of directors, each holding a piece of sponge, dipped in vinegar, or a solution of common salt. When the armature is rotated, and a portion of the body is interposed between the directors, a succession of shocks is experienced. As this machine is not affected by the moisture of the atmosphere, and acids are not required to excite it, it is possessed of advantages which the galvanic battery has not. EFFECTS ON THE ECONOMY IN DISEASE. Electro-magnetism has been employed in all cases in which vol- taic electricity has been deemed advisable. Mr. E. S. Clarke, who applied it in the wards of Dr. Graves at the Meath Hospital, states that he found it act more quickly in neuralgia 3 than in any other disease. Some varieties it removed in two or three applications, but others often required a feeble electro-magnetic current for many successive days. Next in order of facility came "rheumatic and sciatic cases; then cases of deafness ; after those, some varie- ties of catamenial suppression. It also acted readily on certain curable forms of amaurosis ; then in partial paralysis, and with greater difficulty in hemiplegia than in almost any other form." Dr. Golding Bird, 4 and Dr. Neligan 5 found electro-magnetism of immense advantage in many forms of paralysis ; whilst in Dr. Bence Jones's' 3 trials of it, in the same disease, no benefit was derived in the majority of the cases. Dr. Wm. Davis 7 found it of great value in rheumatic paralysis, in a case of subacute articular rheumatism, which had produced such changes in the locomotive organs, that 1 See the author's General Therapeutics and Mat. Med. 4th edit. i. 510. Philad. 1850. 9 Elements of Mat. Med. and Therap. 3d edit. vol. i. p. 56. Lond. 1849. 8 Graves, System of Clinical Medicine, p. 434. Dublin, 1843. • London Lancet. June 13. 1846, p. 649. ■ London and Edinburgh Monthly Journal of Med. Science, April, 1846. 8 London Journal of Medicine, JNo. 2, 1849. 1 Provincial Medical and Surgical Journal, Nov. 15, 1848. ELECTRO-MAGNETISMUS. 297 the patient was unable to walk or use her hands; and Professor Kubik 1 bears equally favourable testimony to it in the same affec- tions. An anomalous case belonging to the neuroses was laid before the Sheffield Medical Society ; a summary of which is given by Mr. Law. 3 A lady, 51 years of age, had suffered from neuralgia of the right inferior maxillary nerve, when she was suddenly seized with vomiting ; fainted, and lost power over the arms when in the upright, but not when in the recumbent posture. Soon afterwards she found it impossible to swallow, and the sickness subsided: after this, she had paralysis of the left side of the face, and of the right arm and leg. Nothing could be introduced into the stomach except through an oesophagus tube. Electro-magnetism was applied to the back of the neck and chest in the course of the oesophagus, to the left side of the face, and from the spine in the course of the nerves to the right arm and leg. This was done for one hour at least, three times a day for a month, and afterwards twice a day. Nutritious and stimulating substances were passed dow T n into the stomach, and quinia and other tonics were adminis- tered. Under this management she completely recovered. "With respect to treatment," says Mr. Law, " the writer doubts whether the electro-magnetism is entitled to the credit of having effected the cure; or whether this should be attributed to the quinine, sti- mulating tonics and great attention which was paid to the digestive organs. Paralysis occasionally terminates favourably quite irre- spectively of medical treatment, and the acknowledged obscurity in which the proximate cause, in the case under consideration, was involved, demands especial caution in assigning to each of the va- rious means employed in the treatment its due share of credit. It is by no means impossible, that the electro-magnetism, instead of having carried off the complaint, retarded the cure, and that this was ultimately accomplished by nature assisted by the general treatment. Until a series of cases treated with electro-magnetism, have been contrasted with a parallel series treated without, it would be unphilosophical to pronounce a decided opinion on this principle as a curative agent in paralysis. Although the writer has employed electro-magnetism in a variety of cases during the last twelve months, yet he has hardly been able to verify a single observation of any one of its numerous and zealous advocates. Dr. Shearman used either the negative or positive pole, as chance directed. Now, Retter asserts, that the former diminishes, whilst the latter augments the powers of life; and J. D. Humphreys, medical galvanist, with Chas. Woodward # and others, says, that the positive pole exerts a salutary influence, by exhilarating the 4 Prag. Vierteljahr, v, 4, 1848; cited in Schmidt's Jahrbucher, u.s. w. No, 2, p. ]59. Jahrganof, 1H49 * Provincial Medical and Surgical Journal, May 15, 1844. 298 ELECTRO-MAGNETISMUS. spirits, and infusing feelings of energy and strength; while the negative excites a sense of exhaustion and of irritation. These writers distinctly state, that the only effect of the negative pole, if applied to the seat of a disease, would be to aggravate its worst symptoms. How are these opinions to be reconciled with Dr. Shearman's belief, that he had cured his patient by the indiscriminate use of the oxidating and deoxidating electricities? Dr. Wilkinson, Dr. Hodgkin, Mr. Ware, and Mr. Carpue, ascribed wonderful power to electro-magnetism in diseases affecting respiration, circulation, digestion and secretion. According to these gentlemen, there is hardly a complaint which it will not either cure or relieve, or an indication in therapeutics, which it will not satisfactorily fulfil. The writer can reconcile the discrepancies between the statements of authors and his own experience only by supposing, that the publications on this subject contain many errors. With respect, however, to the case under consideration, it is right to say the so- ciety (Sheffield Medical,) generally agreed with Dr. Shearman, in ascribing the cure to electro-magnetism; and that Dr. Abercrombie speaks rather favourably of this agent." This case was doubtless one of the large class of anomalous nervous maladies, which require new nervous impressions, and a tonic system of medication. To fulfil the former indication, nothing could be more appropriate than electro-magnetism. The same may be said of a case of hysterical convulsions , which occurred to Dr. Byrne, 1 in a girl, twelve years of age, who was aroused from each paroxysm by having the poles of an ordinary electro-magnetic battery applied — the one to the occiput, the other to the sacrum. Mr. Tuson 2 has recorded observations of a very favourable cha- racter in regard to the benefit of this agent in certain local neu- ralgic affections, the consequence of injury; and it has been ex- tolled by Dr. William Cumming 3 in constipation, and in certain irregularities of the functions of the bowels. Dr. Hays, 4 who, as remarked under Galvanismus, found gal- vanism the most useful remedy in certain cases of amaurosis which fell under his care, employed electro-magnetism in several cases in Wills' Hospital, and in a number in private practice, but with- out its seeming to be productive of the slightest benefit in a single instance; whence he too hastily infers, that for remedial purposes a regular and constant galvanic current would appear to be more useful than the violent shocks produced by interrupted currents, such as are induced by the electro-magnetic apparatus. This is obviously a non sequitur, for the shocks may be diminished so as scarcely to be felt: and^ moreover, theory would suggest, and ex- x Charleston Medical and Surgical Journal, cited in Ranking's Abstract, January to July. 1849, p. 49. a Medical Times, Feb. 24, 1849. 3 London Med. Gazette. Dec. 7, 1849. 4 American Journal of the Med. Sciences, Aug. 1840, p. 288. ELECTRO-MAGNETISMUS. 299 perience has shown, that there are numerous cases in which the excitant and revulsive effect of properly graduated shocks is more serviceable than the regular and constant current. Dr. Kramer 1 has employed the magneto-electric or electro- magnetic current as a remedy for deafness and tinnitus aurium. He found it a decided excitant to the organ of hearing, its action being manifested by convulsive twitchings, pains in the ear, mo- mentary increase in the hearing distance, and aggravation of the tinnitus, either at the time or afterwards; but it did not seem to have any strengthening effect on the nerves, and required to be used with the greatest precaution, and in the mildest manner. The action was strongest when the current was conveyed from the mouth of the Eustachian tube to the external meatus of the affected ear, instead of from one auditory passage to the other. Dr. Thomas Radford 2 employed galvanism with great success in the treatment of cases of uterine hemorrhage, accidental or unavoidable, accompanied by exhaustion, and occurring before, during, or after labour. He considers, from positive trial, that it will be found a most important agent in tedious labour, depending upon want of power in the uterus, and where no mechanical obsta- cles exist. 3 He also suggests the probability of its proving valua- ble in originating uterine action de novo in cases where it may be deemed necessary to induce premature labour; and that it may be worthy of trial in certain cases of menorrhagia in the ungravid state, where, on examination per vaginam, the uterus is found to be atonic, as evidenced by its large, flaccid condition, and the patu- lous state of the fts uteri. His mode of applying it is as follows. Slight shocks are carried through the long axis of the uterus by means of a conductor introduced along the vagina to the os uteri, another being placed externally over the fundus. Shocks may be also passed transversely through the uterus by applying simulta- neously the conductor on each side of the abdomen. The applica- tion must be made at intervals, so as to approximate, as nearly as possible, its effects to the natural labour pains; and be continued so as to meet the exigencies of the case. Successful cases are re- lated by Messrs. Thomas Dorrington/ H.Wilson, 5 Mr. Cleveland, 6 and others. In a case of amenorrhoea, electro-magnetism was used with suc- cess by Dr. Collins. 7 He had applied the electro-magnetic ma- 1 Beitrage zur Ohrenheilkunde, Berlin, 1845; cited in Brit, and For. Med. Review. July, 1847, p. 22. 3 Provincial Medical and Surgical Journal, Sept. 18, 1844, p. 386; and Dublin Quart. Journal, May, 1847. 3 See a case by Mr. Clarke, Dublin Hospital Gazette, March 1, 1845, cited in Braith- waite's Retrospect, January — June, 1846, p. 423. 4 Provincial Med. and Surg. Journal, March 11 and 18, 1846. 5 Ibid. Ap.29, 1846. 6 Dr. G. Bird, Lectures on Electricity and Galvanism, in London Medical Gazette, June 1 1, 1847, 7 London Lancet, Jan. 25, 1845, p. 91. 300 ELECTRO-MAGNETISMUS. chine in some other cases with the happiest effects; and was in- duced to try it in this. He applied one of the buttons on the lumbar region of the spine, and the other in front over the pubic region, using the negative and positive poles alternately to the spine and abdomen: the remedy was continued five days, from five to ten minutes each day, when the catamenia were fully re- established. Dr. Collins adds, that he has used it with good effect in rheumatism. It has likewise been employed with success in amenorrhea and dysmenorrhea, by Dr. Robert L. M'Donnell, of Montreal, 1 and by Dr. Walkly, of Mobile. 2 The former prefers the apparatus sold under the name of the vibrating magnetic machine. When this is in operation, one of the buttons at the free extremity of the electrodes is applied by the physician to the lower portion of the spinal column, corresponding to the point of exit of the sacral nerves, and the other is applied by the patient herself, or by a female attendant, immediately over the pubes. In order to pro- tect the patient from the inconvenience of receiving the shock through the hand which holds the button, a thick glove should be worn. Having desired that one button be kept firmly pressed upon the os pubis, the physician commences by passing the other button along the spine from the occiput to the os coccygis. After this has been done slowly four or five times, the button is kept for five or six minutes immediately over the sacrum, and the electricity is thus passed in an uninterrupted current through the uterus. It is not necessary to put the patient to great torture by increasing the strength of the shocks. More benefit, according to Dr. M'Donnell, will be derived from an uninterrupted and steady transmission of a moderate current than by occasional shocks of great intensity. The current may also be sent transversely through the pelvis, by placing a button on each hip, above the great trochanter. Dr. Walkly 3 thinks electro-magnetism as a parturifacient far preferable to ergot, for the reason, that the pains induced by it are regularly intermittent, as in natural labour, and hence not likely to injure either the mother or the child. The electricity may be applied by placing the negative electrode in a foot-bath with the feet, whilst the positive electrode is placed over the lumbar region, and a succession of shocks passed for from three to five minutes. The application of galvanism to induce and increase parturient contractions of the uterus has often, indeed, been proposed. It was suggested by Herder* in 1803, and by Dr. F. Ramsbotham in 1 British American Journal, cited in Ranking's Half-yearly Abstract, July to Decem- ber, lb46, p. 170. 2 New Orleans Med. and Surg. Journal, July, 1846, p. 52. 3 Op. cit. 4 Diagnostische Praktische Beitrage zur Erweiterung der Geburtshfllfe, Leipz. 1803, cited by Professor Simpson, in Monthly Journal of Medical Science, July, 184(>, p. 33. ELECTRO-MAGNETISMUS. 301 1834, 1 but does not appear to have been employed by them. Several trials were instituted by Professor Simpson, of Edin- burgh, with the view of ascertaining the exact degree of influence which galvanism possesses over the contractile action of the uterus during labour, and consequently the amount of aid which may be expected to be derived from it in any case in which its assistance is had recourse to. His general results were not favourable to it. In one instance the pains were more frequent in their recur- rence, but shorter in their duration during the application of gal- vanism ; in five other cases, it neither increased the average fre- quency of the pains, nor their average duration. In one case, the pains ceased whilst the galvanism was applied, and returned upon its removal. In another, the action ceased whilst the galvanism was applied, and did not return on its withdrawal, nor for 24 hours afterwards. Professor Simpson concludes, that as employed at the present time and in its present mode, it is not a means which can be in any degree relied on to directly excite or in- crease the contractile action of the uterus; " and is so far practi- cally and entirely useless as a stimulant to the parturient action of the uterus." There can be no doubt, however, from the mass of testimony, much of which has been collected by Dr. Channing, 2 of Boston, that uterine contractions may be excited by the powerful stimula- tion which interrupted electro-magnetic currents are capable of inducing. In the opinion of Dr. Golding Bird, 3 electricity is the only really direct emmenagogue with which experience has furnished us. " I do not think," he remarks, " I have ever known it fail to excite menstruation when the uterus is capable of performing this function." " The rule," he adds, " for ensuring success in the great mass of cases of amenorrhcea is sufficiently simple. Improve the general health by exercise and tonics ; remove the accumula- tions often present in the bowels by appropriate purgatives ; and then a few electrical shocks, — often a single one will be sufficient to produce menstruation, and at once to restore the previous deficient function." As the author has elsewhere 4 remarked, however, im- provement of the general health is itself an efficient agency in the removal of amenorrhcea. An admirable mode of using it, ac- cording to Dr. Channing, is the hip-bath, in which one of the poles of the electro-magnetic or galvanic apparatus is immersed near the organs to be especially acted upon. The other handle is applied in the course of the spine, or in the bath on the opposite 1 Simpson, Op. cit. 2 Notes on the Medical Application of Electricity. Boston, 1849. s Lond. Med. Gaz., June 11, 1847. 4 General Therapeutics and Mat. Med., 4th edit., i. 422. Fhilad. 1850. 20 302 ELECTRO-MAGNETISMUS. side of the body. Dr. Tracy E. Waller l recommends it as a valuable agent in prolapsus uteri. An interesting case of poisoning by opium is recorded by Dr. Thomas S. Page, 2 of Valparaiso, in which electro-magnetism was successfully employed to cure the patient. The breathing had become short and hurried ; the mouth widely extended, and jaw fallen; nothing seemed capable of rousing him; the exhaustion was extreme; the pulse could be felt feebly at the wrist, and was maintained there, in Dr. Page's opinion, by the agitation which he had undergone. Electro-magnetism was now applied. Whilst an assistant rapidly rotated the wheel, Dr. Page applied the balls at first to each side of the neck, and ran them down be- hind the clavicles. The arms and body moved convulsively, but the patient lay as unconscious as before. He now passed one ball over the region of the heart, and the other to a corre- sponding point on the right side. In an instant the eyes opened, and with a ghastly expression of countenance the head and body were thrown convulsively toward Dr. Page, and he groaned. He now sank back into his reclining posture, and was again asleep. The balls were reapplied in the same situation with similar results a third and a fourth time, when he cried out: — "no more!" Re- action was now positively established. Dr. Page suggests, that electro-magnetism will not only be found a most useful agent in cases like the above; but in highly congestive forms of disease, where oppression of the nervous sys- tem prevents reaction and speedily destroys life. In all cases of asphyxia he considers it will be useful, and believes that m very many instances it might be applied with the happiest effects in asphyxia neonatorum. When employed — as every form of electricity occasionally is — to modify the function of nutrition for the removal of morbid growths, or to promote the absorption of effused fluid, as in hy- drocele; 3 magneto-electricity is most commonly administered in the way of electro-puncture; yet excellent effects are not unfrequently induced by the employment of the magneto-electric influence in the shape of shocks passed through the part affected for a longer or shorter period. 1 Medical Examiner, April, 1848, p. 238. 3 Amcr. Journ. of the Medical Sciences, Aug. 1843, p. 301. 3 Ogier, in Southern Journal of Medicine and Surgery, No. 3, and Frost, Charles- ton Med. Journal, July, 1848. ELECTRO-PUNCTURA AND GALVANOPUNCTURA. 303 LXXV. ELECTRO-PUNCTURA, GALVANO-PUNCTU'RA. Stnonymes. Electro-puncture, Electro-puncturation, Galvano-puncturaj Galvano-puncture, Galvano-puncturation. German. Elect ropunctur, Galvanopunctur. Electro-puncture consists in a union of acupuncture with elec- tricity. The idea of the conjunction appears to have originated with Berlioz; but Sarlandiere was, doubtless, the first who put it in practice, although J, Cloquet has contested the priority with him — a matter, by the way, as in all such cases, of extremely small moment. The operation consists in employing acupunctu- ration in the usual way, either with a single needle, or with two or more ; and making a communication between them and the prime conductor of an electrical machine in action ; or they may be made to form part of the circuit in the discharge of a Leyden jar. In this way, the electrical influence may be graduated from the simple aura to a full shock. Sarlandiere appears to have em- ployed electro-puncture with great success; but he restricts its use to rheumatic or neuralgic pains, uncomplicated with organic mis- chief or inflammation: when such complications exist, he advises that bloodletting and general antiphlogistics should be premised. Guersent thinks it better, in all these cases, to use simple acu- puncturation, and only to employ electro-puncture when the first proves to be inadequate, as in paralysis, and in tremors produced by the immoderate use of mercury; in all cases, indeed, in which the malady depends on a diminution of the nervous energy. A case of success from its use in paralysis of the right arm, in which voluntary motion and sensibility were destroyed, has been pub- lished. 2 The patient w T as, in the first instance, subjected to the use of blisters and moxas along the course of the radial nerve, from which he obtained some advantage. The remedy which succeeded best, however, was electro-puncture along the nerves from the shoulder to the hand. At first, the punctures were but little felt; but afterwards they w T ere very painful. The sensibility, mobility, and strength of the fingers and hand gradually returned ; and, three months after his admission, the patient left the hospital completely cured, Galvano-puncture has likewise been used by M. Jobert" 5 for the treatment of deafness dependent upon paralysis of the acou- stic nerve. He introduces Itard's sound through the nasal fossae 1 E. Gr'afe,art. Electro- punctura, in Encyclop'ad. Worterb. der" Medicinisch.Wissensch. x. 550. Berlin, 1834. * La Lancette Franeaise, Dec 20, 1836; cited in Amer. Med. Intel., Oct. 16, 1837, p. 265. 3 Cited from L'Examinateur Medicale, in Lond. Med. Gaz., June 2, 1843, p 356. 304 ELECTRO-FUNCTURA AND GALVANO-PUNCTURA. into the Eustachian tube; and into this sound a long *thin acu- puncture-needle is passed, so as to fix itself in a point of the parietes of the tube, whilst the other extremity projects from the end of the sound. Another acupuncture-needle is implanted in the membrana tympani. This being done, one of the conducting wires of a galvanic battery, the trough of which is filled with water and chlorohydric acid, is passed through the eye of one of the needles, and the end of the other conducting wire is made to touch the opposite needle. M. Jobert has used in the beginning eight pairs of plates of the battery ; afterwards, ten and twelve pairs, and as high as eighteen; and he asserts, that he has patients who have been acted upon by the entire pile, which contains forty pairs. At the moment the poles are placed in contact, there is a very painful shock in the ear and head, with convulsive movements; but the shock and pain usually cease immediately. In one patient, the impression was felt for eight days; but it never exceeded a slight pain, and ceased of itself. When the patient was irritable, only one shock was given ; but he has given two and even three shocks to persons whose sensibility was obtuse, and who had been already subjected to electro-puncture. In general, he permitted eight days to elapse between each trial. He relates four cases of well marked deafness, which were completely cured, one after a single shock; another after two shocks; and a third after two sit- tings, each consisting of three galvanic shocks. The author has frequently used both electro-puncture and gal- vano-puncture in rheumatic and neuralgic affections; but he does not think the advantages were more marked than those of simple acupuncture, whilst the suffering from the operation was certainly greater. Magendie regards electro-puncture as the re- medy par exce lien ce in the treatment of obstinate neuralgia} In rheumatism of the chronic form, it has afforded almost in- stantaneous relief; and M. Raciborski 2 found it of essential advan- tage in cases of sprains. Magendie affirms, that he has treated many cases of incomplete amaurosis with great success by galvano-puncture. He fixed a needle in the frontal nerve, and another in the superior max- illary, making these communicate respectively with the poles of a galvanic pile of twelve pairs of plates, each six inches square. Whenever the contact was made, the patient experienced a painful commotion in the course of the nerves, and at the bottom of the orbit; light became better appreciated, and the pupil contracted. A case has been reported by Dr. Dacamina 3 of palsy of the 1 Medico- Chirunr. Rev. July, 1841, p. 202; see, also, Dr. Shuster, cited in Lond. and Edinb. Monthly Joum. of Med. Science, June, 1844, p. 510; and Dr. Cowan, in Address before the Provincial Med. and Surg. Association, cited in Braithwaite's Retrospects, Amer.edit. xii. 36. N. Y. 1845. a Cited in Southern Medical and Surgical Journal, July, 1846, p. 436. 3 Psychological Journal, January, 1840. ELECTRO-PUNCTURA AND GALVANO-PUNCTURA. 305 tongue, which was cured by it. In 1813, an old woman was seized with general paralysis of sensation and motion in conse- quence of fright. This passed away, except as regarded the arms, head and tongue. She was unable to articulate a word. Twenty- three years afterwards, Dr. Dacamina had recourse to galvano- puncture, — one pole of the apparatus being applied to the occipital nerve by means of a needle introduced into the neck, and the other to the tip of the tongue. After two applications, the patient could raise the organ ; and after the third, she could reply to some ques- tions intelligibly, although w T ith difficulty. After this, the points of contact were varied, and the electricity was applied to different parts. The patient gradually recovered her speech, and the other palsied parts were also cured. In cases of asphyxia, galvano-puncture has been proposed to arouse the dormant energies. The effect of electricity, in the dif- ferent forms in which it is adopted in medicine, on the functions of sensibility and muscular contraction, could not fail to suggest it early to observers as a fit agent for this purpose: but it is rarely at hand, and, therefore, seldom available. J. P. Frank, Thillaye, 1 and others have highly recommended it ; — the latter gentleman, on the strength of numerous experiments on animals. As the ob- ject, in these cases, is to arouse the respiratory muscles to action, the electric shock may be passed through the shoulders or the chest in any direction. Neither common nor galvanic electricity is possessed of much — if any — power to restore the action of the in- voluntary muscles. The author has frequently attempted to re- excite the action of the heart, intestines, fibres of the uterus, &c. soon after the cessation of respiration and circulation, by means of the galvanic stimulus, but without the slightest success, although the voluntary muscles responded to it energetically. Besides, were the action of the heart re-excited by it, this could be but momentary. A necessary stimulating agency to that viscus is distention by the proper fluid, and unless the respiratory move- ments were restored, and conversion of venous to arterial blood effected, so that the latter could reach the left heart, the action of that organ could not be maintained. Every attempt, therefore, is properly made to restore the action of the respiratory muscles, so that hsematosis may be accomplished. 2 M. Leroy d'Etiolles 3 has suggested galvano-puncture in a man- ner which, at the first aspect, appears most formidable; but which is really less so than it seems to be, in consequence of the impu- nity with which fine needles can be made to penetrate, as has been 1 Archives Generates de Medecine, torn. xii. * Art. Asphyxia, by the author, in the American Cyclopedia of Practical Medicine, partx. p. 486, Sept, 1836; and in his Practice of Medicine, 3d edit. i. 475. Philad. 1848. Magendie's Journal de Physiologie, torn. vii. torn. viii. and torn, ix.; also, Recherches Experimentales sinM'Asphyxie, Paris, 1829; and Bourgeois. Observations sur la possibility du retour a la vie dans plusieurs cas d'Asphyxie. Paris, 1829. 306 ELECTRO-PUNCTURA AND GALVANO-PUNCTURA. seen, 1 even the most important organs. He introduced an acu- puncture needle on each side, between the eighth and ninth ribs, until it reached the fibres of the diaphragm. He then established a galvanic current between the needles by means of a pile of twenty-five or thirty pairs of plates, an inch in diameter. The diaphragm immediately contracted, and an inspiration was accom- plished. He then interrupted the circle, when the diaphragm, urged by the weight of the abdominal viscera, and, aided by gen- tle pressure made on the abdomen by the hand, returned to its former position, and an expiration was effected. In this way, the two respiratory acts were made to succeed each other, and regular respiration was reinduced. A continuous current was likewise employed in some cases; but the respiratory movements were irregular, and nothing like natural respiration resulted. Leroy tried his method on animals asphyxied by submersion; and when they had not been under water more than five minutes, they were often restored. These experiments were witnessed by Magendie. 3 On different occasions, M. Leroy asphyxied animals of the same kind, and ap- parently of the same strength, and while those that were left to themselves perished, those that were treated by galvanism re- covered. As an aid, therefore, to pulmonary insufflation, and an important one, galvanism, — combined or not with acupuncturation, — might be advantageously employed in asphyxia, but, as has been already remarked, it can rarely be available. Certainly, no time should be lost in adopting the other energetic and indispen- sable measures that are demanded. 3 It has been recommended, that as only a very small apparatus is necessary, batteries, con- sisting of a few plates, might be kept wherever there are station- houses for the reception of persons in a state of asphyxia. 4 The suggestion is good; and they might also with propriety form a part of the cabinet of apparatus of the private practitioner; but whilst an assistant is preparing the apparatus for action, the prac- titioner should be assiduously engaged in employing other means of resuscitation. 5 In a paper read before the French Academy of Sciences, in January, L843, Dr. Shuster 6 reported the following conclusions as the result of his employment of electro-puncture in disease. First, Electricity is only useful as a therapeutical agent when in- troduced into the substance of the affected organs by means of acupuncture. Secondly, Galvanic electricity and the electro- magnetic fluid, when employed by acupuncture, constitute the 1 See art. Acupuncture, p. 51. a Journal de Physiologie, ix. 3 See art. Asphyxia. Op. cit. p. 486. * Kay, in Edinburgh Med. and Surg. Journal, xxix., and in his work on Asphyxia. London, 1 834. * See Most, Art. Galvanismus, in Encyklopad. der gesammten medicin. und chirur- Praxis, u. s. w. 2te Auflage. Leipz. Id36. 6 Op. cit. ELECTRO-PUNCTURA AND GALVANO-PUNCTURA. 307 most powerful and harmless agents that we possess. Thirdly, The affections in which electro-puncture may be employed suc- cessfully are: — First, hydrocele, ascites (idiopathic or sympto- matic of curable lesions,) hydrothorax, and articular dropsies. Its use may be extended to chronic hydrocephalus, dropsy of the pericardium, and the greater part of dropsical effusions. Secondly, lipomatous, steatomatous, atheromatous, melice- rous, serous and synovial cysts. Thirdly, congestions and indurations, chiefly those of the lymphatic glands, of the testi- cles and epididymis; indurations of the areolar tissue in the neighbourhood of certain kinds of ulcers, and in the walls of fistu- lous passages, and certain indolent tumefactions; and there would be nothing irrational, he properly remarks, in attacking cancerous affections in the same way. Fourthly, goitre. Fifthly, varicose dilatations, especially when electro-puncture can be aided by rest and compression ; and he does not despair to employ it with advantage in cases of aneurism and erectile tumours. Sixthly, chronic rheumatism, neuralgia, and cer- tain nervous diseases. Seventhly, paralytic affections in ge- neral, but especially those of the retina, (amaurose asthenique,) and of the muscles of the voice, (mutisme paralytique.) M. Zenobi Pechioli 1 has detailed a case of double hydrocele in which he employed electro-puncture. Two needles were in- serted, one into the upper, the other into the under, part of the tumour. These were connected to opposite poles of a voltaic pile, and the electric fluid was passed in a continued current for five minutes, when it had to be discontinued in consequence of the right testicle becoming painful. Five minutes after the removal of the needles, both hydroceles disappeared completely. In the evening, redness and heat of the scrotum occurred, and the right side of the scrotum became oedematous. The operation was re- peated in ten days, and was followed by a like result. Ten days afterwards, it was again resorted to, after which he had no return of the disease. M. Pechioli is of opinion, that the openings made by the common mode of acupuncturation are too small to allow the fluid to escape, and he thinks, that by passing a current of electricity through the hydrocele, the contained fluid is forced out through the sac into the areolar tissue of the scrotum, whence it is removed by absorption. M. Petrequin, 2 of Lyons, has applied electricity to the cure of aneurism in three cases. Two of these he had lost sight of be- fore the influence of the treatment could be duly appreciated. In another case, of aneurism of the temporal artery, galvano- 1 Bulletin delle Scienze Medic, di Bologna, Sept., 1841; cited in Dublin Journal of Med. Sciences, November, 1842, p. 311. 2 Amer. Journal of the Med. Sciences, Jan. 1846, p. 229 ; cited from Med. Times, Nov. 15, 1845; and Revue Medicale, Nov. 1846, p. 340. 308 ELECTRO-PUNCTURA AND GALVANO-PUNCTURA. puncture was performed by the introduction into the tumour of two sharp steel pins crossing each other at right angles; the heads of the pins were then placed in communication with the wires of a voltaic pile, and a shock and sharp pain were ex- perienced, the pain increasing with the intensity of the electric action. The operation lasted ten minutes, and fifteen plates were employed. The pulsations gradually diminished in the tumour during the operation, and, at its close, had entirely disappeared. No accident followed the experiment; and in ten days neither tumefaction nor pulsation could be detected in the spot where the aneurism had existed. M. Petrequin lays down the following precepts, an observance of which, he thinks, will ensure a com- plete coagulation of the blood contained in an aneurismal tumour. First, compression of the artery between the aneurism and the heart during the application of the galvanic agency. Secondly, the pins introduced into the tumour should be numerous, cross each other at right angles, and their surface should be protected by a coat of varnish, in order to prevent unprofitable loss of the electric fluid. Thirdly, after the operation, ice should be applied to the tumour. Successful cases of its employment in aneurism are given by Drs. Bellingham, O'Shaughnessy, 1 Abeille, 2 Borelli, 3 and others; but it has been unsuccessful in the hands of Liston, Phillips and others, and has been very unfavourably reported on by M. Gimelle, 4 before the Academy of Medicine of Paris, who is so impressed with the numerous dangers and the ill success of it, that he desired the Academy to pass an absolute condemnation of it. This was, however, regarded as too extreme a measure, since cases in which the ligature could not be employed, or had been so usually without success, might sometimes be benefitted by this procedure. There can be no doubt that electro-puncture is capable of ma- terially modifying the nutrition of the part on which it is prac- tised, and that it will, consequently, be found to exert power over morbid depositions, solid as well as fluid. 1 Ranking's Half-yearly Abstract, January to July, 1847; Amer. edit., p. 196; and Ib'id. July to December, 1847, p. 203. a Annales de Therapeutique, Novembre, 1847; cited in Ranking, Op. cit, January to June, 1848, p. 107. 3 Schmidt's Jahrbiicher, Bd. lxiv., S. 75; cited in Canstatt und Eisenmann, Jahres- bericht, u. s. w. im Jabre, 1849, v. 145. Erlangen, 1850. * Bulletin de l'Academ. xv. 572-82; cited in British and Foreign Medical Review, July, 1850, p. 268. EMETIA. 309 LXXVI. EMETIA. Syxontmes. Emetina, Emeta. Emetinum, Emetium, Emetine. French. Emetine, La Matiere Vomitive. German. Emetin, BrechstofT. In the year 1817, MM. Pelletier and Magendie, 1 by a series of chemical and physiological experiments, discovered, that the vari- ous kinds of ipecacuanha are indebted for their emetic properties to a peculiar substance to which they gave the name Emetine. This substance possesses the emetic power in a very concentrated state, and has neither the disagreeable smell, nor the nauseous taste of ipecacuanha. They considered, therefore, that it might be advantageously substituted for ipecacuanha on all occasions. There are two varieties of the active principle — the coloured and the pure — which, as Magendie remarks, 2 bear the same rela- tion to each other as moist sugar does to the white and crystal- lized. Ipecacuanha, derived from cephaelis ipecacuanha, contains the most emetia. Emetia has been received into many of the Pharmacopoeias, as the Parisian, Batavian, Hanoverian, &c. METHOD OF PREPARING. 1. Coloured Emetia. — Powdered ipecacuanha is digested in ether at 60° (.720) to dissolve the fatty matter whence it derives its disagreeable odour, and which possesses no emetic virtue. When the powder yields nothing more to ether, it is ex- hausted by means of alcohol : the alcohol is then evaporated in a water-bath, and the residue is dissolved in cold water. It thus loses some of the wax, and a little fatty matter, which still ad- hered to it; it is then only necessary to mix it with carbonate of magnesia, whereby it loses its gallic acid, — to redissolve it in alcohol, and to evaporate to dryness. By a similar process, M.Boullay obtained from the roots, leaves, flowers and seeds of Viola odorata, an active, alkaline, bitter and acrid principle, similar to emetia from ipecacuanha, which he denominates emetine of the violet, indigenous emetine or vio- line. According to Orfila, it possesses highly poisonous qualities. 3 2. Pure emetia — Cepha'elinum, of BischofT. — This is obtained by substituting calcined magnesia for the carbonate used in the process just described, in such quantity, that the acid existing in the liquid may be neutralized, and that which is associated with the emetia be separated from it. The precipitate of magnesia and emetia must now be washed with a little very cold water, to re- move the colouring matter, which is not combined with magnesia ; 1 Journal de Pharmacie, iii. 145; and Magendie's Formulaire pour la preparation de plusieurs nouveaux medicamens, &c. * Op. cit. 3 Journal De Pharmacie, Janvier, 1824. 310 EMETIA. and, after being carefully dried, it must be treated with alcohol, which dissolves the emetia. The einetia obtained by the evapo- ration of the alcohol, must then be dissolved in a dilute acid, and treated with pure animal charcoal. After this purification, the emetia must be precipitated by a salifiable base. The waters used to wash the magnesian precipitate still contain emetia, which may be separated by a second series of operations. Coloured emetia appears in the form of reddish brown, trans- parent scales; is almost inodorous, and of a bitter, but not nau- seous taste. It can withstand the heat of boiling water without experiencing change; is very deliquescent, soluble in water, and not crystallizable. Pure emetia has a white and frequently a somewhat yellowish appearance; is pulverulent, and does not deliquesce, like the for- mer, in the air. In cold water, it is but little soluble; more so in warm. In ether arid alcohol, it dissolves readily. Its taste is feebly bitter. It has an alkaline reaction, is dissolved by all the acids — diminishing their acidity, but without wholly neutralizing them. With the acids it forms crystallizable compounds, from which it may be precipitated by galls, which are the best agents for obviating the effects of emetia, when given in too large a dose. EFFECTS ON THE ECONOMY IN HEALTH. According to Magendie, 1 from half a grain to two or three grains of coloured emetia given to dogs and cats, excited vomit- ing, at times followed by long sleep. In larger doses, — ten grains, for example, — it occasioned, in dogs, repeated vomiting, after which the animal fell asleep, and generally died in twenty-four hours. On dissection, violent inflammation was found in the lungs, and in the mucous membrane of the stomach and bowels through- out their whole extent. The effects were the same when the emetia was injected into the jugular vein, or absorbed from any part of the body. In a healthy man, two grains of coloured emetia taken fasting, produced repeated vomiting, to which suc- ceeded a decided disposition to sleep. Even a quarter of a grain, at times, induced nausea and vomiting. It acted also on the bowels. The effects of pure emetia are analogous, but more powerful: two grains were sufficient to kill a strong dog. EFFECTS ON THE ECONOMY IN DISEASE. The same effects are induced on the morbid as on the healthy economy. Magendie recommends the administration of coloured emetia — as the pure is much too dear — in every case where it is desirable to excite vomiting, and especially where ipecacuanha is indicated. It has not, however, been much used, except by Ma- gendie himself. M. Lerminier, who prescribed it, says that one or 1 Op. citat. EMETIA. 311 two grains of coloured eraetia are equal in strength to from ten to twenty of ipecacuanha ; but that he observed no difference in their operation, and Dr. Domeier 1 appears to have arrived at the same conclusion. The obvious advantages it possesses are — the con- venient and agreeable form under which it may be administered, and the circumstance that several spurious sorts of ipecacuanha are frequently passed off in commerce, and occasion, in conse- quence, considerable disappointment in the mind of the practitioner. The employment of the active principle of course precludes these inconveniences. 2 Prollius has frequently administered pure emetia, which he re- commends as a substitute for ipecacuanha, on the grounds above mentioned; and he properly adds, that the price is not a matter of so much moment as it might seem to be, by reason of the very small quantity required to produce the desired effects. When made into an ointment, with lard, and rubbed on the skin, it produces a great number of small painful pustules, which neither suppurate nor leave pits. It may be used in all cases in which the unguentum antimonii is needed ; and where it cannot be applied, as on the face. It has been rubbed on the chest in dis- eases of the lungs, nervous palpitation, and rheumatic pains? MODE OF ADMINISTRATION. To produce vomiting, three grains of coloured emetia may be dissolved in any vehicle, and given in divided doses, at short in- tervals. In several cases, with Dr. Domeier, 4 one grain was amply sufficient. Of pure emetia, Magendie found, in a man eighty-five years of age, one-sixteenth of a grain enough to in- duce vomiting. He remarks, however, that the man was easily made to vomit. Prollius found the medium dose of pure emetia, for an adult, to be from two-sixteenths to three-sixteenths of a grain ; sometimes it was requisite to give another sixteenth. Very rarely had he to give more than four-sixteenths, or one-fourth of a grain. As, on account of its sparing solubility, pure emetia, when given alone, might be restricted in its operation, Prollius adds an equal portion of tartaric acid, and a little sugar. Mistura e me tise vomitoria. Emetic mixture of emetia. R. Emet. colorat. gr. iv. Infus. flor. aurant. f ^ij. Syrup, flor. aurant. f ^ss. M. Dose.— A dessert-spoonful every half hour, — to excite vomit- ing. Any simple distilled water and syrup may be substituted for those of orange flowers. Magendie. 1 London Medical Gazette, Sept. 14, 1839, p. 229. a Clinique Medicale, vol. i. Paris, 1 823. 8 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 108. Erlangen, 1848. 4 Op. citat 312 EMETIA. Pastilli emetiffi pec t o ri ales. Pectoral lozenges ofemetia. R. Emetise colorat. gr. xxxij. Sacchar. ^iv. Mucilag. q. s. ut fiant pastilli, pond. gr. ix. sing. These lozenges are commonly coloured red, to distinguish them from those of ipecacuanha. A little carmine may be added for this purpose. Given in cases of catarrh, hooping-cough, chronic diarrhoea, &c. Dose. — One lozenge occasionally. Magendie. Pastilli emetiae vomitorii. Emetic lozenges of emelia. R. Emetiee colorat. gr. xxxij. Sacch. ,§ij. Mucilag. q. s. ut fiant pastill. pond. gr. xviij. singul. Dose. — One of these lozenges, taken fasting, is generally enough to make a child vomit : three or four are required for an adult. Magendie. Mistura emetiae purificatae vomitoria. Emetic mixture of purified emetia. R. Emetise purif. — in pauxil. acid. nitr. solut. — gr. j. Infus. fior. tiliae f jfiij. Syrup, althaese f ^j. M. Dose. — A dessert spoonful to be given every quarter of an hour, until vomiting is induced. LXXVII. ER'GOTA. Secalinus, Calcar, Secalis Mater, Semina Monstrosa Secalis Cerealis, Ustilago, Clavus Siliginis, Spurred Rye, Corned Rye, The Spur, Ergot, Hornseed. French. Seigle ergote, Ergot de Seigle, Ble cornu, Clou de Seigle, Mere de Seigle, Bled avorte, B. farouche, Faux Seigle, Seigle cornu ou cor- rompu, S. k eperon, S. ergotise, S. ivre, S. noir. German. Mutterkorn, Gebarpulver, Afterkorn, Schwarzkorn, Aetzroggen, Hahnensporn. The effects which this substance is capable of exerting on the uterus are so well known as not to need any lengthened descrip- tion. Its employment in parturition having been revived in this country, there are but few who are ignorant of its reputed proper- ties. Certain other effects have, however, been ascribed to it, in very recent times, which require mention. Spurred rye or ergot — the latter being the common name, from ERGOTA. 3] 3 its "spurred" appearance 1 — is usually considered to be the result of a disease in rye, occurring most frequently when a hot summer succeeds a rainy spring. 3 Decandolle, however, regards it as a parasitic fungus, which he terms Sclerotium clavus; whilst Le- veille esteems it to be a fungus giving a coating to the diseased grain — the medical virtues residing in the coating. This fungus he calls Sphacelia segetum. Brande refers it to the Natural Order Fungaceae, and terms it Spermoldia clavus; and in the last edition of the London Pharmacopoeia, it is referred io Acinula clavus of Fries; 3 but, according to Lindley, Fries has no such plant in any of his works; and the only species of Acinula known, Aci- nula candicans, is found on the rotten leaves of the common alder, and among melting snow ; its organization is of another kind from that of the spermoedia; and Fries, who regards the other as a morbid state of the grain of certain grasses, regards acinula as a true fungus. 4 M. Debourge considers, that ergot is an animal product of the telephorus family. The insect deposits a liquid of its own formation on a grain of rye, and produces the ergot; whence it follows, he conceives, that ergot may be produced at pleasure by expressing this liquid upon all the grains of rye that are within a certain period of their maturity. 5 Mr. Smith 6 and Mr. Quekett, 7 however, maintain that ergot is not a fungus but a diseased state of the grain occasioned by the growth of a fungus not previously detected : to this fungus the latter gives the name Ergotastia 8 abort ans or Ergotsetia abor- tifaciens. By the microscope, they discovered sporules, sporidia, or jointed bodies, which appeared to be the reproductive particles of the fungus. 9 Mr. Francis Bauer, 10 who has made ergot a subject of parti- cular study, and who, many years ago, undertook, at the sug- gestion of Sir Joseph Banks, a series of careful microscopical * French, ergot, a "spur." 3 Dr. Wright, Edinb. Med. and Surg. Journ., Jan. 1841. 8 Syst. MycoL 4 Brande's Dictionary of the Materia Medica, p. 233, Lond. 1839. See, also, Venus, Grundriss der Medicin. Receptirkunst, u, s. w. S. 347, Weimar, 1838 ; and the opinions of Schreber, De Geer, Parmentier, Buffon, Von Munchausen, Tessier, Zuckert, Rossig, Hube, Aymen, Robert, Tillet, &c, in Wright, op. cit. 5 S octet es Savantes, in Encyclographie des Sciences Medicales, Avril, 1838; and A. Richard, Elements d'Histoire Naturelle Medicate, 4eme edit. ii. 13, Paris, 1849. 6 Transactions of the Linnean Society of London, xviii. Pt. 3, p. 449. Lond. 1840. 1 Ibid. p. 453, and London Lancet, June 22, 1839, p. 465. See also an abridgment of a communication read by Mr. Quekett before the Linnean Society, Dec. 4, 1838, with illustrative wood cuts, in American Journal of Pharmacy, for July, 1839, p. 116. For remarks on an insect met with in the diseased grain, see a paper by Mr. Muller, of Butler county. Pa., with comments by Dr. Carson, in Amer. Journal of Pharmacy for Jan. 1839, p. 269. 8 From ergota, and ounce, " cause." 9 See the views of Quekett, Zink, Corda and others on the fungus, to which Dr. Pe- reira has given the name Oidium abortifaciens , ergot-mould, from a>ov, "an egg." and eiSa, "resemblance;" in Pereira's Elements of Mat. Med. and Therap. 3d edit. vol. 2, Pt. i., p. 944. Lond. 1850. 10 Transactions of the Linnean Society of London, xviii. Pt. 3, p. 481. Lond. 1S40. 314 ERGOTA. observations with a view to determine the nature and cause of that singular production, does not consider the question as to the cause of the ergot to be finally and satisfactorily settled. He states that he is not convinced that the filamentous fungi with numerous sporidia, pointed out by various recent observers, are the cause or the consequence of the ergot: — because, first— every gramineous plant is equally infected with that minute filamentous fungus, yet very few of these plants produce ergots, — amongst agricultural grains, the rye being the only one that is subject to the disease; and secondly, in autumn all decaying plants are infected with such filamentous fungi and minute sporidia. M. Bauer's investigations led him, however, to determine the ergot to be a morbid condition of the seed. Ergot is in grains, from a third of an inch to an inch and a half long, and from a line to three lines in diameter, usually curved like the spur of a cock, having commonly two longitudinal fur- rows, and often irregularly cracked and fissured. Externally, it is of a dingy-purple hue; internally of a pale grayish-red or gray- ish-white. Its odour is peculiar, fishy and nauseous; taste ob- scurely acrid and disagreeable. Unless excluded from the air, it swells and softens, acquiring a deep black colour and heavy smell; and becoming infested by a little acarus, which is about one-fourth the size of the mite of cheese, and destroys the interior of the er- got, leaving the grain as a mere shell. In four months, seven and a half ounces of fecal matter of the acarus were formed from seven pounds of ergot. 1 The powder becomes quickly damp, and full of animalcules. It ought, therefore, to be fresh: certainly not to be kept for a longer period than two years. To prevent the formation of the parasites, Mr. Rowle 2 keeps a small piece of camphor in the stopper bottle which contains the ergot. This soon annihilates the whole race of insects, and adds greatly to the certainty of the effect of the medicine. The plan had been recommended before by Dr. Bright. 3 It has been advised that the camphor should be mixed with the ergot, in the propor- tion of a grain to a scruple. 4 It has been proposed to dip the dried ergot in a concentrated solution of gum Arabic; to dry this on a plate of white iron; and when it is dry, to repeat the process two or three times; keep- ing it afterwards in a well stopped bottle. 5 A recent writer 15 has advised the following method for preserving it in good con- dition for several years. First. To reduce fresh well dried ergot 1 Pereira. Elements of Mat. Med. and Therap. ii. 016. Lond. 1842 ; or 2d Amer. edit, by Carson,' Philad. 1846. " Lond. Lancet, Aug. 10. 1844. ' * Edinb. Med. and Surg. Journ. No. 141, and Lond. Lancet, Aug. 24, 1844. 4 Mr. Simpson, Lond. Lancet, Sept. 7, 1844. s M. Martin, Journ. de Chim. Med., Avril, 1841. 9 V.Legrip, in Journal de Chimie Medicate, cited in Lond. and Edinb. Montbly Journ. of Med. Science, April, 1845. ERGOTA. 315 to powder. Secondly. To expose the powder to a temperature of 112° or 120° Fahrenheit, in order to dry it thoroughly and quickly. Thirdly. To put it into glass bottles not exceeding a hectogramme, (about three ounces) in size, and seal them herme- tically. Fourthly. To withdraw it from the action of light by shutting it up either in a dark place, or by covering the bottles with black paper. Mr. R. M. Nunn, of Wexford, extols the following plan of pre- servation, of which he speaks from experience. 1 Procure a choice specimen of ergot; reduce it to powder; have in readiness a suffi- cient number of two dram bottles; into each bottle put one dram, of sulphuric ether, (alcohol may do as well) and then press in two drams of the powdered drug : (if the bottles are of the proper size, a slight pressure will be necessary to make them hold this quantity:) then cork well, and either seal with wax or cover with bladder. When required for use, put the contents of one of the bottles into a tumbler; and pour on them a small quantity of boiling water: violent effervescence takes place, which speedily subsides, and during w 7 hich the ether is evaporated. As much boiling water may then be added as is necessary. It is instantly fit for use. As it is important to judge between a good and a bad specimen Dr. Wright remarks, 2 that if it be clear and smooth on the sur- face; not powdery; of a deep purple colour; neither entirely black nor light brown; having a full strong odour; breaking clear- ly; exhibiting a pink blush interiorly; unpunctured by insects; burning with a clear jetting flame, and of a less specific gravity than water, its activity may be trusted. It has been affirmed, as the result of actual trials, that ergot picked from growing rye is much more powerful than that which is gathered on the barn floor after the grain had been threshed. 3 When examined by the microscope, the internal structure of ergot is found to consist of minute roundish cells, many of which contain particles of oil. The bloom seen, at times, on its surface, seems to be composed of the sporidia of the fungus, to which it is believed by many to owe its origin. 4 Chemical analysis has thrown no light on the cause of its pro- perties. According to the analysis of Vauquelin 5 it contains a colouring matter of a yellowish hue; a white oily substance; a vio- let-colouring matter insoluble in alcohol; a free acid, which is in part phosphoric; a very abundant vegeto-animal matter, which is greatly disposed to putrefaction, and furnishes much thick oil and ammonia on distillation: and a small quantity of free ammonia, 1 London Lancet, cited in Med. Examiner, Oct. 19, 1844, p. 251. 2 Etlinb. Med. and Surg. Journ. Oct. 1839, p. 296. 3 Bottcher and Kluge, cited by Christison, Dispensatory, p. 414. Edinb. 1842. * Christison, Op. cit., p. 4 1 1 . Edinb. 1 842. 8 Memoir, du Museum, iii. 198, Paris, 1817. •316 ERGOTA. which may be obtained at the temperature of boiling water. A more recent analysis has been made by Maas, 1 of Hamburg. He found it contain gluten; ammonia or a peculiar alkali; acetic acid; a violet-colouring matter: resin; fixed oil ; an alkaline acetate; but neither starch, hydrocyanic acid, narcotina, nor phosphoric acid, which some had discovered in it. 2 It has likewise been analyzed by Bonvoisin, Pettenkofer, Winkler, Robert, Wiggers, 3 Legrip, 4 and others. The analysis of Wiggers is very elabo- rate. The results were, — a thick white oil, 35.000 ; white fatty matter, 1.0456 ; cerin, 0.7578 ; fungin, 46.1862 ; ergotin, 1.2466; osmazome, 7.7645; sugar, 1.5530 ; gum extractive and colouring matter, 2.3250; vegetable albumen, 1.4600; phosphoric acid and phosphate of potassa, 4.4221; phosphate of lime and traces of iron, 0.2922; silica, 1394. Dr. Wright's 5 analysis furnished him with the following constituents and their proportions in 100 parts of ergot; thick white oil, 31.00; osmazome, 5.50 ; mucilage, 9.00; gluten, 7.00 ; fungin, 11.40 ; colouring matter, 3.59 ; fecula, 26.00 ; salt, 3.10 ; loss, 3.50. Ergot appears to him to differ from sound rye, chiefly in the presence of oil, osmazome and fun- gin. He gives the following process for preparing the oil of ergot. 6 Digest ergot in liquor potassse, at a temperature of from 120° to 150°, until a perfect saponaceous mixture is formed. The liquid must then be diluted with half its weight of water, be accu- rately neutralized by sulphuric acid, and submitted to distillation from a sail-water or oil bath. The product is white, adhesive, and fatty-looking, almost free from empyreuma, and nearly tasteless. The readiest and best, but most expensive mode of obtaining it, is to pass ether through ergot in fine powder by the process of displacement. By allowing the ether to evaporate spontaneously, the oil is left in its purest form. 7 This Dr. Wright considers to be the active matter of ergot ; and he states — as the result of positive experiment — that it has the same effect in inducing power- ful uterine contractions as ergot itself. EFFECTS ON THE ECONOMY. The effects produced on the animal economy by ergot, when eaten as food, are extremely injurious; the aggregate of the symp- toms has been termed Ergotism. At times they are limited to vertigo, spasms, and convulsions, with a peculiar tingling or for- mication in the arms and legs, which has given the affection the 1 Bulletin des Sciences Medicales de Ferussac, xix. 332; and Merat and De Lens, Diet, de Mat. Med. art. Ergot. 3 For Mr. Battley's Analysis, see Lond. Med. Gaz., Feb. 1831 , and for that of Wig- gers, Lancet, Nov. 10, 1832, cited from Allgem. Med. Zeitung. 3 Wright, Edinb. Med. and Surg. Journal, Oct 1S39, p. 298. * Bouchardat, Annuaire de Therapeutique, pour 1845, p. 44. Paris, 1845. * Op. cit. 6 Edinb. Med. and Surg. Journal, July, 1840. 1 Duhamel, Amer. Journal of Pharmacy, July, lS41,p. 95. ERGOTA. 317 name among the Germans ofKriebelkrankheit or "creeping disease." Most commonly, the limbs waste away, lose sensation and the power of motion, and separate from the body by dry gan- grene — constituting gangrenous erethism or mildew mortifica- tion. 1 These, however, are the toxical, not the therapeutical, effects of the agent. 2 The extraordinary property, ascribed to ergot, of assisting the parturient efforts, has long been credited in Germany. Its old German names, Mutterkorn ("womb-grain") and Gebarpul- ver ^ parturient powder" pulvis ad par turn,) are sufficient evi- dences of this notion ; but, for a long time, this was rather a mat- ter of popular than of scientific belief, although the "pulvis partu- rientis " of the Marburg Pharmacopoeia consisted principally of ergot. 3 Upwards of forty years ago, it was recommended in this country by Dr. John Stearns, of Saratoga county, New York, and since that time the weight of testimony adduced in its favour on both sides of the Atlantic has been overwhelming. Still, there are many dis- tinguished individuals, who deny it all power over the uterus both in the unimpregnated and the impregnated state, and who affirm, that it acts only indirectly on that viscus through the general dis- turbance it occasions; and that, therefore— like every other internal agent administered as an abortive — it ought to be esteemed rather indirect than direct in its action. Such is the decided opinion of Jorg, 4 whose attention has been directed to the effects produced by different medicinal agents on the sound and diseased economy, and who goes so far as to affirm, from his experiments and obser- vation, that there is no " farther connexion between these dege- nerate grains and the uterus, than the word Mutter ( c uterus') which is common to both." From his various and varied experi- ments, Dr. Jorg infers, that ergot, when given in small doses, pro- duces little or no effect upon the functions; but that when fresh dried in an oven, and administered in large doses, it oppresses the stomach, occasioning nausea, vomiting, colic, liquid evacuations; destroys the appetite, and injures the digestive powers ; these effects being accompanied by a sense of weight in the head, vertigo, ce- 1 See articles, Convtdsio cer talis, and Ergotism, in the author's Medical Lexicon, 7th edit., Philad. 1848; also, his Therapeutics, p. 272, Philad.,1836 ; or his General Therapeutics and Mat. Med., 4th edit. ii. 197, Philad. 1850 ; and a case of K r ie b el- krankheit, induced by ergot, in Med. Times for July, 1847, recorded by Dr. It. R. Nuttall. 2 See Christison on Poisons, 3d edit. chap. xl. Wright, op. cit. p. 307, and Jan. 1840, p. 9. 3 Wright, op, cit. p. 22. See, on ttie history of Ergot, Ramsbotham, Principles and Practice of Obstetric Medicine and Surgery; appendix, Amer. edit. Philad. 1845. 4 Dass der Gebrauch inner Reizmittel zur Beforderung der Geburt des Kindes unnb- thig, fruchtlos, und gesunden Frauen sogar sch'adlich sei; u. s. w. S. 40, Zeit. 1833. See, also, Pereira, op. cit. p. 919, and Bonjean, in Rapport de MM. Bussy, Pelletier, Dubail, Fremy pere et F. Boudet, in Journ. de Pharmacie, Fevrier, 1842, p. 175. 21 318 ERGOTA. phalalgia, and by general torpor of the system. Under these cir- cumstances, he thinks, it is not difficult to understand, that the connexion between the foetus and the uterus may be modified, and abortion take place. The researches of M. Arnal, 1 satisfied him, that the first action of ergot is on the intestinal canal, in the mu- cous membrane of which it produces an inflammation sui generis (?), and anatomical lesions, which remind the observer of those seen in typhoid fever ; whilst the greater part of the phenomena seen towards the termination of poisoning by it resemble many of those of the same malady. The composition of the blood he found greatly altered. It was rendered more diffluent; a portion of its fibrin was removed; and, if long continued, it produced softening of the gums, and pathological phenomena, analogous to those of scurvy. The author caused various experiments to be instituted with ergot in doses of half a dram, and a scruple, of the powder, and in the form of the oily matter referred to below. These were made on both males and females ; and the general effects were those described by Dr. Jorg ; — when the dose was too large, nausea or vomiting often resulting, with signs of narcosis. They were made, at the author's desire, by Drs. Cottman and M'Kee, at the time resident physicians at the Philadelphia Hospital. 2 A case of narcosis, produced by this drug in the dose of thirty grains — administered for the purpose of restraining a real or supposed tendency to hemorrhage after the expulsion of the placenta— was communicated to the author by Dr. Beckwith, of Raleigh, North Carolina. 3 Dr. Hooker, of New Haven, 4 found, when a quantity of pul- verized ergot was macerated for several days in sulphuric ether, and the liquid evaporated in a glass vessel until it no longer afforded a smell of ether, that there remained at the bottom of the vessel a small quantity of thick heavy oil, resembling in ap- pearance fish oil ; above this was a lighter oil, much more abun- dant than the former, of a light reddish brown colour, and of a sweetish nauseous taste. The light oil was found to be possessed of decidedly narcotic properties. In two experimental cases, the effects of ergot continued apparent for nearly a week ; the pupils of the eye were dilated ; the pulse, respiration, and capillary action were very slow, and the skin livid, — with loss of appetite, general languor and lassitude, and rigidity and soreness of the muscles; 1 See a Resume, by M. Piorry, of the Memoire of M. Arnal, in Bouchardat, An- nuaire de Thcrapeutique pour 1849, p. 124. 2 Amer. Med. Intelligencer, Sept. I, 1839, p. 161. See, also, M. Cordier, in Jouni. Gen. de Med. Avril. 1823, and U. T. De Gravina, in Annali Universali di Medicina, Ottobre, 1839, cited in Brit, and For. Med. Rev. Oct. 1840, p. 555. 3 Amer. Med. Intelligencer, Oct. 15, 1839, p. 213. See, also, Trousseau and Pidoux, Traite de Therap. i. 54G ; Paris, 1837. * Boston Med. and Surg. Journal, x. 298, Boston, 1837. ERGOTA. 319 those of the thighs and other parts of the lower extremities being more particularly affected. For three days, the pulse continued below fifty, with a proportionate infrequency of respiration. 1 In the experiments made with this substance, by Dr. M'Kee, 2 he found that in every case, when given in doses of from ten to forty drops, it at first produced slight exhilaration of the spirits with increase of circulation; but these symptoms were soon fol- lowed by sedation, and in the larger doses by nausea, also. The sedative properties were equally exhibited in experiments insti- tuted on the healthy individual, by Dr. Q. Gibbon, 3 of Salem, New Jersey, with the decoction, extract, and oil. The experi- ments of Dr. De Gravina, 4 led him to infer that ergot is a direct sedative, like digitalis, and hence he considers it a good antiphlo- gistic remedy, and well calculated to lower the vital powers. An ethereal solution has been prepared by Dr. Rees, by digest- ing four ounces of powdered ergot in four fluidounces of ether for seven days. The ether dissolves the fatty matters contained in the drug. It is then poured off, evaaporated to dryness, and the residue again dissolved in two fluidounces of ether. Repeated trials of this preparation have been made by Mr. J. C. W. Lever, 5 who affirms that it acts most powerfully on the parturient powers of the uterus during and after labour. What is singular, — Mr. Lever remarks, — whilst all the other preparations of ergot not un- frequently produce acro-narcosis, he has not once seen these symp- toms supervene on the use of the ethereal solution. He thinks they are most probably caused by some constituent of the drug, which ether does not dissolve, — a view which cannot be recon- ciled with the results of the experiments detailed above. Each ounce of the preparation, Dr. Rees thinks, may be considered equivalent to two ounces of ergot; or fifteen drops to half a dram dose of the powdered drug. Mr. Lever gave it, dropped upon sugar, in doses varying from fifteen drops to thirty, and found that uterine action commenced in twenty minutes or half an hour. Although ergot is capable of producing the acro-narcotic effects described above, 6 their supervention is not desired by those w T ho regard it to be possessed of peculiar powers by which it causes 1 See Amer. Med. Intelligencer, Dec. 15, 1837, p. 329. A case has been recently published, by Dr. Myddleton Michel, of sudden death, which he ascribes to ergot taken with the view of producing abortion in one who, owing to her having been previously afflicted, in two attacks, with well-marked opisthotonos and emprosthotonos and nervous depression of the vital energies, was a fit subject for the occurrence of such fatal re- sults. It does not, however, appear to the author as clearly as it does to the nar- rator of the case, that the sudden — immediate — death, was owing to the toxical influence of the ergot. Charleston Med. Journal and Review for Sept. 1850. 2 Ibid. Sept. 1, 1839, p. 161. 8 Amer. Journ. of the Medical Sciences, Jan., 1844, p. 244. • 4 Op. cit. 5 London Medical Gazette, April 10, 1840, p. 108. 6 Bonjean, cited in Bouchardat, Annuaire de Therapeutique, pour 1843, p. 85. Paris, 1843. 320 ERGOTA. contraction of the uterine fibres of the parturient female, and who administer it with that view. When given in appropriate and properly repeated doses, the uterine action, they assert, becomes more energetic, and the contractions constant and almost unremit- ting; but there is no accompanying disorder. Cases are on record 1 in which it has appeared to induce rupture of the uterus, where the obstacles to delivery were invincible. ; It has been largely administered, and in no country, perhaps, more than in this. Practitioners of eminence — here and elsewhere — have placed the fullest reliance on its powers to excite contraction of the uterine fibres, and although in many of the cases which fell under their observation, the parturient efforts might have recurred without the agency of the ergot, this could scarcely have been the case with the remainder. From the results, therefore, of these cases, we seem compelled to admit, that ergot is possessed of expulsive properties by which it acts upon the parturient uterus ; but that it is capable of producing any effect upon the unimpregnated uterus, or upon the impregnated, at any time except when par- turition has commenced, is denied by many. It has been affirmed, indeed, that in the neighbourhood of Trois Croix, in France, there was, during the season of 1841, an epizootic abortion amongst the cows, which had produced much consternation amongst the farmers ; and that M. Bodin, 2 director of the school of agriculture, had discovered that the grains of rye, and of many other of the gramineae, contained a considerable quantity of ergot. This, he concluded, was the cause of the epizootic. On the other hand, the experiments of Dr. Wright, 3 and of Dr. De Gravina, 4 seem to exhibit the singular fact, that ergot appears to have the power of prolonging gestation in the guinea pig and rabbit, when ad- ministered for a considerable period ! 5 The result of all observa- tions precludes the belief, that the increased parturient efforts resulting from its agency are produced indirectly by violence done to the constitution of the mother, inasmuch as, in most of the recorded cases of benefit accruing from its administration, no such violence would appear to have been perpetrated. Yet, ad- mitting the full power ascribed to ergot, in these cases, it can be rarely necessary to have recourse to it; and it is doubtless often employed, where the propriety of the administration of it, or of any other agent, is extremely questionable. A writer, who places the discovery of its powers in the same rank with that of the vaccine virus, states, that he has administered it in 1500 cases ! 6 But the effect produced by ergot upon the mother has not been 1 Delmas, Journal de Medecine de Montpellier, and Journal de Pharrnacie, Juin, 1842, p. 546. - Journal de Med. et Chirurg. Pratiq. Oct 184 I. 3 Op. cit. 4 Op. cit. * Brit, and For. Med. Review. Oct. 1840, p. 55(5. 6 Wardleworth, Essay on the Chemical. Botanical, Physical and Parturient Proper- ties of the Secale Cornutum. London, 1840. ERGOTA. 321 the only topic of interest in regard to its use in parturition. It has been maintained by many, that, since its introduction, the number of the still-born has augmented, and that observation has sufficiently shown, that where it is given to expedite delivery, more or less danger always accrues to the offspring J 1 either by the induction of asphyxia, or of positive death, owing to the violence of the uterine contractions, or to the deleterious agency of the drug on the foetus in utero. 3 Observations by Dr. Hardy, 3 of Dublin, show, that it exerts a powerful sedative influence on the action of the heart of both mother and foetus. But even were we to admit its prejudicial effect on the foetus to be true — and it has been deposed to by many obstetricians — and that the number of the % still-born is greater than formerly — which, however, appears to be by no means the case — its influence could be but small, and could not account for the statistical differences that have been noticed. 4 Mr. Braithwaite 5 affirms, that in order that ergot should act perniciously on the child, it is necessary that its action on the uterus should be uninterrupted. He has seldom or never seen any bad effects on the child when the patient had some rest between the pains. In many cases, it has been largely adminis- tered, and yet the child has been born alive. Dr. James Patterson, 6 of Glasgow, details the particulars of a case in which the enor- mous quantity of four ounces was given, yet the movements of the child continued lively; and he refers to an excellent paper, now before the author, by Professor Von Busch, 7 of Berlin, which contains a reference to one hundred and seventy-five cases, in which it was given on account of deficient labour-pains. One hundred and seventy-seven children were born ; of these, one hun- dred and forty-tw r o were born alive; eighteen in a state of asphyxia, which was removed by appropriate treatment; and seventeen still born. Of the seventeen dead, seven had evidently died before labour, and were more or less putrid; and ten, during labour; of these, two lost their lives from turning; one from presentation of the breech ; two from prolapsus of the funis ; one from narrow pel- 1 Chevasse, in Transact, of the Provincial Med. and Surg. Association, iv. 306, Lon- don, 1836. Huston, North American Med. and Surg. Journal, 1829; and Chatto, in London Med. Gaz., July 13, 1839, p. 575 ; also, Reports of Med. Society of London, in Lancet, Oct. 26, 1839, p, 168, and Wright, Edinb. Med. and Surg. Journal, Jan., 1840, p. 25. 3 Mojon, in Gaz. Med. de Paris, 19 Janv., 1839; and T. E. Beatty, Dublin Journal of Med. Science, May, 1844, p. 218. 3 Dublin Journal of Medical Science; cited in Med. Examiner, for Jan., 1848, p. 75. 4 Avery, in Transact, of the Med. Society of the State of New York, vol. iii. Pt. 2, p. 185, Albany, 1837. 5 Retrospect of Pract. Med. and Surg., vol. i. No. 1, p. 181, 3d edit. London, 1842. 8 Lond. Med. Gaz., June I, 1839, p. 337. See, on this subject, E. Warren, New England Quarterly Journal of Medicine and Surgery, July, 1842, p. 10. ' Die geburtschulfliche Klinik an der kbniglichen Friedrich-Wilhelms-Universitat zu Berlin, in neue Zeitschrift fur Geburtskunde, u. s. w. B. v. H. i. S. 107. Berlin, 1 837. 322 ERGOT A. vis and detention of the head therein; one from the long duration of the fourth stage of labour; one from a difficult forceps case, which required perforation afterwards; one from a peculiar de- formity of the extremities; and one from no assignable cause; so that, of the one hundred and seventy-seven cases, there was but one which could be referred to the agency of ergot, and there was no reasonable ground for such reference. A recent writer 1 is disposed to think, that ergot, improperly ad- ministered, produces puerperal convulsions as a remote effect, — and that it gives rise to hour-glass contraction, and to a predisposition to hydrocephalus in the early stage of infantile life ! The chief or only cases in which Dr. Catlett seems to think it admissible are, when there is serious hemorrhage, owing to detachment of the placenta, accompanied by deficient uterine tone; and in the latter stage of labour, in checking hemorrhage from whatever cause. Dr. Frank Ramsbotham, 2 who regards ergot as capable of ex- erting specific powers on the uterus at all periods of utero-gestation, and who has referred to several cases of premature labour, induced in his own practice by its use, is disposed to conclude, that al- though it may bring on labour without having recourse to any operation, yet that it does not present a more likely, or indeed, so probable a means of saving the infant as the older method of puncturing the membranes; and he infers, from his experience, that whatever might have been the quantity administered, unless it exerted a decided influence over the uterus, the child suffered no detriment. 3 Dr. Paterson 4 and Mr. Heane 5 have directed ergot successfully in large doses with the view of inducing premature labour. The former of these gentlemen is disposed to think, that its abortive properties are not exerted upon the impregnated uterus at an early period of utero-gestation, but that, at a certain stage of development, the uterine fibres are capable of being excited by it so as to expel the foetus. It would be strange were its agency to be thus restricted. When ergot was found to be possessed of the power of exciting uterine contractions, it was philosophical to employ it in retention of the placenta, in after-pains, 6 and in cases of uterine hemor- rhage, and of convulsions 7 in the parturient state, accompanied by atony of the uterus. 8 In such cases, means of more speedy action 1 Catlett, Edinb. Med. and Surg. Journal, Jan. 1842. 2 London Med. Gaz., June 15th, 1839, p. 420. See, also, Ibid. June 28, 1834. 8 See, on this subject, J. J. Kelso, in London Lancet, June 22, 1839, p. 462; and Duparcque, in Revue Medicale, Mars, 1838. 4 Lond. Med. Gaz., June 1, 1839, p. 332. See, also, Ibid., Sept., 1838. s Ibid., Jan. 26, 1839. For various opinions on this subject, see Dr. Wright, in Edinb. Med. and Surg. Journal, Jan. 1840, p. 27. 6 Hoffman, in Berl. Med. Zeitung, June 29, 1836; and Beatty, in Op. infra cit T Duparcque, Revue Med. Mars, 1838. 8 Von Busch, Op. cit. L 105. ERGOTA. 323 are needed ; but still, cases might arise in which its administration might be serviceable, and several such, attesting the benefit ren- dered by it, have been published. 1 It has been strongly recom- mended, likewise, for the prevention or removal of uterine he- morrhage, by Stearns, 2 Dewees, 3 Bradley, 4 Abraham, 5 Kisch, Trousseau, 6 T. E. Beatty, 7 and others. In a case of copious hemorrhage from the uterus connected with polypus, Mr. Moyle 8 administered two drams of the tincture, which was repeated at intervals, with the effect of inducing uterine contraction and the expulsion of the polypus, " which equalled in size two large pla- centae." He was equally successful in a similar case. Other cases, in which the effect of the ergot was to force down the polypus so that a ligature could be applied to it, have been re- lated by Dr. Somerville and Dr. M'Farlane. 9 The employment of ergot has been extended to amenorrhcea, 10 and dysmenorrhea, and to uterine hemorrhage in the unimpreg- nated female, and many cases have been published in confirmation of its being possessed of decided virtues. 11 It was thought, also, that it might be serviceable, — and was found so by Bazzoni, 12 Negri, Langlet, 13 and others, — in leucorrhcea, and in gonorrhoea, 14 dysentery, 15 &c; and again, as it proved to be useful in uterine hemorrhage, it was conceived that it might exhibit like powers in other hemorrhages ; and, accordingly, it was given in cases of epistaxis, 16 haemoptysis, hcematemesis, hcematuria, &c. In these last cases, it has not been so often employed. 17 The author has frequently administered it in them, but has never had reason to believe that it exerted any efficacy; and such has been the case with MM. Trousseau and Pidoux, 18 Dr. Pereira, 19 and others. 20 * Camps, London Med. Gaz., Jan. 13, 1843. 2 Philada. Journ. of Med. and Phys. Science, v. 44. ^ 3 System of Midwifery. 4 Lancet, April 15, 1837. 5 Ibid. April 22, 1837. 8 Journal des Connoissances, 1839. I Dublin Quarterly Journal of Med. Science, May, 1846, p. 322. 8 Lond. and Edinb. Monthly Journ. of Med. Science, June, 1841. 9 Ibid. Aug. 1841. 10 Enriotti, in Repertorio Med. Chirurg. del Piemonte, cited in Journ. des Connois- sances, Mars, 1838. Langlet, Bulletin Medical Beige, Juin, 1839, p. 125. Dewees, Midwifery, chap. Amenorrhea; Locock, Cyclop, of Practical Medicine, i. 70. Nauche, Nouveau Diet, de Med. et Chirurg., art Ergot; and Dr. Wright, in Med. and Surg. Journal, Jan. 1840, p. 34. See, also, Churchill, (with whom it failed,) Diseases of Females, Amer. Med. Library edit. p. 54. Philada. 1839; and G. Fyfe, Med. Gazette, June 18, 1841. II G. Fyfe, Op. cit. ; and John Yale, Boston Med. and Surg. Journal, July 8, 1846, p. 459. 12 Annali Universali di Medicina, Feb. 1831 ; and Ryan, Medical Formulary, p. 264, 3d edit. London, 1839. 13 Op. citat. 14 Muller, in Rust's Magazin, B. xl. H. iii., cited in Amer. Journal of the Medical Sciences, Feb. 1835, p. 527; Ryan, Op. cit. and Desruelles, Gazette des Hopitaux, 2 Juin, 1842. 15 Mojon, Op. cit. 18 John Yale, loc. cit. 11 Duparcque, Op. cite, and De Gravina, Annali Universali di Medicina, Ottobre, 1839. 18 Traite de Therap. i. 546. Paris, 1837. 19 Elem. of Mat. Med. and Therap. ii. 925. Lond. 1842. 80 See the author's General Therap. and Mat. Med., 4th edit ii. 198. Philad. 1850. 324 ERGOTA. The narcotic or sedative property, however, which it exhibits in certain cases and doses, and the sedative action which it exerts in others, may render it, at times, serviceable in these affections, whatever may have been the process of reasoning which led ori- ginally to its employment. 1 Where hysteria depends upon simple atony of the generative system; or of the nervous and generative systems combined, Dr. Nardo 3 found the internal administration of ergot followed by the rapid removal of the disease. His practice consists in giving about a scruple of the powder mixed with sugar, in divided doses each day, intermitting the dose every third or fourth day. Many cases are related by him to show the efficacy of the practice* — the hysteria, and the irregularity or absence of the menstrual secretion being removed at the same time. In spermatorrhea, too, dependent upon atony or excessive irritation of the genital organs, it has been useful in the dose of from three to five grains three times a day. 3 Dr. Wright 4 affirms, that when applied to an abraded surface, it gives rise to profuse sloughing. He tried it on wounds nearly healed, and in less than 24 hours they discharged purulent matter abundantly, which was generally of an offensive character: and the wounds, thus treated, even under the application of proper curative means, were long and tedious in healing. In the form of powder, he found it very serviceable in arresting hemorrhage : and not simply in a mechanical manner, as was proved by experi- ment. Even in the form of infusion, it possessed the power in an extraordinary degree. Muller divided the popliteal artery in the sheep, and completely arrested the bleeding by lint dipped in an infusion of ergot. The caudal artery, and the anterior crural artery of a horse were cut, and the bleeding was similarly subdued. Dr. Wright says, that he has several times divided the external jugular and the saphena major veins, and has never failed to arrest the hemorrhage by an infusion of ergot, although with arteries he has been generally less successful. In the greater number of his experiments, he used a dilute solution of ergot, in the place of warm water, to sponge the bruised parts, and always succeeded in preventing that continued flow of blood, which is often a serious obstacle to the safe direction of the knife. He consequently re- commends it as a valuable means of preventing troublesome he- morrhage from small vessels in the course of surgical operations; and, upon the same principle, believes the injection of a similar solution into the uterus, in cases of flooding, will be found to an- swer every practical end that can be desired. The decoction has 1 See some remarks on this subject, by the author, in his Amer. Med. Intel, vol. i. p. 2 1 9 a Cited in Edinb. Med. and Surg. Journal, Jan., 1843, p. 225, and in Bouchardat, Annuaire de Therapeutique pour 1843, p. 93. Paris, 1843. 3 Ibid, pour 1848, p. 80. Paris, 1848. * Op. cit., Jan. 1840, p. 20. ERGOTA. 325 proved to be an equally efficacious hasmastatic in the hands of others. 1 In a severe case of epistaxis, Dr. Wright 2 arrested the hemor- rhage by injecting up the nostrils equal parts of very dilute spirit and oil of ergot; and he has little doubt, that in the severe cases of uterine hemorrhage that follow delivery, the injection of the oil diffused through water into the uterus would be productive of the happiest results. It proved also serviceable in arresting he- morrhage after the extraction of a tooth, and from leech-bites. It will be seen, presently, however, that the styptic properties of the ergot have been supposed to reside chiefly, if not exclusively, in the ergdtin, or extract of ergot. Snuffed up the nose, powdered ergot was observed, by M. Cowperat, 3 to have the power of removing the dilatation of the. pupil caused by belladonna. Dr. J. F. M'Evers 4 repeated the experiment, and found that it did not cause any change when employed on the same day with the belladonna ; but, in every case, on the subsequent morning, whilst the pupils were still largely dilated, the ergot had a marked effect in a few minutes. In a case of mydriasis he prescribed it with success. Dr. Wright found the oil a valuable external application in cases of local rheumatism. In three instances, it was entirely suc- cessful. The affected part was well rubbed with it for a quarter of an hour, night and morning until relief was obtained. He states, farther, that it is one of the most valuable remedies with which he is acquainted in toolhach, and has repeatedly known it subdue the pain when creasote had failed. By M. Lisfranc, 5 the powder was employed in the dose of from two to eight grains, in cases of hypertrophy of the uterus of various kinds, whenever reduction of the organ to a less size seemed to be the prominent indication ; and Dr. Perrine 6 has published some cases of periodi- cal disease, in which it was administered with advantage during the intervals; but no farther results appear to have been elicited. M. Payan 7 thinks it demonstrated, that ergot is primarily and essentially an excitant of the spinal marrow; and he conceives, that its action on the uterus, bladder, and muscles of the lower extremities is but secondary, from a reflex action transmitted from the spinal marrow to those organs through the nerves distributed to them. He has given the details of some cases of paraplegia, which seemed to be relieved by it ; an infusion of fifteen grains in 1 Wright, cited in Liston's Lectures, London Lancet, Aug. 31, 1844, p. 69] . 2 Edinb. Med. and Surg. Journ., July, 1840. 3 London Medical Gazette, Sept., 1848. 4 Dublin Quarterly Journal of Med. Science, November, 1848. 5 Pauly's Lisfranc, translated by Lodge, p. 330. Boston, 1839. 8 American Journal of the Medical Sciences for Nov., 1833, p. 279. 1 Revue Medicale, Fevrier et Mars, 1839; and Journal de Pharmacie, Juin, 1842, p. 545. 326 ERGOTA. water being given at first in the course of the day, and the dose being gradually augmented. 1 M. Allier, fils, 2 from having observed, as he believed, contrac- tion of the fibres of the bladder under the administration of ergot, has recommended it highly in cases of retention of urine; and feels himself justified in inferring, from the results of varied ob- servation, that it is capable of restoring to the bladder the con- tractility it may have lost, owing to immoderate distention of its coats by accumulation of urine; — that its action has been evinced in cases in which this kind of paralysis has resisted all known therapeutical agents; and that, owing to the fugacious character of its operation, it ought to be administered at short intervals, in broken doses, and these be long continued. He recommends, that it should be commenced in the quantity of a scruple in the day, divided into six equal parts; that the dose should be afterwards raised to forty grains, and then gradually diminished to a scruple ; and afterwards discontinued by degrees in eight or ten days after the cure, in order to consolidate it. A case of retention in the male, cured by ergot, is recorded by Dr. Kingsley, 3 of Roscrea. Ten grains were given three times a day. Similar testimony is afforded by Dr. J. J. Ross, 4 of Cambusmore, Dr. Houston, of Dublin, Dr. Sainmont, 5 and others. 6 It has been recommended by Dr. Steinbeck, 7 in incontinence of urine, from want of power in the sphincter of the bladder. It was associated, however, with extract of belladonna, nux vomica, and phosphoric acid; so that it is impossible to say what precise influ- ence was exerted by it. Lastly, in the Annates de la Societe de Medicine de Gand, M. Guersant 8 has published two cases in which he administered it with the greatest advantage to effect the expulsion of fragments of calculi after the operation of lithotrity. Twenty-four grains were first given in three doses during the day; but no effect having been produced, the dose was increased to thirty grains, when the patient experienced frequent desire to pass the urine, followed by pain in the hypogastric region, pricking in the limbs, and slight derangement of vision. After using the medicine for five days, fragments of calculi were passed, and, during twenty-four hours, in three times the quantity that had been discharged during the whole previous period subsequent to the operation. 1 See, also, Petrequin, Bulletin de Therapeutique, Mars, 1840. 2 Journal des Connoissances Medico-Chirurgicales, Nov. 1838. s Dublin Medical Press, April 26, 1843. * London and Edinburgh Monthly Journal of Med. Science, Jan. 1844. p. 43. s Gazette des Hopitaux, Juillet, 1848, cited in Schmidt's Jahrbucher, u. s. w. No. 7, S. 17. Jahrgang, 1849. 8 Provincial Medical and Surgical Journal, April 24, 1844. 1 Medicin. Zeitung, cited in Lond. Lancet, March 4, 1843. 8 Journal de Medicine et de Chirurg. Pratiq. Novembre, 1839, ERGOTA. 327 MODE OF ADMINISTRATION. The great difference which has been observed in the effects of ergot has led to the belief, that there must be much difference in the article, and that every care must be taken to have it good. Dr. Ryan, 1 indeed, affirms that not one druggist or chemist in a hundred has it genuine. According to Dr. Wright, if it be clear and smooth on its surface; not powdery; of a deep purple colour; neither entirely black, nor light brown; have a full strong odour; break clearly, exhibiting a pink blush internally; be unpunctured by insects; burn with a clear jetting flame, and be of less specific gravity than water, its activity may be trusted. It must be recently pulverized, too, if we are desirous to count upon its action when given in this form. 2 When prescribed with the view of augmenting parturient energy, it is most commonly perhaps given in powder, in the dose of from ten to twenty grains, repeated every twenty minutes until the effect upon the uterus is elicited. By many, as by M. Arnal, 3 it is considered more active than any of its preparations. Professor Von Busch 4 found the best results when it was given in the dose of ten grains at short intervals — from ten to fifteen minutes. In one case it was requisite to repeat it eight times ; in four cases, six doses were sufficient; in twelve, five; in thirty-three, four, and in the remainder of the one hundred and seventy-five cases, three and less : the smallest quantity exhibited was a single dose of ten grains ; the largest, nine doses often grains. Dr. Ryan 5 says the maximum dose is a dram and a half; but it, obviously, cannot be thus limited. Dr. Samuel Hardy, of Dublin, 6 has observed, that it has always commenced its action within twenty-five minutes at the farthest, when the child has been expelled alive; and that if a longer time than this has elapsed, instruments have been necessary, and the child has been born dead. The beneficial effects of ergot are evi- denced by the pains running into one another without any appre- ciable interval. Professor Beatty, of Dublin, affirms that when delivery was not effected within two hours from its exhibition, the child's life was generally lost ; and such is the result of the obser- vations of Dr. Hardy. 7 Several cases are, however, reported by Mr. J. Pratt, which disprove this statement. In one, three hours elapsed between the taking of the medicine and delivery ; in ano- ther, five hours; in another, three and a half; and in a fourth, six hours; and, in all the cases, fine healthy children were born. 8 Dr. Hooker, who considers, that the ecbolic and the narcotic 1 Formulary, p. 264. 2 Allier, op. cit. * Bouchardat, Annuaire de Therapeutique pour 1849, p. 124. 4 Op. cit. S. 1 06. 5 Op. cit. 6 Dublin Journal of Medical Science, May, 1845. 1 Dublin Journal of Med. Science, cited in Med. Examiner, Jan. 1848, p. 76. 8 Dublin Hospital Gazette, cited in Amer. Journ. of the Medical Sciences, Jan. 1846, p. 244. 328 ERGOTA. properties of ergot may be separated, recommends, in these cases, the clear infusion, which possesses, he conceives, the former pro- perty only. The powder of course contains both. Dr. Bishop, of New Haven, 1 asserts, that he has seen but once any unpleasant effects from ergot, and then he gave it in powder; the labour was protracted and narcotism induced. In New Haven, it is the general practice to administer the infusion, and in that form it is considered safe and effective in parturition. It is not easy, however, to see how the fixed oil can be taken up by hot water. 2 The infusion is termed in France, " Thede Seigle noirci des sages-femmes Americaines"! 2, By some, as will be seen hereafter, the sedative and other properties of ergot have been af- firmed to exist in the aqueous extract or ergotin. It is proper to remark, that the form of infusion, as well as of decoction, was found by Dr. Jorg to be highly unpleasant to the stomach, and it could not be repeated in his experiments — which, it must be remembered, were not made on the parturient female — in large doses for any length of time, without irritating the bowels, pro- ducing loss of appetite, and general impairment of the digestive function. Dr. Wright 4 recommends the oil of ergot to be given in the dose of twenty to fifty drops in tea, weak spirit and water, some aromatic water, or made into an emulsion with mucilage and syrup. It would seem to be the most advisable form of exhibition, as the oil retains its properties for several years, if kept in well closed bottles excluded from light. As to the form of tincture, Mr. Battley affirms, that alcohol will not extract the active property, and Dr. Ryan 5 states, that he has certainly found the tincture to fail in the majority of cases. Mr. Battley prefers the w r atery extract. For the purpose of inducing premature labour, it has been ne- cessary to give ergot in larger doses. Dr. Paterson 6 gave it in the form of infusion, until the patient took six drams of the medicine. The infusion w ? as likewise given by Dr. F. Ramsbotham, 7 and the quantity which each of his patients took varied from two to twelve drams. As a parturifacient, Dr. W. R. Gore 8 has recommended the ammoniacal solution of ergot, a formula for w ? hich is given here- after. This, he says, contains all the active principles in a conve- nient form, and with increased efficacy, the ammonia causing the ergot to act more rapidly, and with greater certainty. When ergot is given w T ith other views, the usual dose is 10 or 1 Amer. Med. Intel. Dec. 15, 1837, p. 330. 3 See the author's General Therapeutics and Mat. Med. 4th edit. i. 429. Philad. 1850. 3 Journal de Pharmacie, Fevrier, 1842, p. 177. 4 Edinb. Med. and Surg. Journal, Julv, 1840. 3 Op. cit. p. 266. 6 Lond. Med. Gazette, June 1, 1839, p. 333, T Ibid. June 15, 1839, p. 421. ERGOTA. 329 15 grains of the powder, three or four times a day : the results of the observations of Dr. Cottman * have shown, however, that in 30 grain doses its sedative effects are more marked. , This, too, was the dose in which it was administered by Dr. Hooker. In such cases, the tincture, and the light oil described by him may also be prescribed; — the latter, in the dose of ten to thirty drops. Infusuni ergots.. Infusion of ergot. R. Ergot. 3j. Aquas bullientis f ^iv. Infunde. Dose. — One third, to be repeated every 15 or 20 minutes in deficiency of uterine contractions. R. Ergot, ^ss. Aquae bullientis f |xxiv. Colaturae adde Syrup, simpl. f gj. Dose. — Two ounces every three or four hours, to induce pre- mature labour. Paterson. R. Ergot. gss. Infunde per semihoram in Aquae bullientis f ^iss. et cola. This quantity to be taken for a dose, and repeated every four hours. F. Ramsbotham. R. Ergot. £ss. Infunde in Aquae bullient. f ^iij. Cola et adde Ergot, in pulv. gr. x. — gr. xv. M. This quantity sweetened with sugar to be taken for a dose. To be repeated in twenty minutes; and if the uterus should not contract well, to be given a third time. S. L. Hardy. R. Ergot, in pulv. crass, gij. (avoirdupois.) Aquae bullient. §ix. Infuse for an hour in a covered vessel and strain. The product should measure about eight ounces. Dublin Pharmacopoeia of 1850. Liquor ergots ammoniacalis. Ammoniacal solution of ergot. Into half a pint of spiritus ammonias aromaticus put four ounces of fresh ergot, bruised coarsely. Let them stand for a month, frequently stirring with a glass rod, after which squeeze out every drop of the spirit. In a glass stoppered bottle, it may be preserved for any length of time without deterioration. Dose. — Thirty drops in a wineglassful of cold water, every 1 American Medical Intelligencer, Sept. 1, 1839, p. 161. 330 ERFOTA. ten minutes, until the action required is sufficient, applying at the same time a gentle pressure with the flat of the hand on the abdomen. When the pains are present, three doses are usually enough. W. R. Gore. Decoctum ergots. Decoction of ergot. R. Ergot, gj. Aquae Oijss. Coque ad Oij. et cola. Dose. — A table-spoonful every quarter of an hour. Tinctura ergots. Tincture of ergot. R. Ergotse in pulv. crass. §viij. (avoirdupois.) Alcohol, dilut. Oij. f Jxl. Macerate for fourteen days, and strain; express, and filter. Five fluidrams contain one dram of ergot. Dublin Pharmacopoeia of\S50. R. Ergot, gijss. Alcohol, dilut. Oj. Macera per dies quatuordecim et cola. Dose. — Twenty minims to two fluidrams, two or three times a day, as a sedative agent. Guy's Hospital. Sympus ergotse. Syrup of ergot. (Sirop de Calcar. — Desgranges.) R. Ergot, gr. xx. Extract, opii. gr. f. Syrup, f §viij. M. Dose. — Two table-spoonfuls (one ounce) in cases of engorge- ment of the uterus. Lisfranc Pnlveres ergots compositi. Compound powders of ergot. (Antihemorrhagic powders. — Ryan. ) R. Ergot. 5ss. Pulv. aromat. ^ss. Sacch. ^ss. M. et divide in chartulas x. Dose. — One, every hour or every second or third hour, in ac- tive hemorrhage from any outlet. In leucorrhoza and gleet, one may be given three or four times a day, and should they fail the following may be substituted. R. Ergot, pulv. 9rj. Cubeb. pulv. §j. Pulv. aromat. £ss. Sacchar. gj. M. et divide in chartulas. viij. Dose. — One, three or four times a day. Ryan. ERGOTA. 331 Pilule ergotae, Pills of ergot. B. Ergot, pulv. gr. ix., xij. vel xviij . Ext. hyoscyam. gr. i. Potass, nitrat. gr. xv. Camphor, pulv. gr. iij. M. et divide in pil. xl. Two to four, every two hours, in cases of urethritis of the prostatic or membranous portion of the canal. Desruelles. Yinum ergots, Wine of ergot, R. Ergot, contus. |jij. Vini Oj. Macerate for 14 days, shaking occasionally ; then express, and filter through paper. Dose.— f 3j. to f 3ij. Pharm. U. $. 1842 Injectio ergotra. Injection of ergot. R. Ergotse |ss. Aq. bullient. Oss. Used in cases of erythemoid vaginitis and urethritis. Desruelles. Extractum ergots. Extract of ergot. — Ergotin. (Ergotine ou Extrait hemostatique, of Bonjean.) Powdered ergot is exhausted by water, by the process of dis- placement, and the watery solution is heated in a water batho At times it coagulates, owing to the presence of a portion of albumen ; at others, it does not. In the former case, the coagulum is sepa- rated by the filter, and the filtered liquor is evaporated in a water- bath, until it has the consistence of a clear syrup. A considerable excess of alcohol is then added, which precipitates all the gummy matters. The mixture is left at rest, until the whole of the gum is precipitated, and the liquid has assumed a state of limpidness. The liquor is then decanted to reduce it in a water-bath to the consistence of a soft extract. In the latter case, the w T atery solu- tion is brought directly to a half syrupy state, and is treated by alcohol as mentioned above, to obtain from it the extract, whichj procured by this process, is soft; of a red or brown colour; very homogeneous ; of an agreeable odour of roast meat, and of a slightly piquant and bitter taste, more or less analogous to that of damaged wheat. It forms with water a limpid solution of a beau- tiful red colour. 500 parts of ergot furnish from 70 to 80 parts of extract. M. Bonjean affirms, contrary, as has been seen, to the opinions of other observers, that whilst ergotin contains the medicinal 332 ERGOTA. property of ergot, the oil and the resin contain the poisonous properties. He considers it a real specific [?] in hemorrhage in general. "When my ergotin," he remarks, "shall have been tried, observers will be struck with the immediate effect it pro- duces in the most frightful (foudroy antes) hemorrhages: the most rebellious cases of hxmatemesis yield in a short time under its use ; and relapses are generally rare, especially when the precaution is taken to continue it's employment some time after the cessation of the symptoms." To be convinced that the ergotin is also the obstetrical principle, we have only to treat pow- dered ergot with ether, by the process of displacement, until the whole of the matter that is soluble in the liquid is exhausted : in this manner the poison is removed, — that is all the oil of ergot and the resin. A powder remains, which is no longer unctuous, but rough like sand, without any disagreeable taste or poisonous influ- ence, and which in the dose of 6 or 8 grains, powerfully excites uterine contractions, in every case of inertia of the womb, in which the employment of ergot would be esteemed proper. 1 Dr. Sachero, 2 Professor of clinical medicine in the University of Turin, prepared two extracts of ergot, the one aqueous, and the other alcoholic. The former had the characters described above, whilst the latter was of a deep brown colour, with no particular smell, and was very pungent and slightly bitter to the taste. The watery extract he regards as a hyposthenic remedy, well adapted for cases of hemorrhage ; the resinous extract, he thinks, probably acts as an excitant; whilst the oily is the poisonous principle. — "The action of the ergot," he remarks, "when administered in its natural state, appears to be of two kinds ; the one, as in labour, affects the sanguineous system, the energy of which it diminishes {hyposthenises,) by means of the ergotin : the other affects the nerves of the uterus, which it stimulates by its resinous principle. To this double action must be added a third, equally hypos- thenic, that of the oily or poisonous principle." Dr. Ebers 3 found ergotin of very marked advantage in ute- rine hemorrhage. He employed it "with the most perfect success" in those forms that are attendant upon cancer of the uterus, and which so greatly exhaust the patient's strength, and lead rapidly to death. These he treated exclusively with ergo- tin, in doses of two grains every two hours. In almost all the cases, twelve doses were sufficient to arrest the hemorrhage. In uterine hemorrhage occurring at different periods of life, in youth, and especially at the critical period, he has found it of equal ad- vantage. 1 Bouchardat, Annuaire de Therapeutique, pour 1843, p. 83, & pour 1844, p. 21. 2 Cited in Lond. and Edinb. Monthly Journ. of Med. Science, Aug. 1844, and in the Amer. Journ. of the Med. Sciences.' Oct. 1844, p. 463. 3 London Medical Gazette, Nov. 1845. ERGOTA. 333 It is proper to remark, that Drs. J. Lawrence Smith and S. D. Sinkler infer, from the results of a trial of ergotin on the divided carotid of a sheep, that it depends greatly, if not altoge- ther, upon the manner in which the lint is applied to the wound of the artery, whether the hemorrhage is arrested or not. If it be placed immediately upon the orifice of the cut vessel, " success is certain : if, however, the vessel shrinks from contact with the lint, the animal is almost certain to bleed to death." 1 Such, also, is the opinion of M. Velpeau, 2 and of M. Bouchardat 3 , the latter of whom had done much to disseminate the views of M. Bonjean. He has concluded, that the facts adduced by M. Bonjean, in "sup- port of his discovery, are very far from presenting the charac- ters of demonstration." "As regards the success on animals," he remarks, " it is well known how plastic their tissues are, and with what ease they are repaired after serious injuries ; and as respects the effects of ergotin on wounds in individuals of the human spe- cies, those that have been hitherto published may be attributed with probability to the circumstances that were associated with the application of the remedy almost as much as to the action of the remedy itself." 4 Mistura extract i ergots. Mixture of extract of ergot* {Potion d'ergotine.) R. Extracti ergotsejgr. xv. Aquae f |iij. Syrup, flor. aurant. seu limonis f ^j. M. Dose. — A table-spoonful every quarter of an hour, in cases of hemorrhage, or of inertia of the uterus. In very violent cases of hemorrhage the quantity of ergota must be increased, and the doses be given more frequently. Bonjean. Syrupus extracti ergotse. Syrup of extract of ergot. (Sir op d'ergotine.) R. Extract, ergot, giiss. Solve in Aq. flor. aurant. seu Aq. rosae f ^j. • Syrupi f §xvj. r Coque syrupum et adde solutum. Dose. — Two to four table-spoonfuls a day, more or less, accord- ing to the urgency of the case. Bonjean. 1 Southern Journal of Medicine and Pharmacy, July, 1846, p. 406. 3 Comptes rend us, 6 Juillet, 1846. 3 Annuaire de Therapeutique, &c, pour 1847, p. 49. Paris, 1847. 4 Annuaire, &c, pour 1848, p. 81. Paris, 1848. 22 4 EUPHORBIA LATHYRIS. Pilule extracti ergots. Pills of extract of ergot. (Pilules d'Ergotine.) R. Extract, ergotse 3j. Glycyrrhiz. pulv. q. s. ut fiant pil. i. Dose.— Six to ten in the day. Bonjean. LXXVIII. EUPHORBIA LATHYRIS. Synonymes. Cataputia Minor, Lathy ris, Tithymalus Latifolius, Caper Spurge. Garden Spurge, Mole Plant. French. E purge, Catapuce. German. Kleines Springkraut, Purgi rko rn er-Euph orbie. The oil of spurge — Oleum Euphorbia Lathyridis — has been recently recommended in medicine. Although the euphor- bia is not a native of this country, it is sometimes met with in situations where it has the appearance of growing wild. It is easily cultivated, and in some parts of New Jersey, where it has been introduced, is found in abundance. 1 The oil obtained from the seeds resembles in colour oleum ricini, but is less dense. It has no odour when newly prepared, and no perceptible taste. It is soluble in sulphuric ether, insoluble in alcohol, and forms a soap with the alkalies. Its s. g. is .920. EFFECTS ON THE ECONOMY IN DISEASE. Dr. Charles Calderini found, that, in the dose of from four to eight drops, it acted as a cathartic on the adult, without occasion- ing colic or tenesmus. In half the quantity, it proved cathartic to children. He gave it in sugared water, or in the form of an emulsion ; and was of opinion that it might be advantageously substituted for castor oil, especially for children. After him, it was employed by M. Grimaud, and subsequently by M. Bally, 2 who carried the dose as far as ten drops, and by M. Martin Solon, 3 at the Hotel-Dieu of Paris, who uses it with excellent effects as a hydragogue cathartic in various diseases, in the dose of from 23 to 46 grains — or one and a half to three grammes. Louis Frank 4 has suggested its employment in cases of taenia, hysteralgia, ascites, &c. It would appear, from the remarks of Mr. Scattergood, that the oil obtained from the beans grown in this country, does not pos- sess the mild qualities ascribed to the European article. Six, eight, 1 Scattergood, in Philad. Journ. of Pharmacy, iv. 124, Philad. 1833. See, also, Journ. de Chimie Med. ii. 178. 2 Journal Universel des Sciences Medicales, xli. 264. 3 Bullet. General deTherapcutique, Aoiit, 1S48. 4 Journ. de Pharrn. xi. 273: and Merat and De Lens, Diet, de Mat. Me'd. iii. 183. Paris, 1831. FERRI PR^PARATA. 335 ten, and twelve drops were given to several individuals as a ca- thartic; and although administered in conjunction with aromatic oils, and in one or two cases with an alkali in the form of soap, it invariably produced nausea, and even vomiting. Mr. Scattergood adds, that he has been informed by the manufacturer, Mr. Thomas Bellangee, of Crosswicks, New Jersey, that when administered in small quantities, and repeated at intervals of half an hour or an hour, it operates on the bowels freely as a cathartic, without producing^much nausea. . PichonnierMias proposed the following formula for a cathartic mixture. Mistura olei euphorbias. Mixture of oil of euphorbia. R. Olei euphorb. lathyr. gtt. viij. Acac. pulv. gj. Sacchar. 5fij. Aquae destillat. f 3 iij. M. LXXIX. FERRI PRiEPARATA. Synonymes. Preparations of Iron. French. Les Preparations de Fer. German. Eisenpraparate. Metallic Iron has long been employed in the cases in which chalybeates in general are indicated. The French Codex directs it to be formed into an impalpable powder prepared by porphyrizing bright and clear iron filings without water. Of late years, it has been proposed by M. Quevenne to reduce the sesquioxide by means of hydrogen, which is done by passing a stream of the gas over the oxide, contained in an iron or porcelain tube heated to low redness. The iron, thus prepared, Ferri pulvis 2 — Lefer re'duit par Vhydrogene — must be kept in a dry, well stopped, bottle, on account of its great liability to oxidation. Mr. Wm. Procter pre- pares it by placing precipitated carbonate of iron on layers of iron- gauze in a tube of wrought iron; passing a stream of hydrogen through it heated to a dull red ; maintaining this for some hours, and keeping up a small current of gas till cool. 3 MM. Miquelard and Quevenne combine it with sugar and choco- late, and form it into granules and pills. 4 M. Raciborski 5 has strongly recommended it in anaemic and, especially, in chlorotic 1 Journ/de Chimie Medicale. Paris, 1827. 2 A formula for this is introduced into the last edition (1850) of the Dublin Pharma- copoeia. 3 R. E. Griffith, Universal Formulary, &c, p. 199. Philad. 1850. 4 Trousseau and Pidoux, Traite de TMrapeutique et de Matiere Medicale, i. 2. Paris, 1847. ■ De la Paberte, &c. Paris, 1844. 336 FERRI ARSENIAS. cases: and it is a favourite chalybeate with the author's col- league, Professor Meigs. 1 The ordinary dose is about two grains three times a day in the form of pill made with sugar and gum. It has not appeared to the author to possess any marked advantage over the carbonate or sesquioxide. LXXX. FERRI ARSENIAS. Synonymes. FerrumArseniatumseu ArsenicicumOxydulatum, Arseniate of Iron, Arseniate of Protoxide of Iron. French. Arseniate de Fer. German. Arsensaures Eisenoxydul, Ar seniksaur es Eisen- oxydul. This preparation has been recommended by Mr. Carmichael, 5 who often applied it externally in cases of cancerous ulcers. Naturally, it presents itself in small, clear, bluish-green crystals, of a regular octahedral shape, and is called scorodite. Artificially, it is formed by double decomposition. METHOD OF PREPARING. Glaser gives the following formula for its preparation: — Eight ounces of semivitrified white arsenic, sprinkled with a little spirit oj 'wine , and reduced to fine powder, are mixed with as much purified saltpetre. The mixture is then placed in an uncovered Hessian crucible, which should only be half filled with it, and then be placed in a wind furnace. At first, a slight degree of heat is applied, under which the mass soon melts, giving off copious red fumes, the inhalation of w T hich should be carefully avoided. The process had better, therefore, be carried on in the open air, or in a laboratory that has a chimney with a good draft. When the mass no longer gives off red fumes, and flows tranquilly, the cru- cible must be carefully removed from the fire, the contents be suffered to cool somewhat, and boiling distilled water be poured upon them : under active boiling they will dissolve altogether. Hot ivater, sufficient to fill the crucible, is now added, and the whole is allowed to remain at rest for twenty-four hours; at the expiration of which time a considerable quantity of beautiful crys- tals of acid arseniate of potassa is found on the sides of the crucible. The fluid, holding the salt in solution, is now filtered into a clean porcelain or glass vessel; the crystals are collected, dried carefully in the shade, and put away amongst the poisons as the idrsenias potassx acidus. The fluid, poured from the crystals and filtered, is now diluted with distilled water, and a solution of pure sulphate of iron 1 Females and their Diseases, p. 371. Philad. 1848. 2 An Essay on the Effects of the Carbonate and other Preparations of Iron upon Can- cer, 2d edit. Dublin, J 809. FERRI ARSENIAS. 337 added thereto so long as any precipitate is thrown down. The bluish-green precipitate, insoluble in water, is the ferri arsenias, which must be collected on a filter, washed and dried in the shade. The process must be conducted with the greatest care, and the vessels used be cautiously cleansed or broken, for fear that mis- chief may arise. In these chemical operations, the acid of the saltpetre is decomposed by being heated with the arsenious acid or white arsenic, a part of its oxygen is taken by the latter, and ar- senic acid is thereby formed, which unites with the potassa of the saltpetre and forms acid arseniate of potassa : the nitric acid be- ing converted into nitrous acid is given off in the form of red fumes : by admixture of a solution of sulphate of iron with the solution of the acid arseniate of potassa, a double decomposition ensues, the result of which is the formation of sulphate of potassa and arse- niate of iron, which last, being insoluble, falls to the bottom of the vessel EFFECTS ON THE ECONOMY. According to Carmichael, this preparation acts more powerfully on the vitality of cancerous formations than any other agent, and the dead slough caused by it is much deeper than that caused by the application — which was at one time so much celebrated — called "Plunket's caustic." He allows, however, that the greatest cau- tion should be observed in its use. Of late, he has employed a compound of arseniate of iron with phosphate of iron; half a dram of the former to two drams of the latter. This mixture must be applied very thin by means of a camel's hair pencil, and not over the whole surface of the ulcer when it is extensive. It has also been administered internally in cancerous affections and lepra, by Cazenave ; and Biett 1 recommends it in lupus, elephantiasis, psoriasis, chronic eczema and lichen. MODE OF ADMINISTRATION. Arseniate of iron may be applied externally in the form of oint- ment, composed of from Bj. to £>ss. to from §ss. to %]. of lard ; or the compound, just mentioned, may be applied in the following manner : — Ungucntum ferri arseniatis compositum. Compound ointment of arseniate of iron, R. Ferri arseniat. gss. phosphat. 3ij. Cerat. cetacei gvi. M. This ointment must be spread on lint and applied to the ulcer. Carmichael fy Wernech. Werneck gives it the preference over all the usual arsenical pre- parations. The dose is from T Vth to f ^th of a grain, made into a pill. 1 Aschenbrenner, Die neueren Arzneimittel, S. 131. Erlangen, 1848. 338 FERRI BROMIDUM. The following formula may be used in cancerous and other affections. PilulSB ferri arseni atis composite. Compound pills of arseniate of iron. R. Ferri arseniat. gr. iij. Extract, gentian, gj. Glycyrrhiz. pulv. £ij. Syrup, cujusvis q. s. ut fiat massa, in pilulas xlviii. dividenda. Dose. — One, three times a day. LXXXI. FERRI BRO'MIDUM. Synonymes. Ferrura Bromatum seu Perbromatum. Brometum Ferricum, Bromated Iron, Bromide of Iron; — in solution, Hydrobromate of Iron, Ferri Hydrobromas, Ferrum Hydrobromicum Oxydatum. French. Bromure de Fer. German. Bromeisen, Eisenbromid, Bromwasserstoffsaures Eisenoxy d. METHOD OF PREPARING. This preparation is made by heating equal parts of bromine and iron filings under water. As soon as the fluid becomes of a greenish colour it is filtered and evaporated to dryness: the reddish residue — again dissolved in water and evaporated — is bromide of iron. It has a brick-red colour ; dissolves readily in water, is deliquescent in the air, and has a very styptic taste.' EFFECTS ON THE ECONOMY, AND MODE OF ADMINISTRATION. Magendie has prescribed it successfully, in cases in which the preparations of bromine have been indicated. (See Brominum, p. 142.) He recommends the following formula. Pilulse ferri bromidi. Pills of bromide of iron. R. Ferri bromid. pulv. gr. xij. Confect. rosae gr. xviij. Acacise pulv. gr. xij. Fiat massa in pilulas xx. dividenda. Dose. — Two, morning and evening. Magendie. R. Ferri bromid. gj. Extract, glycyrrhiz. q. s. ut fiat massa in pilulas Ix. dividenda. Dose. — One or two, morning and evening, in cases of scrofula, and hypertrophy — of the uterus especially. Werneck. 1 Magendie, Formulaire pour la preparation, &c, de plusieurs nouveaux medicamens, derniere edit FERRI CARBURETUM. 339 LXXXII. FERRI CARBURETUM. Synonymes. Ferrum Carburetum seu Carbonatum seu Supercarburetum ," Carburetum Ferri Nativum, Graphites, Plumbago, Plumbum Nigrum, Carbo Mineralis, Cerussa Nigra, Black Lead, Carburet of Iron. French. Carbure de Fer, Graphite, Crayon noir, Plombagine. German. Kohlenstoffeisen, Graphit, Reissblei, Mineral- ische Kohle. This well known substance was formerly considered to be slightly astringent and desiccative. By Weinhold, 1 it has been advised strongly in certain cutaneous affections, but although it has been received into various pharmacopoeias of continental Europe, as the Antwerp, Bavarian, Brunswick, Spanish, Parisian, Finnish, Prussian, Saxon, and Swedish, it has never been recog- nised as a therapeutical agent in this country or in Great Britain. METHOD OF PREPARING. As crude graphite is frequently very impure from the attached matrix, the Prussian Pharmacopoeia has a formula for its purifica- tion, the product of which bears the name graphites depuratus. With this view, the graphite muat be very finely pulverized : a pound of it is boiled in a proper quantity of common water for an hour; the water is then decanted, and two ounces of nitric acid and of muriatic acid, and eight ounces of common water are poured upon the graphite. This mixture is digested for twenty- four hours, frequently shaking it ; the acid fluid is then poured off, and, after the residuum has been washed by an appropriate quantity of common water, it is dried. EFFECTS ON THE ECONOMY. The internal use of graphite produces no perceptible change on the organic functions, except that, according to Weinhold, under its protracted use, the urinary secretion is augmented, and a dis- position to micturition excited. He found, however, that in her- petic and other cutaneous affections, it occasioned a very favour- able modification in the eruption, and wholly removed it. In consequence of the results of his observations, he published a monograph in which he recommended it to physicians in those diseases. He employed it as well internally as externally. The urine, he asserts, after its administration, commonly began to make a deposit, and this continued until some change in the cu- taneous affection announced its approaching cure. In cases of complication of herpes with other affections, Weinhold combined it with other remedies; — in syphilitic eruptions, adding corrosive sublimate, &c. The efficacy of graphite in herpetic and other cutaneous affec- tions has also been attested by many other respectable physicians, * Der Graphit als ein neu entdecktes Mittel gegen Flechten. Leipz. 1809. 340 FERRI CARBURETUM. as Horn, Heira, Ruggieri, Brera, Bernstein, Hildenbrand, Richter, Hufeland, Marc, 1 &c. This circumstance gave occasion to its admission into the Prussian Pharmacopoeia ; yet it has not the confidence of physicians, even in those countries into the pharma- copoeias of which it has been received, and is consequently but little prescribed. Its use in chronic cutaneous diseases is said to have been suggested by the circumstance, that in Venice the makers of crayons are speedily cured of any such affections under which they may labour. 2 MODE OF ADMINISTRATION. Internally, graphite is given in doses of from five to fifteen grains, from two to four times daily; and the dose may be aug- mented, according to circumstances, to a dram in the day. It is given in powder or in the pilular form. Externally, it is applied in the form of ointment or plaster — from 3ij. to 3vj. of the gra- phite to an ounce of the constituent. Pulyis ferri carbureti. Powder of carburet of iron. R. Ferri carburet. Sacch, aa. gss. M. Divide in partes aequal. vi. Dose. — One, every two hours, in lichen lepro'ides. Von Hildenbrand. Electnarium ferri carbureti. Electuary of carburet of iron. R. Ferri carburet, ^ss. Mellis despumat. ^ij. M. Fiat eiectuarium. Dose. — A coffee-spoonful, morning and evening. — Weinhold. Pilulae ferri carbureti. Pills of carburet of iron. R. Ferri carburet. Extract, dulcamar. aa. gj. M. riant pilulas pond. gr. ij. sing. Dose. — Six, three times a day. Marker. R. Ferri carburet, gij. Zinci oxid. gss. Adipis 3J. M. Mayer. 1 Riecke, Die neuern Arzneimittel, u. s. w. Stuttgart, 1837, S. 214; see, also, Wein- hold, in Hufeland's Journal, B. xxxiv. St. 1, S. 118: Heim in Horn's Archiv. 1810, xii. 326, and Ibid. 1811, B. 1, S. 91 ; Huber, in Med. Chir. Zeitung, 1811, No. 68, S. 282; Hufeland, Journ. der prakt. Heilkunde, B. xxxviii. St 6; Bernstein, Ibid. B. xli. St. 5; Mayer, Ibid. B. lx. St. 2, and Osann, in Encyclop. Worterb. der Med. Wissensch. x. 434. Berlin, 1834. a Merat and De Lens, in Diet, de Mat. Med., art. Carbone. FERRI CITRAS. 341 Unguentum ferri carbureti. Ointment of carburet of iron. R. Ferri carburet. Sulphur, aa. ^ij. Adipis q. s. ut fiat unguentum. Br era. Emplastrum ferri carbureti. Plaster of carburet of iron. R. Ferri carburet, ^ij. Emplast. sapon. ^iv. Misce intime. Weinhold. LXXXIII. FERRI CITRAS. Synonymes. Ferrum citricum, Citras ferricus, Citrate of Iron. French. Citrate de Fer. German. Citronsaures Eisenoxydul, Citronensaures Ei- senoxy d . Two citrates of iron have been proposed, of late years, by M. Beral 1 — the one the sesquicitrate or citrate of the sesqui- oxide of iron ; the other, the citrate of the protoxide of IRON. An AMMONIO-CITRATE, a POTASSIO-CITRATE, and a SODIO- citrate have likewise been introduced. METHOD OF PREPARING. The citrate of the sesquioxide, according to Mr. Duhamel, 2 is prepared as follows: — Take of Citric acid, crystallized, ^iij. or three parts; Hydrated oxide of iron, dry, ^ij. or two parts; Distilled water, ^xij. or twelve parts. If the moist hydrate be used, about §vj. are required; but as the degree of moisture is not always the same, Mr. Duhamel suggests, that the oxide should be in excess. The water may be heated to about 180° : a boiling temperature should be avoided, as it renders the sesquioxide less readily soluble. 3 The solution is filtered, and the filter washed with distilled water sufficient to obtain twelve parts of liquid. This forms what is kept by the French Pharmaciens under the name Liquid Citrate of Iron, marking 24° of Beaume. It holds in solution one-third of its weight of dry citrate of iron. The solution is evaporated to the consistence of thick syrup. It is then spread out on glass or porcelain plates, where it speedily dries in thin layers, which are separated and broken into fragments. 1 Journ. de Chimie Medicale ; cited in Amer. Journ. of Pharm., April, 1841, p. 72. 2 Amer. Journ. of Pharmacy, Oct., 1842, p. 225. 3 W. Procter, cited in Dispensatory of the United States, 8th edit., p. 1246. Phila., 1848. 342 FERRI CITRAS. Its taste is acid, but not disagreeable, and it is said to be, of all chalybeate salts, the least unpleasant to the taste. Citrate of protoxide of iron is prepared by M. Beral, 1 by treating iron flings with citric acid previously dissolved in dis- tilled water. It has a strongly marked chalybeate taste. Citrate of sesqui-oxide of iron is a somewhat insoluble salt: it occurs in transparent laminae of a garnet hue, which are perma- nent in the air. Citrate of the protoxide is of a dark-green colour; soluble, and the solution does not change its green colour by exposure to air. Ammonio-citrate of iron, Citrate of iron and ammonia, Ammonias ferro- citras, A. ferrico-citras, Ferri et ammo- nias citras, Ferrum citricum cum ammoniaco, Ferrum ammoniaco-citricum ; German, Eisenoxyd mit Ammo- nia k, is prepared by neutralizing the excess of acid in pre- paring the nitrate of the sesquioxide by ammonia, and evaporating as before. 2 It is a much more soluble salt than the citrate of the sesquioxide, and is slightly deliquescent. If the acid or the citrate be neutralized by soda or potassa in place of ammonia, the sodio- citrate, and the potassio-citrate of iron, are formed, which greatly resemble the ammonio-citrate. 3 The ammonio-citrate — Ferri ammonio citras— is officinal in the last Dublin Pharma- copoeia. 4 A citrate of magnetic oxide of iron is prepared by com- bining the magnetic oxide with citric acid. Mr. Edward Parrish 5 makes a syrup of citrate of iron as fol- lows. He first prepares a moist protocarbonate of iron, by mix- ing together solutions of sulphate of iron and carbonate of soda, precisely as directed for Vallet's ferruginous mass, and washing with sweetened water. This is then dissolved by means of a slight excess of citric acid in water, and is evaporated to dryness. A greenish deliquescent, freely soluble, uncrystallizable salt results, the taste of which is ferruginous, but not very unpleasant. To make the syrup, one ounce, Troy, of this salt is dissolved in five fluidounces of simple syrup. The solution is easily effected, and forms a dark greenish-brown liquid. The dose is from thirty drops to a tea-spoonful. The syrup of citrate of iron of Beral, is a sac- charine solution of the citrates of ammonia and sesquioxide of iron. EFFECTS ON THE ECONOMY IN HEALTH. The citrates of iron resemble, in their properties, the tartrate and the lactate of iron, and may be given in the same cases. The 1 Amer. Journ. of Pharm., April, 1841, p. 72. 2 For forms of preparation see Redwood, in his edition of Gray's Supplement to the Pharmacopoeias. 2d edit., London, 1848. 3 Ballard and Garrod, Elements of Mat. Med. and Therap., p. 389. London, 1845. 4 The Pharmacopoeia of the King and Queen's College of Physicians in Ireland, 1850, p. 43. Duhlin, 1850. b Amer. Journ. of Pharmacy, October, 1848, p. 649. FERRI CITRAS. 343 author has used the citrate largely, and is much pleased with it. It is unquestionably one of the most agreeable of the chalybeates, and equally effective perhaps with any. MODE OF ADMINISTRATION. The dose of citrate of iron may be the same as that of the salts above mentioned. The author generally prescribes it in the quan- tity often grains three times a day. The citrates are not decom- posed by alkalies, and hence may be given with them if desirable. The ammonio-citrate, according to MM. Ballard and Garrod, is the most used, and may be conveniently administered in porter, which conceals its taste, without its own flavour being impaired. It has long been administered in wine, of which the following are two forms ; — the first from the Hamburg, and the latter from the Wirtemburg, Pharmacopoeia. Yinnm ferri citratis aromaticum. Jlromatic wine of citrate of iron. R. Ferri liraatur. ^j. Limon. succ. giij. Macera per noctem, et adde Gentian. |[s's. Cinnam. ^ij. Vinifgxvj. Dose. — Of the decanted wine, f ^ss. to f ^ij. and more. This preparation, or one analogous to it, is said to be prescribed by certain physicians of this country — of Charleston, for example. 1 Take of Iron filings, four ounces; Bitter oranges, four. Remove the peel, the white, and the seeds; beat them in a stone mortar, and let the paste remain at rest for two days; then pour upon it Madeira wine, ten ounces, and Spirit of orange peel, two ounces. After sufficient digestion, express and filter. This preparation is called, in the Wirtemburg Pharmacopoeia, Tinctura Ferri Jlurantiaca seu Tinctura Martis cum Vino Malvatico et Pomis Aurantiis? According to Mr. Gore, 3 it possesses the most agreeable odour and taste of any medicinal compound ever introduced into practice. It is aromatic, carminative and tonic; and, he adds, that he has no doubt it will supersede the prepara- tions in general use, when once it has been fairly tried. In strumous habits; in passive uterine hemorrhage; in anasarca from general debility; in chlorosis; in malignant disease, in which iron has been extolled ; and in all diseases that arise from a general deficiency of tone, Mr. Gore considers this preparation to be " of exceeding utility, from its agreeable and chalybeate qualities." He suggests, also, its use in chronic bronchitis, in which he gives it in combination with ipecacuanha wine. 1 Duhamel, loc. cit. 3 Jourdan, Pharmacopee Universelle, i. 545. Paris, 1828. 8 Dublin Medical Press, April 29, 1840. 344 FERRI ET MAGNESLE CITRAS. Aqua chalybeata effervescens. Effervescing chalybeate water. R. Aquae Oiss. Ferri citrat. sice. 9j. Acid, citric, ^iv. Sodse bicarb, ^v. Add first the citrate of iron and citric acid, then the bicarbonate of soda, corking the bottle at once, and securing the cork. 1 This is a delicate but active chalybeate. It may be formed, also, con- veniently and agreeably, by dissolving 5 to 10 grains of the citrate in f §vj. of the mineral water of the shops, and flavouring with syrup of orange peel. It is said, however, to be apt to excite un- pleasant eructations. 2 It has been called ' Chalybeate Champagne? A citrate of iron and magnesia, Ferri et Magnesia Citras, is prepared by dissolving hydrated oxide of iron in a solution of citric acid, saturating the liquid with carbonate of magnesia, and evaporating to dryness. 3 The salt presents itself in the form of brown brilliant scales, of a sweetish and feebly inky and not disa- greeable taste. It is perfectly soluble in water, and has the advan- tage over the ferro-citrate of ammonia, that it is not deliquescent, so that it can be given in powder. Moreover, it does not induce constipation, like most of the salts of iron. The dose is from 4 to 15 grains in solution. It may also be given in powder or pill. Syrupus ferri et magnesise citratis. Syrup of citrate of iron and magnesia. R. Ferri et magnes. citrat. p. x. Solve in Aq. flor. aurant. p. xx. Syrup, p. cc. M. • Van den Corput. Pnlvis ferri et magnesia citratis. Powder of citrate of iron and magnesia. (Saccharure de citrate defer et de magnesie.) R. Ferri et magnes. citrat. p. v. Sacchar. pulv. p. xl. Canellse albse p. v. M. Dose. — Fifteen grains. Van den Corput. Troschisci ferri et magnesia? citratis. Lozenges of citrate of iron and magnesia. R. Ferri et magnes. citrat. p. v. Sacchar. pulv. p. xl. Vanill. Sacchar. (Saccharure de vanille.) p. 2. Mucilag. tragacanth. p. v. M. Each lozenge to contain fifteen grains. Van den Corput. 1 Bullet, de Therap. cited in Provincial Med. and Surg. Journ. Dec. 10, 1842. 2 Pereira, Elements of Materia Medica and Therap. 3d edit. i. 791. Lond. 1849. 8 Van den Corput, cited in Bouchardat, Annuaire fie Therap. pour l8oO,"p. 186. The formula of Van den Corput, with remarks by Mr. Wm. Procter, Jr. is given in Amer. Joum. of Pharmacy, October, 1650, p. 314. FERRI FERROCYANURETUM. 345 M. Beral has likewise introduced a Citrate of Protoxide of Iron and Quinia — Ferri et Quinia Citras, Ferrum et Chininum citricum] German, Citronensaures Eisenchinin; which is formed by the union of four parts of Citrate of iron with one part of Citrate of quinia in solution, and evaporating. It may be given in the form of pill, wherever a combination of these tonics is needed. An extemporaneous formula may be made by uniting citrate of iron, and citrate or even sulphate of quinia together, which may be given either in pills or solution. LXXXIV. FERRI FERROCYANURETUM. Synonymes. Ferri Cyanidum seu Cyanuretum seu Borussias seu Sesqui- cyanidum seu Ferrosesquicyanidum seu Percyanidum seu Ferrocy- arias, Ferrum Cyanogenatum seu Cyanuretum seu Zooticum seu Bo- russicum seu Hydrocyanicum seu Oxydulatum Hydrocyanicum, Cse- ruleum Borussicum seu Beroliniense, Prussiate or Cyanide or Cyanu- ret of Iron, Prussian Blue, Berlin Blue. French. Trito-hydro-ferro-cyanate de Fer; Deutoxicyanure de Fer Hy- drate, Tritohydrocyanate Ferrure de Fer, Prussiate de Potasse et de Fer, Bleu de Prusse. German. Cyanei sen, BlaustofFeisen, Blausaures Eisenoxy- dul, Eisenblausaures Eisenoxyd, Blausaures Eisen, Ei- sencyanurcyanid, Berliner Blau, Pariser Blau. In commerce, this preparation, with us, bears the name of "Prus- sian blue" but in Germany it is called "Pariser blau." It is not in a state of purity, and, consequently, that which the apothecary prepares is best adapted for internal use. METHOD OF PREPARING. The form given by Buchner is as good as any. Ferrocyanuret of potassium, as commonly met with in commerce, is dissolved in warm distilled water, and to the clear filtered solution is gradually added, in a glass vessel, a solution of chemically pure sulphate of iron so long as a precipitate is thrown down. After the precipi- tate has fallen to the bottom of the vessel, and the supernatant fluid, which contains sulphate of potassa, has been poured off, the precipitate is first digested with dilute sulphuric or muriatic acid, in order to dissolve the excess of oxide of iron ; the beautiful dark blue precipitate is then collected on a filter, carefully washed with boiling water, and dried. The following form for the preparation of " pure Prussian blue," is admitted into the last edition of the Pharmacopoeia of the United States : — Take of Sulphate of iron, giv. ; Sulphuric acid, f siiiss. ; Nitric acid, f 3VJ., or a sufficient quantity; Ferrocyanuret of Po- tassium, givss.; Water, Oij. Dissolve the sulphate of iron in a pint of water, and, having added the sulphuric acid, boil the solu- tion. Pour it into the nitric acid in small portions, boiling the 346 FERRI FERROCYANURETUM. liquid for a minute or two after each addition, until it no longer produces a dark colour; then allow the liquid to cool. Dissolve the ferrocyanuret of potassium in the remainder of the water, and add this solution gradually to the first liquid, agitating the mixture after each addition; then pour it upon a filter. Wash the precipi- tate with boiling water until the washings pass tasteless. Lastly, dry it and rub into powder. 1 Ferrocyanuret of iron is of a beautiful deep blue colour, and devoid of odour and taste. It is decomposed by heat, and is inso- luble in water, alcohol, ether, oils and dilute acids. Potassa and soda decompose it. It adheres firmly to the tongue, which Riecke thinks is owing to its containing argil. EFFECTS ON THE ECONOMY. Of the effects of ferrocyanuret of iron on the human economy in health we have no evidence. Coullon gave it to various ani- mals, but observed no action from it. It has been given, however, and not without success, in several diseases; and Dr. L. W. Sachs, who has not unfrequently administered it, considers it one of the most important chalybeates with which we are acquainted. He thinks it probable, that the hydrocyanic acid has not much agency; yet it certainly seems to differ from all the other preparations of iron. It has been especially recommended in epilepsy by Kirck- hoff, 2 of Ghent; and more recently by M. Faivre d'Esnans. 3 In very obstinate cases, not dependent upon organic mischief, Kirck- hoff succeeded entirely with it; with the adult, he commenced with half a grain daily, and raised the dose gradually to three, four, and even six grains and upwards. When the patient was plethoric, he premised blood-letting, or applied leeches, from time to time, to the temples. Hildenbrand and Gergeres confir#n its efficacy in epilepsy. M. Faivre d'Esnans used the following formula: — R. Ferri ferrocyanuret. gr. xv. Ext. Valerian, gr. xlv. M. et divide in pil. xxiv. One pill to be taken three times a day, at an interval of six hours, and each pill to be followed by a wineglassful of infusion of valerian. It has also been administered by Dr. Zollickoffer 4 successfully in a case of chorea; three grains being given in the form of pill, three times a day. In six days, the girl, twelve years old, was entirely cured, after camphor, opium, quinia, and asafostida, nitrate of silver, and subcarbonate of iron had been given in vain. In 1 Pharmacopoeia of the United States, p. 109. Philad. 1842. 2 Journal de Chimie Medicale, iii. 285. See, also, Journ. des Connais. Med. Chirur. Aout, 1841 ; or Encyel. des Sciences Med. Sept. 1841, p. 468. 3 Journal de Medecine et de Chirurgie Pratiques, cited in Amer. Journ. of the Med. Sciences, July, 1850. p. 202. 4 Medical Examiner, May 16, 1840, p. 314. FERRI FERROCYANURETUM. 347 intermittent fever, Dr. Zollickoffer * found it so efficacious, that he even gave it the preference over cinchona : and his experience has been confirmed by that of Eberle, 2 Hosack, 3 J. E. Craighead, 4 Hasse, 5 and others. Wutzer, in Germany, also exhibited it suc- cessfully ; and Stosch gave it advantageously, in combination with cinchona and rhubarb, in a case of obstinate intermittent. Sachs likewise tried it frequently, but as often without, as with, success. When it has proved efficacious in intermittents, the dose has been by no means large. Some have given six or eight grains every four hours during the apyrexia, and even as much as a scruple has been administered. Sachs found it several times efficacious, when four doses of two grains each were taken; and Riecke 6 affirms, that his father obtained essential service from it in the leucophleg- matic conditions resulting from intermittent fever. Zollickoffer extols the ferrocyanuret also in remittent fever ; and there may, doubtless, be periods when it may be administered with benefit; but it is not often used. He recommends it, likewise, in dysentery? when the inflammatory condition has passed away, either sponta- neously or under the efforts of art ; and Sachs remarks, that in atonic conditions of the intestinal canal, which supervene on dysentery, it may doubtless be of great service. Gergeres admi- nistered it successfully in chronic diarrhoea. L. W. Sachs enters into a long theoretical disquisition on the precise action of the remedy, in which there is, doubtless, much that is speculative. He used it, he says, with success, in many cases which it would be difficult to classify under any formal nosology ; their common bond, however, was, that they were dependent upon " nervous disorders, especially of the plastic functions of the abdominal organs, the mischief appearing first of all to be gastric." In such affec- tions he found a combination of the ferrocyanuret of iron with rhubarb especially serviceable. He gave it in not less than two grain doses, which were gradually augmented to six, three times a day. Dr. Moll saw decidedly good effects from its use in a case of immoderate menstruation from atony of the uterus, with gene- ral elevation of nervous excitability, after he had employed the remedies, commonly recommended, unsuccessfully. He found it also extremely beneficial to children of a 'strumous habit, and of great torpor. Stosch found it serviceable in a case of scrofula, in which hsematosis was imperfectly accomplished; and Dr. Bridges 8 obtained great advantage from it in a case of severe and protracted facial neuralgia. 1 American Medical Recorder, v. 540. 2 Materia Medica, 2d edit. i. 233. 3 New York Medical and Physical Journal, 1823, * American Medical Intelligencer, May, 1S42, p. 230. 5 Aschenbrenner, Die neueren Arzneimittel, u. s. w, S. 122. Erlangen, 1848. 6 Op. citat. S. 217. T Chapman's Philadelphia Journal, Aug. 1823. 8 Wood and Bache's Dispensatory, art. Ferri Ferrocyanuretum. 348 FERRI FERROCYANURETUM. It has been also recommended as probably more effective than any other remedy in inveterate cases of ascarides in the rectum. With this view, five grains of the salt may be rubbed up in two ounces of warm water or mucilage of gum arabic, and be thrown up into the rectum, to be retained there " until the next regular defecation." This must be repeated daily, gradually increasing the quantity of the cyanuret, until perfect and permanent relief is afforded. 2 Externally, the ferrocyanuret has been used in the form of oint- ment, in cases of ill-conditioned, torpid and foul ulcers, and even of noli me tangere. Stosch applied it in a case of fungous ulcer with marked advantage; making it into a paste with water and using it in that form. MODE OF ADMINISTRATION. Pulvis ferri ferrocyanureti. Powder of ferrocyanuret of iron. R. Ferri ferrocyan. gr. iij. ad. xxxvj. Sacchar. 31J. M. et divide in pulveres vj. Dose. — A powder, two or three times a day, in epilepsy. Kirckhoff. R. Ferri ferrocyan. gr. j., iv., vj., ad xij. Sacch. ZY Fiat pulvis in partes xij. aequales dividendus. Dose. — A powder, every two hours, in epilepsy. Von Hildenbrand. R. Ferri ferrocyan. Guaiac. pulv. aa. gj. Misce et divide in chartulasxij. Dose. — One, three times a day. — Employed successfully in m- termittents. 3 Pilulae ferri ferrocyanureti. Pills of ferrocyanuret of iron. R. Ammoniac. Rhei Ext. taraxac. aa. gj. Ferri ferrocyan.gr. xviij. ad. xxxvj. M. et fiat massa in pilulas lx. dividenda. Dose. — Four to six, twice a day, in disorder of the ganglionic system. L. W. Sachs, fy Radius. Unguentum ferri ferrocyanureti. Ointment of ferrocyanuret of iron. R. Ferri ferrocyan. 3J. Unguent, cetacei ^j. M. et fiat unguentum. ' Amer. Journ. of the Medical Sciences, Jan. 1847, p. 247. ' Ellis's Formulary, 8th edit p. 186. Philad. 184b*. FERRI IODIDUM. 349 LXXXV. FERRI IODIDUM. Synonymes. Ferri Ioduretum, Ferrum lodatum, Iodated Iron, Iodide or Ioduret, Protoioduret, Protoiodide or Protiodide of Iron. French. Iodure de Fer, Protoiodnre de Fer. German. Iodeisen. In solution, Ferri Hydriodas, Ferrum Hydriodatum seu Hydroiodicum Oxydulatum, Hydriodated Iron, Hydriodate of Iron, Hydriodate of Pro- toxide of Iron. French. Hydriodate de FeT. German. H ydroiodsaures Eisenoxydul, Iodeisen, Iodwas- se r s t of fsaure s Eisenoxydul, Eiseniodiir. Although attention had been directed, several years ago, to this preparation, it was not much used, until Prof. A. T. Thomson, 1 of the London University, recommended it strongly in a special monograph several years since. It has been received into different Pharmacopoeias. METHOD OF PREPARING. The following method is recommended by Dr. Thomson. One part of iron wire should be rubbed in a porcelain or wedgewood mortar with about three or four parts of iodine, gradually adding distilled water, until fifteen parts of the fluid have been used ; the whole is then to be introduced into a Florence flask, with an ad- ditional portion of wire and of distilled water. This excess of iron is a matter of indifference in the preparation of the hydriodate, and in that of the iodide it is necessary for preserving the combi- nation from decomposition during the evaporation of the solution. These materials are next to be boiled together, until the fluid ac- quires a pale greenish colour, when it must be filtered. This solu- tion contains a hydriodate of the protoxide of iron; and, if the exact quantity of the iodine be previously ascertained, so as to enable the solution to be procured of a definite strength, it may be kept in this state for medicinal use. In general, however, the solution is evaporated to dryness, and, for this purpose, it may be poured into a clean flask, containing a piece of iron wire suffi- ciently long to reach from the bottom to the surface of the fluid, and the boiling should be continued until the bulk of the solution is reduced to one-third. It must then be filtered, after which the evaporation should be continued to dryness. It is necessary to break the flask as soon as the mass is cold, in order to obtain the solid iodide, which should be immediately transferred to a dry bottle, accurately fitted with a ground stopper. The bottle should not hold more than two ounces of the preparation; for when it is large and not full, the iodide deliquesces nearly as rapidly as when it is exposed to the free action of the atmosphere. 1 Some Observations on the Preparation and Medicinal Employment of the Ioduret and Hydriodate of Iron, 8vo. p. 64. Lond. 1834. 23 350 FERRI IODIDUM. When the flask is broken, and the iodide bottled before the mass is cold, deliquescence also takes place, a peroxide of the metal is formed, and iodine is evolved. The form for the preparation of the solid iodide recommended in the last edition of the Pharmacopoeia of the United States is the following: — Take of Iodine, jij., Iron filings, gi., Distilled water, a pint and a half. Mix the iodine with a pint of the dis- tilled water in a porcelain or glass vessel, and gradually add the iron filings, stirring constantly. Heat the mixture gently until the liquid acquires a light greenish colour ; then filter, and after the liquid has passed, pour upon the filter half a pint of the dis- tilled water boiling hot. When this shall have passed, evaporate the filtered liquor, at a. temperature not exceeding 212°, in an iron vessel, to dryness. Keep the dry iodide in a closely stopped bot- tle. 1 The plan proposed by Mr. Durand, 2 of Philadelphia, after that by MM. Baup and Caillot, 3 for preparing the solution of the pro- tiodide of iron (hydriodate of protoxide of iron) is the following: — Take of Iodine, 3x., Iron filings, perfectly pure and unoxidized, 3 v., Distilled ivater, ^xiiss. Put the iodine into a porcelain cap- sule, with one half the quantity of water, and add the iron filings by small portions, stirring the mixture w T ith a glass rod. The com- bination soon takes place; heat is evolved with the disengagement of a small quantity of vapour of iodine, and the mixture acquires an orange colour, which gradually deepens to a dark red. When the whole of the iron has been added, the capsule is put in a sand bath, or over the flame of a spirit lamp, and heated slowly ; con- tinuing to stir the liquid. An ioduretted hydriodate of iron is first produced, which, under the action of heat, soon passes to the state of a simple hydriodate. This point is indicated by the entire dis- coloration of the solution. In this state it is filtered ; and the dregs and filter are carefully washed with the remaining half of the distilled water, previously heated to the boiling point. In this manner, a solution forming twelve and a half fluidounces is afforded, one ounce of which represents one dram of iodide of iron. The solution, which is at first colourless, acquires a deep red colour by standing, and precipitates some oxide of iron; by which it is reduced to the state of an ioduretted hydriodate of iron; but it may be easily restored to its former state by heating it again with a small quantity of iron filings, until the liquid becomes colourless : or, to prevent these changes, a coil of soft iron wire may be kept immersed in it; a fact which has been long known, 4 but which M. Dupasquier has recently rediscovered. 5 1 Pharm, of the United States, p. 1 1 0. Philad. 1842. 2 Philad. Journ. of Pharmacy, iv. 287. Philad. 1833. - 3 Ibid. i. 201. * Squire. Annals of Philosophy, May, 1836, p. 79. 5 Journal de Pharmacie, Mars, 1842, p. 224. FERRI IODIDUM. 351 The iodide of iron is obtained by evaporating to dryness the filtered solution, taking care, towards the end, to stir incessantly with an iron spatula, and to detach the salt from the bottom of the capsule as it forms. The heat must be managed most care- fully, diminishing it gradually, and removing the capsule quickly from the fire as soon as the odour of iodine is evolved. The solution of this salt, when the iodide is well prepared, is of a pale greenish colour, and deeper in proportion to the decomposition which some parts may have undergone towards the end of the operation. Iodide of iron requires to be well secured from the influence of the atmosphere, both on account of its deliquescent property, the rapid oxidation which the metal undergoes when deliquescence occurs, and the consequent decomposition which takes place. It is important to prevent this, as the peroxide of iron is compara- tively inert as a medicinal agent; whilst the free iodine extricated during its oxidation, according to Dr. Thomson, alters altogether the virtues of the medicine. This partial decomposition of the iodide is rendered immediately apparent on dissolving it in twenty times its weight of distilled water, and filtering: instead of a per- manent, clear, very pale greenish-yellow, we obtain an ochre- coloured, completely insoluble precipitate. Much of the iodide usually prepared is of this description, and to this may, doubtless, be referred some of the disappointment and discrepancy amongst practitioners as to the operation of the medicine in cases appa- rently similar. Even when the iodide has been carefully prepared, it often contains a little free iodine; but, according to Thomson, it is chiefly owing to the carelessness of assistants and apprentices in compounding prescriptions, by frequently exposing the iodide to the air, that its properties, and, consequently, its medicinal powers, are impaired : hence, it is preferable to keep it in solution, or in the form of hydriodate, which it becomes, whenever water is added to it. If the solution be prepared with a definite quantity of iodine, as described, it will keep without changing its characters; but as it is usually made by dissolving the iodide in distilled water, it requires to be rendered neutral by the following means: — Intro- duce into a flask the solution of any given strength, and place in it two or three doubles of clean and soft iron wire, sufficiently long to extend to the surface of the fluid; boil for a few minutes, and then leave it at rest, until the solution becomes clear, after which it may be either decanted off from the precipitate which forms, or filtered: no farther change takes place in a solution thus treated, however long it may be preserved, provided it be kept in a black- ened or, a green bottle. In this process, the wire affords iron to saturate any free iodine present in the solution, or that may have been extricated by the formation of the peroxide of iron in 352 FERR1 IODIDUM. the iodide; and a perfectly neutral solution being thus obtained, by the immediate conversion of the newly formed iodide into the hydriodate of the protoxide, no subsequent change takes place so long as the solution is kept secluded from the light. The best proportions, according to Dr. Thomson, for forming the medicinal solution, are three grains of the dry solid iodide to each fluidram of distilled water. If the water be not either distilled or filtered rain water, perfectly free from foreign ingredients, and particu- larly if it contain any earthy or saline carbonates, decomposition instantly takes place, iodine is extricated, and a carbonate of iron, which rapidly passes into the state of a peroxide of that metal, is precipitated. To protect the solution of iodide from decomposition, it has been advised to associate it with sugar, which appears to exert the same protective agency as it does on the protocarbonate. With this view, the following preparation has been proposed by Mr. Procter. 1 Take of Iodine, eleven drams; Iron filings, four drams; Syrup, Uncryst alii z able honey, or Uncrystallizable sugar, four ounces; Distilled water, a sufficient quantity. Mix the iodine with eight fluidounces of the distilled water, and gradually add the iron filings, stirring constantly; then apply a gentle heat until the solution shall have acquired a light green colour, or shall not give a blue colour to a solution of starch ; then add whichever of the three protecting saccharine substances may be chosen; continue the heat a short time and filter. Lastly, wash the filter with as much distilled water as will make sixteen fluid- ounces of solution of iodide of iron. Liquor Ferri Iodidi, or Solution of Iodide of Iron of the last edition of the Pharmacopoeia of the United States (1842,) is essentially the same as this. The saccharine matter employed in it is prepared honey. The solution, thus obtained, is of a pale- greenish colour. It has little or no sediment. M. Oberdorffer, of Hamburg, 2 gives the following form for the preparation of the sesqui-iodide of iron; whose effects, and mode of administration are the same as those of the iodide. It may be preserved a long time without undergoing decomposition. Mix in a glass vessel half an ounce of iodine; a dram and a half of iron filings; and an ounce of water. When the reaction is com- pleted, the mixture is to be slightly shaken, until it becomes of a clear green colour, which is due to the iodide of iron. It is then diluted with four ounces of water, filtered, and some water is passed through the filter. To the solution two drams of iodine are afterwards added, which are readily dissolved. A deep red- dish-brown liquid results, to which a sufficient quantity of water 1 American Journal of Pharmacy, for July, 1840, p. 13; and Ibid, for January, 1841, p. 3Q3. * Zeitschrift fur die gesammte Medicin. Juin, 1S40, FERRI IODIDUM. 6Do is added to make the weight of the whole ten ounces. Each dram contains about four grains and a half of iodine. When iodide of iron is carefully prepared, it is of an iron-gray colour, foliated texture, brittle, and exhibits a crystalline arrange- ment similar to metallic antimony, except that it is darker. In the dry state, it is inodorous; but, when moist, it smells somewhat of iodine: the taste, w r hen dry, is simply styptic; when moist, somewhat acrid, before it impresses the gustatory organs. At 350° of Fahrenheit it fuses ; and, at a higher temperature, is de r composed — the iodine being volatilized, and the iron remaining in the state of oxide. It dissolves in alj proportions in water, — the changes supervening, which have been already indicated. It is decomposed by chlorine, the mineral acids, oxide of arsenic, meconic acid — consequently by opium and laudanum — gallic and tannic acids, the pure and carbonated alkalies, different metallic salts, and by the infusions of digitalis, belladonna, hyoscyamus, tobacco, amylaceous substances, &c. : such articles ought not, therefore, to be given in combination with it. EFFECTS ON THE ECONOMY IN HEALTH. From experiments made on his own person, Dr. Thomson states the following to be the physiological effects of iodide of iron. When taken in doses of from three to five grains, it makes no sensible impression on the stomach, although it sharpens the appetite, and improves the digestive function : it seems to stimu- late moderately the digestive canal through its entire length ; for it opens the bowels ; and, whilst it produces the black colour of the alvine discharges, characteristic of all the preparations of iron, it corrects their foetor. When it does not affect the bowels, it augments the action of the kidneys, increasing the flow of urine ; and if the solution be taken two or three times a day, for several days in succession, the presence of both the iodine and the iron can be readily detected in the urine. The temperature of the skin is moderately elevated, and the insensible perspiration in- creased. On one occasion, having taken ten grains for a dose, it almost immediately caused an uneasy sensation at the epigastrium, accompanied with nausea, that continued for several hours, and a slight degree of headach. These symptoms were relieved by a copious evacuation, which was perfectly black. Two hours after taking the medicine, a large quantity of urine was discharged ; which, on being tested, displayed the presence of both iodine and iron. The experiments on animals, made by Dr. Cogswell, 1 in- duced him to infer: — 1. That it acts as a local stimulant, possess- ing the power of affecting peculiar disorganization. — 2. That its action is more particularly directed to the tract of the alimentary canal. 1 Essay on Iodine, p. 132. Edinburgh, 1837. 354 PERRI IODIDUM. When added to blood out of the body, it promotes its coagula- tion. 1 EFFECTS ON THE ECONOMY IN DISEASE. From the chemical composition of iodide of iron, Dr. Thomson considered it might be specially adapted for cases in which aug- mented activity of the capillary or intermediate system, with a tonic effect, might be indicated, and particularly in scrofulous affections, tabes mesenterica, chlorosis, incipient scirrhus, rickets, amenorrhea, bronchocele, atonic dyspepsia, — indeed in all cases accompanied by debility. In such affections, he con- ceives the iodide will act more efficiently than any of the other preparations of iron. In secondary syphilis, it may be combined, he suggests, with iodide of potassium; and in incipient cancer, its efficacy is aided by the administration of arsenic at the same time. Dr. Thomson has found it serviceable in atonic gastric dyspepsia, when combined with bicarbonate of potassa, and taken at the moment of admixture, in the dose of from three to eight grains or more. 2 A great advantage it possesses is its ready solu- bility, owing to which it can enter the circulatory system with facility, and modify the condition of the fluids. In chronic scro- fulous cases, it produces all the good effects of the preparations of iron, without any of the concomitant and subsequent symptoms that are so apt to supervene, especially in impressible individuals. Where the case is accompanied by vascular erethism, or fulness, it must be reduced before the iodide can be esteemed appropriate. In chlorosis, occurring in strumous habits, it has been found most serviceable. Dr. Ashwell 3 prescribed it with success in such cases, in association with colomba or gentian, according to the formula given hereafter. Its efficacy in cancer is elucidated by Dr. Thomson, by the details of a case of scirrhous mamma, which, after protracted and fruitless treatment by other agents — as by other preparations of iron combined with conium — ultimately yielded to a combination of iodide of iron and conium. Some cases are also detailed in which it was very effective in removing old syphilitic affections, especially of the skin. M. Baumes, 4 who employed the iodide with the most satisfactory results in old and obstinate syphilitic ulcers, especially when the patient was feeble and scrofulous, gave it in the form of pills with extract of opium, — increasing the dose of the iodide from two or three to twelve or twenty grains in the twenty-four hours. Along with the cicatrization of the sores, the improvement of the general health was most remarkable. 1 Magendie, Lecons sur le Sang, &c.; or translation in the Lancet. Jan. 26, 1839. 2 London Dispensatory, and Brande's Dictionary of Mat. Med., p. 252. Lond., 1839. See, also, Solon, in Diet, de Med. et de Chirurg. Pratiq., art. lode ; and Ashwell, in Guy's Hospital Reports, pt. i. 128; and pt. iii. 555. 3 A Practical Treatise on the Diseases Peculiar to Women, American edit., p. 32. Philad., 1845. « Medico-Chirurgical Rev., Oct., 1840. FERRI IODIDUM. 355 Prior to the publication of Thomson, Pierquin had given the io- dine in cases of leucorrhcea, and amenorrhoza ; and Eager 1 had recommended it in scrofula. Ricord 2 found the very best effects from its internal use in cases where tonics required to be combined with antisyphilitic remedies, especially where any scrofulous vice (lymphatisme) constituted a complication. He administered it, likewise, with great success, to remove the consequences of syphilis; and found it advantageous in atonic ulcers of the legs, and in spreading ulcers of the throat, which had been aggra- vated or had not yielded to mercury. The strength of M.Ricord's solution was half a dram of the iodide to §viij. of water, given, we presume, in the twenty-four hours. M. Ricord 3 also uses it in the form of injection in cases of blennorrhea: wherever, indeed, tonic astringent injections are needed, the iodide, in his opinion, should occupy the first rank. Its use, he thinks, can only be contraindicated when there is much inflammation or pain in pass- ing the urine, or when cystitis exists. The strength of the in- jection should be three grains to the fluidounce of water. In consequence of its promoting the coagulation of the blood out of the body, Magendie 4 prescribed it in the form of injection (f gi. to Oij. of water,) several times a day in a case of severe uterine hemorrhage. The hemorrhage ceased. A case of confirmed diabetes 5 was treated in the Hotel-Dieu of Paris, by the iodide given in the form of pill, each pill containing five grains. Four pills were taken in the twenty-four hours. In this case, the iodide must have been efficacious, for the usual animal diet recommended in such cases had failed previously to do good, until the iodide was associated with it. It has likewise afforded apparent benefit in cases of tubercular phthisis, and in the mass of such cases is as well adapted for modifying the morbid action of the system of nutrition, so deeply implicated in that fatal malady, as any other agent, with the ex- ception, perhaps, of cod liver oil. The syrup is the best prepara- tion. Dr. C. J. B. Williams 6 considers the iodide to answer better than any other chalybeate in chorea. It pervades the system more rapidly, he thinks, and keeps the secretions more free. He gives it in doses of one grain three times a day, increased to four or five grains, taking care, at the same time, that the bowels are open. 1 Dublin Journ.of Med. Science, 1834 ; also, Cogswell on Iodine, p. 138. Edinb. 1837. 3 J. J. L. Rattier, in La Lancette Franchise, 4 Fev., 1837. 3 J. J. L. Rattier, Ibid. 16 Fev., 1837; see, also, Revue Medicate, Janvier, 1838, cited in Amer. Med. Intel., Sept. 15, 1838. 4 Op. cit. 5 Cited in Provincial Med. and Surg. Journal, Nov. 5, 1842. The results obtained in the Hotel-Dieu are referred to in London Lancet, July 8, 1843, p. 517; see, also, M Boissiere, Gazette Med. de Paris, 24 Dec, 1842; cited in Amer. Journ.of the Med. Sciences, April, 1843, p. 454. 6 Medical Times, May 24, 1845, p. 133. 356 FERRI IODIDUM. Mr. B. Phillips 1 prefers it in scrofula to any of the preparations of iodine. The minimum dose was a grain twice a day; the max- imum, three grains, three times a day. In 232 cases, it was only necessary to intermit its use for a few days in three cases. In one, it excited ptyalism. About once a week he gave an aperient or cathartic. In cases of scrofulous ulceration, as a consequence of abscess, or from other causes, he employed, with the best effect, a lotion containing three or four grains of the iodide to an ounce of distilled water. Where parts are irritable, he usually recom- mends the ointment of iodine to be applied to the part on lint. Stauss 3 gives the case of a young female affected with ascites, hydrothorax and anasarca, who had been tapped for the ascites, and had taken gratiola and lactuca virosa without any benefit, who was cured by a mixture of Tinctura ferri iodid., Tinct. cort. aurant. aa. 3ij., and Aq. for. aurantior. ^ij., of which a spoonful was given four times a day. Under this, the status hydropicus disappeared. The author has frequently given this remedy in public and private practice, and has considered it especially adapted for those cases in which there appears to be torpor in the system of nu- trition, as in asthenic dropsy, old visceral engorgements, and indeed of hypertrophy of any kind, accompanied by defi- cient action in the system of nutrition. In oligemia, where there is paucity of red corpuscles of the blood, and the fluid is alto- gether too thin, it would seem to be especially indicated, from its property, mentioned above, of promoting the coagulation of the blood, and, therefore, of inspissating it. Hence, in all cases of scorbutic, hydropic and other dyscrasies, and in hemorrhages occurring in such pathological conditions, the author has pre- scribed it largely, and with excellent effects. It appears to him to be the best remedy we possess w 7 herever a eutrophic and tonic is indicated. MODE OF ADMINISTRATION. The dose of iodide of iron, administered in the cases above referred to was generally three or four grains two or three times a day. Pilulse ferri iodidi. Pills of iodide of iron. These pills may be prepared in the following manner, according to a formula communicated by Mr. Robert Leslie, of Glasgow, to Dr. Christison of Edinburgh. 3 Take of iodine, 127 grains; iron 1 London Med. Gazette, Jan. 10, 1840; see, also, Scrofula; its Nature, Causes, &c. by B. Phillips, F. R. S., Amer. edit., p. 248. Philad. 1846. a Casper, Wochenschrift, No. 24, cited in Canstatt und Eisenmann's Jahresbericht iiber die Fortschritte in der Heilkunde im Jahre 1848, V. 135. 3 Pharmaceut. Transact., Aug. 1, 1844, p. 79. FERRI IODIDUM. 357 wire, of about the thickness of a thin quill, half an ounce ; dis- tilled water, 75 minims. Agitate them briskly together in a strong ounce phial provided with a well fitted glass stopper, until the froth which forms becomes white. This will happen in less than ten minutes. Pour the liquid upon two drams of finely powdered loaf sugar in a little water, and triturate immediately and briskly for a few minutes; add gradually a mixture of the following pow- ders, — liquorice powder, half an ounce; powder of gum Arabic, a dram and a half; flour, a dram. Divide the mass into 144 pills. Each pill will contain about a grain of iodide of iron. Yinum ferri iodidi. Wine of iodide of iron. R. Ferri iodidi gss. Vin Bordgalens. Oj. M. Dose. — A tea-spoonful, morning and evening. Pierquin? Tinctura ferri iodidi. Tincture of iodide of iron. R. Ferri iodidi gij. Alcohol is, Aquae, aa. f gij. M. Dose. — A tea-spoonful, morning and evening. Pierqain. Mistura ferri iodidi composita. Compound mixture of iodide of iron. R. Ferri iodidi gr. xvj. Tinct. colomb. seu gentianae comp. f ^j. Aquae destillat. f^vij. M. Dose. — Two table-spoonfuls two or three times a day. Jishwell. Syrupus ferri iodidi, Syrup of iodide of iron. Various forms have been given for this preparation. 3 The following is the one admitted into the last edition of the Edin- burgh Pharmacopoeia:— Take of Iodine (dry,) 200 grains; Fine iron wire, recently cleaned, 100 grains; White sugar in powder, four ounces and a half; Distilled water, six fluidounces. Eoil the iodine, iron and water together in a glass matrass, at first gently, to avoid the expulsion of iodine vapour, afterwards briskly till about two fluidounces remain. Filter this quickly, while hot, into 1 Journal de Chimie Medicale, p. 310, Mai, 1831. 2 Frederking, Repertor.fiirdie Pharmacie, 1839, cited in Amer. Journ. Med. Sciences, Feb. 1840, p. 499; Dupasquier, Journ. de Pharm. Mars, 1841, p, 116, and Mars, 1842, p. 225; F. Boudet, ibid. Sept. 1841, p. 335; Beral, Journ. de Chim. Med. cited in Amer. Journ. of Pharmacy, April, 1841, p. 74 ; A. T. Thomson, Lond. Pharmac. Transactions, Aug. 1841; and Leistner, Journ. de Pharmacie, Fevrier, 1842, p. 122. 358 FERRI IODIDUM. a matrass containing the sugar; dissolve the sugar with a gentle heat, and add distilled water to make up six fluidounces. Twelve minims of this syrup contain one grain of the iodide. It ought to be nearly colourless or pale yellowish-green, and with- out sediment. Dr. Christison states, that it will always be defect- ive in strength "when made with British iodine, as now commonly met with in the market, unless allowance be made for the water, which it very generally contains in large proportion." 1 Trochisci ferri iodidi. Lozenges of iodide of iron. R. Ferri iodidi ^ss. Croci pulv. gij. Sacchar. ^iv. M. fiant trochisci No. 120. Dose. — Six to ten, daily. Pierquin. Solutio ferri iodidi. Solution of iodide of iron. (French, Eau d'Hydriodate de Fer.) R. Ferri iodidi ^ss. Aqua3 Oij. M. Added to enemata, lotions and injections. R. Ferri iodidi ^ss. ad ^ij. Aquse destillat. Oj. M. To be added to a general bath in cases of leucorrhcea, amenor- rhcea, &c. In jectio ferri iodidi. Injection of iodide of iron. R. Ferri iodid. gr. iij. Aquse destillat. f Jvi. M. The quantity may be increased to nine grains to the ounce of water, care being taken to avoid irritation. Used in gonorrhoea. Ricord. 2 Unguentum ferri iodidi. Ointment of iodide of iron. R. Ferri iodidi ^iss. Adipis §j. M. ut fiat unguentum. A piece the size of a hazelnut to be rubbed, morning and even- ing, on the inner part of the thigh, in cases of leucorrhcea and amenorrhcea. ' Dispensatory, p. 431. Edinb. 1842. ' A Practical Treatise on Venereal Diseases, translated by Drummond, Araer. edit p. 237, 249. Philad. 1843. FERRI LACTAS. 359 LXXXVI. FERRI LACTAS. Synonymes. Ferrura lacticura, Lactas ferrosus, Lactate of Iron, Lactate of Protoxide of Iron. French. Lactate de Fer. German. MilchsauresEisenoxyd 3 MilchsaiiresEisenoxyduh This preparation was recommended by MM. Gelis and Conte, internes at La Charite,in Paris, and has been favourably reported upon by M. Bouillaud, in the name of a committee, consisting of MM. Bally, Fouquier, and Bouillaud. 1 METHOD OF PREPARING. MM. Gelis and Conte prepare lactate of iron by treating pure iron filings with lactic acid, diluted with water. M. Louradour 2 extracts lactic acid from whey, which he collects from the dairies in the neighbourhood of Paris, where much cheese is made. The whey, exposed a long time to fermentation under the influence of an elevated temperature, becomes charged with a large quantity of lactic acid. It is evaporated to one-third or one-fourth of its volume, decanted and filtered ; and is then saturated with milk of lime, which produces an abundant deposit, chiefly of phosphate of lime. The filtered solution is precipitated by oxalic acid, and again filtered, and then concentrated to a syrupy consistence. It is now diluted with alcohol, which precipitates the lactine and the salts. The solution, on being filtered, and the alcohol distilled off, yields pure lactic acid. Lactate of protoxide of iron is pre- pared by digesting in a sand-bath, at a low temperature, this acid, diluted with water, upon iron filings. At the end of six or seven hours of reaction, the liquid is boiled, filtered, and concentrated; when, on cooling, it deposits crystals. These crystals, drained on a funnel, and washed with alcohol by displacement, should be dried rapidly, and be preserved from any contact with air. The salt presents itself under the form of crystalline plates, which are very white, and but slightly alterable. It is sparingly soluble in water; reddens litmus paper, and possesses the ferruginous taste in a tolerable degree. When dissolved in water, it attracts oxygen, and quickly becomes yellow. The sparing solubility of the lactate has permitted M. Loura- dour to simplify still more his process, by omitting the purification of lactic acid by alcohol, and treating it immediately with iron filings: the liquor, suitably evaporated, affords crystals of the lactate: the foreign salts and the lactine remain in the mother waters, which are rejected. 1 .Journal de Pharmacie, cited in Amer. Journal of Pharmacy, July, 1 840, p. 121 . See, also, Beral, Journ. de Chimie Medicale, cited in Amer. Journ. of Pharm. April, 1841, p. 74; and Gelis and Conte, in Bouchardat, Annuaire de Therapeutique pour 1848, p. 166. Paris, 1848. 9 Bulletin General de Therapeutique, Mars, 1840. 360 FERRI LACTAS. As the lactate would seem to be often adulterated with efflo- resced sulphate of iron, or the same precipitated with alcohol, or with starch or sugar of milk, M. Louradour recommends, that no lactate should be used except what is under the form of crystalline plates, which do not readily admit of fraud. 1 EFFECTS ON THE ECONOMY. Lactate of iron has been used in cases in which protocarbonate of iron is employed, and chiefly in chlorosis. MM. Gelis and Conte are disposed to refer the beneficial agency of the proto- carbonate to its becoming lactate of iron in the stomach, by uniting with the lactic acid, which has been presumed to be one of the healthy gastric acids. This idea led them to administer lactate of iron ready formed. In chlorosis the remedy has been given by MM. Fouquier, Bally, Beau, Rayer, Nonat, Andral, Bouillaud, Gerdy, Franz, and others, who have collected a great number of cases, which show its success in that disease. 2 M. Bouillaud 3 made trial of it in twenty-one cases, fourteen of which were treated at La Charite. One of the last cases not being de- cidedly chlorotic may be excluded. Of the thirteen, ten were females, and three males. Of the ten females, eight presented well marked chlorosis; two were rather of anaemia. The dose was carried to six, eight, ten, twelve, and fifteen lozenges, each con- taining about five centigrammes of the salt (gr. |) in the twenty- four hours. It was well borne, and always sensibly increased the appetite; but, as Mialhe 4 and Pereira 5 remark, there seems to be no evidence of its superiority over the citrate or tartrate of iron. MODE OF ADMINISTRATION. MM. Gelis and Conte form freshly prepared lactate of iron into lozenges, in which the sugar prevents the superoxidation of the iron, and preserves the medicine; whilst, at the same time, a form is given, which allows of great facility of administration. MM. Andral and Fouquier seldom exceed twelve grains of the lactate in twenty- four hours; and M. Bouillaud never gives more than twenty. The following formulae have been proposed by Mr. Cap : 6 1 Journ. de Pharmacie, and Amer. Journ. of Pharmacy, Oct. 1840, p. 230. Wohler' process is given by Christison, Dispensatory, Amer. edit, by R. E. Griffith, p. 978. Philad. 1848. F. Roder's process, which resembles it, is given in Dierbach. Die neuesten Ent- deckungen in der Mat. Med. 3er Band. 2te Abth. S. 856. Heidelb. und Leipz. 1847 See, also, on this subject, Dispensatory of the United States, 8th edit. p. 1278. Philad" 1849. 2 Bulletin General de Therapeutique, Mars, 1840; also, La Lancette Franchise, cited in London Lancet, Feb. 8, 1840, p. 707. * Encyclographie des Sciences Medicales, Mars, 1840, p. 226. Academie Royale de Medecine de Paris, Seance du 4 Fevrier. 1840. 4 Traite de l'Art. de forrader, p. 184. Paris, 1845. 1 Elements of Mat Med. and Therap. 3d edit. i. 790. Lond. 1849. • Journal de Pharmacie, and Amer. Journ. of Pharmacy, Oct. 1840, p. 228. FERRI NITRAS. 361 Trochisci ferri laetatis. Lozenges of lactate of iron, R. Ferri lactat. ^vij. gr. 43 (30 grammes.) Sacchar. ^xiss. (360 grammes.) Mucilag. acacise q. s. Make into lozenges, each weighing gr. x. (65 centigrammes) which will contain gr. I (5 centigrammes) of the salt. Syrupns ferri laetatis. Syrup of lactate of iron. R. Ferri lactat. £i. (4 grammes.) Aquas destillat. bullient. ^viss. (200 grammes.) Sacchar. alb. ^xiij. (400 grammes.) M. Cap considers the use of this syrup to be more convenient than that of the lozenges, because the ferruginous taste does not remain so long in the mouth. Pilulse ferri laetatis. Pills of lactate of iron. R. Ferri lactat. Althaeas pulv. aa. gr. xvss. (1 gramme.) Mellis q. s. ut fiant pil. xx. Chalybeate bread has been administered in one of the largest hospitals of Paris to chlorotic patients, and with the best effects. From four to five grains of lactate of iron may be mixed with every three and a half ounces of bread, without giving it any unpleasant taste or injuring its quality. 1 LXXXVII. FERRI NITRAS. Synonymes. Ferri Pernitras, Ferrum Nitratum sen Nitricum Oxydatum, Nitras Ferri, Nitras Ferricus, Nitrate of Iron, Eernitrate of Iron. French. Nitrate de Fer. German. Salpete r sau r es Eisenoxyd. LIQUOR FERRI PERSESQUINITRA'TIS. Synonymes. Liquor seu Solutio Nitratis sen Pernitratis Ferri, Liquor Ferri Nitrici Oxydati, Solution of Persesquinitrate of Iron, Solution of Nitrate of Iron. METHOD OF PREPARING. This preparation, which has been introduced of late years into practice, may be formed in the following manner: Take of small chips or pieces of Iron wire, an ounce and a half; Nitric acid, three ounces by measure; Water, twenty-seven ounces; Muriatic acid, one dram. Put the iron into an earthen- ware vessel, and pour on the nitric acid, previously diluted with fifteen ounces of the water. Set the vessel aside till the whole of 1 Provincial Medical and Surgical Journal, June, 1841. 362 FERRI NITRAS. the acid has united with the iron, so as to form a persesquinitrate ; then decant the liquid from the portion of iron, which remains undissolved; strain, and filter. Add the muriatic acid with the remainder of the water, or with as much of that liquid as will in- crease the whole solution to thirty ounces. When the process is finished — which takes some hours — the liquid has a red colour, so dark, that when viewed by reflected light, it seems almost black. Three ounces of nitric acid of the usual strength (1.4) generally dissolve an ounce of iron, so that when the process is completed, a portion of the metal remains undissolved. The solution then consists entirely of persesquinitrate of iron ; and, if speedily decanted, it may be preserved in that state ; but if allowed to stand for a few hours longer on the iron, it will undergo a farther change, becoming gradually converted into pernitrate and protoni- trate of iron. The first of these is insoluble, and renders the liquid turbid; and the latter, which remains dissolved has not the medicinal properties that render the persesquinitrate valuable. When the solution contains nothing but nitric acid and peroxide of iron, it slowly undergoes decomposition on standing, so that, at the end of a few weeks, the whole liquid begins to become tur- bid. The addition of some muriatic acid prevents this decom- position, and the quantity sufficient for this purpose is too small to affect the medicinal powers of the persesquinitrate. The solu- tion, when properly prepared, is of a beautiful dark red colour, when viewed with transmitted light. Its taste is very astringent, and not at all caustic. 1 A formula, since given by Mr. Kerr, is the following. Take of Iron wire, (No. 17,) one ounce; nitric acid, three fluidounces ; water, fifty-seven ounces; muriatic acid, a dram. Mix the nitric acid with fifteen ounces of water in an earthen vessel, capa- ble of holding three or four times the quantity. Put into this the iron wire broken into a number of pieces : cover the vessel lightly. In eight or twelve hours, the solution must be poured off, and the remainder of the water, with the muriatic acid, be added. The formula admitted into the last edition of the Dublin Phar- macopoeia 2 is the following. Take of fine Iron wire, free from rust, jj, (avoirdupois;) pure nitric acid, three fluidounces; dis- tilled ivater, a sufficient quantity. Into the acid first diluted with gxvj. of the water introduce the iron wire, and leave them in con- tact until gas ceases to be disengaged. Filter, and add as much water as will make the bulk one pint and a half, (f ^xxx.) 1 Kerr, in American Journal of the Medical Sciences, for May, 1832, cited from the Edinb. Med. and Surg. Journal. 2 The Pharmacopoeia of the King and Queen's College of Physicians in Ireland, 1850, p. 88. Dublin, 1850. PERRI NITRAS. 363 EFFECTS ON THE ECONOMY. This preparation greatly resembles solution of chloride of iron in its medicinal properties. Mr. Kerr considers, that to an as- tringent power it unites that of diminishing the irritability and tenderness of the mucous membranes with which it comes in contact; and, of late, he has called attention to it as a remedy in cholera. 1 In chronic diarrhoea an experience of eighteen years has proved its great value ; but he has not found it serviceable where ulceration of the bowels is present; and, therefore, he thinks it not applicable in the diarrhoea of phthisis. Kopp adminis- tered it with the greatest success in many cases of chronic diai*- rhcea, that had resisted every approved remedy. The faeces were blackened by it, as by the preparations of iron in general. He remarks that it must be continued for some time. The dose he gave was ten drops several times a day in oatmeal gruel, and this was gradually raised to twenty and twenty-five drops. When the cure was accomplished, the remedy was gradually diminished, until it was left off altogether. 2 Dr. Graves 3 speaks in equally high terms of the persesquinitrate in these cases; and Dr. T. C, Adam, of Lenawee County, Michigan, has recorded the remark- able assistance which he has derived from its use in the treat- ment of several diseases, especially diarrhoea and other affec- tions of the mucous membranes accompanied by discharges. 4 In chronic diarrhoea, depending mainly on an excess in the sen- sibility of the organic nerves which supply the digestive tube, Dr. Adam rarely orders less than fifteen drops at the commence- ment, and after a few days' employment of the remedy, he in- creases the quantity to twenty, twenty-five, and thirty drops. In leucorrhcea, occurring in such as are pale, exanguious, feeble, and languid, the internal, conjoined with the external, use of the persesquinitrate has been found very advantageous. In these cases, Dr. Adam adds such a quantity of water as a diluent as will still leave in the vagina a gentle degree of heat or smarting. Dr. Adam recommends it, also, in cases of aphthous sores; and he affirms that its application has afforded relief in toothach. Dr. J.W.Williams 5 employed it successfully in the diarrhoea and intestinal hemorrhage of typhoid fever. Mr. Kerr gave it in a case of urticaria, which yielded speedily, after having resisted other remedies. He found it also potent in allaying hiccough. It is, doubtless, a powerful astringent, but it is questionable whether it possesses any advantage over the tincture of chloride of iron. 1 Monthly Journal of Med. Science, Jan. 1848. 2 See, also, Twining on the Diseases of India, i. 217. Calcutta, 1835. 3 Clinical Lectures, Amer. Med. Library edition, p. 128. Philad. 1838. 4 Amer. Journal of the Medical Sciences, May, 1839, p. 61. * Boston Med. and Surg. Journal, April 7, 1841. 364 FERRI OXIDUM HYDRATUM. LXXXVIII. FERRI OXIDUM HYDRATUM. Synonymes. Ferri Sesquioxidum Hydratum, Ferrugo, Hydras Ferricus, Ferrum Oxydatum Hydratum, F.O. Hydricum, Oxidum Ferri seu Ferri- cum Hydratum, Hydro-oxide of Iron, Hydroxide of Iron, Hydrated Oxide of Iron, Hydrated Peroxide of Iron, Hydrated Tritoxide of Iron, Hydrated Sesquioxide of Iron, Oxyhydrate of Iron. German. Eisenoxydhydrat, Wasserhaltiges Eisenoxyd. Hydrated oxide of iron has been introduced into practice as an antidote to white arsenic. Dr. Bunsen, of Gottingen, had already made frequent experiments with it, which satisfied him, that it was an efficacious agent; but, along with Dr. Berthold, 1 he subjected it to fresh trials. The results of their investigations were published, and since then it has received attention every where. METHOD OF PREPARING. The best mode of preparing it ; according to Dr. Bunsen, is to take a solution of pure sulphate of iron > increase the dose of oxy- gen by treating it with nitric acid, and precipitate the oxide by adding pure ammonia in excess, — washing the precipitate. In or- der not to deprive the precipitate of its water, and to diminish its loose state of aggregation as little as possible, it is not filtered, but is put aside for a few days, until the precipitate is wholly deposit- ed, after which the supernatant fluid is poured off. It is then kept in well-stopped vessels. Riecke 2 has added the formula for pharmaciens, which is re- commended by Von Specz: — R. Vitrioli ferri puri crystallizati libram; teratur in pulv. subtiliss. et detur in vas. porcellan. aut murrhinum, impositum balneo arense ; dein adde acidi nitrici concentrati lbss.; terantur ope baculi vitrei usque dum massa resolvitur in pultem ; nunc, igne animato, masses pultaceae calidse affunde sensim terendo, sensim acid, nitric, concentrat. q. s. donee nullum amplius evolvatur gas nitrosum. Massa tunc leni igne evaporetur ad siccitatem et solvatur demura in aq.destill. q. s.; solutioni filtratse instil- letur ammonia puree q. s. donee praecipitatio cesset: stent nunc per horam unam alteramve et liquor limpidus a sedimento bruneo decantetur; mas- sae residuae fundum petenti adfunde aq. destillat. lbiij. et agitentur; nunc filtra, et prsecipitatum in filtro aq. destill. q. s. edulcora donee aqua in- sipida defluat. Prsecipitatum bene edulcoratum in umbra, siccatum con- vertat. in pulv. subtilissim. qui servetur vase vitreo bene clauso. 3 1 Das Eisenoxydhydrat ein Gegengift der arsenigen Saure. Gotting. 1834. 2 Die neuern Arzneimittel, S. 227. Stuttgart, 1837. 3 " Take of pure crystallised sulphate of iron a pound ; rub it into a subtle pow- der, and place it in a porcelain or glass vessel in a sand-bath; then add half a pound of concentrated nitric acid; stir them with a glass rod until the mass is resolved into a soft paste ; then — the fire being raised — pour gradually on the hot pultaceous mass concen- trated nitric acid, until no more nitrous gas is evolved. Let the mass be evaporated by a gentle heat to dryness, and at last be dissolved in a sufficient quantity of distilled water. Into the filtered solution drop pure ammonia so long as any precipitate occurs; let it now stand for an hour or two, and then pour off the limpid liquor from the brown sediment. On the residuary mass remaining at the bottom, pour three pounds of distilled water, and shake them together: filter and wash the precipitate on the filter with distilled water, until the water is tasteless. The well-washed precipitate dried in the shade forms a subtle powder, which may be kept in a well closed vessel" , FERRI 0XIDUM HYDRATUM. 365 Lassaigne advises it to be prepared as follows: — Take iron filings: pour gradually upon them four times their weight of the nitric acid of commerce in small portions. Heat is thereby deve- loped, and deutoxide of nitrogen, which is transformed by the atmo- spheric air into nitrous acid vapours. When the evolution of gas has ceased, ten or twelve parts of water are added ; the mixture is then filtered, and ammonia added until the mixture begins to exhi- bit an alkaline reaction. The precipitate, thus formed, is the hy- drated oxide of iron, which is collected on the filter, and washed with boiling water until it is tasteless, and ceases to exhibit any alkaline characters. The mode of preparation recommended by Majeste, agrees with this, except that he boils one part of iron filings with four of nitric acid and four of muriatic acid. The following form was advised by the late Dr. William R. Fisher, 1 who asserted that it w T as subjected to practice by Mr. Durand, an able pharmacien of Philadelphia, who obtained a per- fect result, with a satisfactory economy of material. Take of sul- phuric acid, (67° Baume,) 8 oz. or 16 parts; iron wire, 8 oz. or 16 parts ; nitric acid, (49° Baume,) 5J oz. or 11 parts ; water of ammonia, as much as is sufficient; water, a gallon and a half, or 384 parts. Mix the sulphuric acid with the water in a glass ves- sel. Add the iron, and, after the effervescence has ceased, filter. Add the nitric acid in divided portions, and apply heat so long as orange-coloured fumes are given off. To the heated solution, pour in the water of ammonia until a decided excess has been added ; then wash the precipitate by decantation, until the washings give no precipitate with nitrate of baryta. The water is then to be drawn off until just enough remains to give the consistence of thick cream. It has been supposed that this preparation is not injured by keeping ; but some careful experiments by Mr. Wm. Procter, Junr., 2 show, that even when kept under water its power of neu- tralizing arsenious acid gradually decreases ; that if kept in the form of a thick magma, it will retain its properties longer than when mixed with much water ; and that this decrease of power is probably owing to a change in the relative proportion of the ox- ide, and the w T ater chemically combined with it, as well as to an alteration in its state of aggregation. Mr. Procter advises, that a ferruginous solution similar to that directed in the United States Pharmacopoeia should be kept in every shop as a source for obtaining the peroxide; that the solution of ammonia should be added to it w 7 hen the demand occurs, and the peroxide be separated in the manner advised in the Pharmacopoeia. In this mode the first doses may be given in ten or fifteen minutes. In 1 American Journal of Pharmacy, vol. vi. No. 1, April, 1840. 2 Ibid. April, 1842, p. 37. 24 366 FERRI OXIDUM HYDRATUM. the mean time, however, the moist peroxide prepared according to the Pharmacopoeia should be given, and if recently prepared it may be sufficient; but for the reasons adduced by Mr. Procter it is advisable that the recent oxide should always be adminis- tered, especially where the amount of poison taken has been large. 1 The form for this preparation admitted into the last edition of the Pharmacopoeia of the United States (1842,) is the following : Take of Sulphate of iron, ^iv.; Sulphuric acid, f 3iijss.; Nitric acid, f 5vj., or a sufficient quantity; Solution of ammonia, a sufficient quantity; Water, Oij. Dissolve the sulphate in the water, and, having added the sulphuric acid, boil the solution; then add the nitric acid in small portions, boiling the liquid for a minute or two after each addition, until the acid ceases to pro- duce a dark colour. Filter the liquid, allow it to cool, and add solution of ammonia in excess, stirring the mixture briskly. Wash the precipitate with water, until the washings cease to yield a precipitate with chloride of barium, and keep it in close bottles with water sufficient to cover it. a EFFECTS ON THE ECONOMY. If a solution of arsenious acid be decomposed by freshly preci- pitated oxyhydrate of iron suspended in water, traces of arsenic can no longer be detected in the filtered liquid made acid and tested by a stream of sulpho-hydric acid gas. To throw down one part of arsenic, in this manner, requires a quantity of the oxyhy- drate, which contains at least ten or twelve parts of oxide of iron. Yet, even where a smaller quantity is employed, the arsenious acid is almost wholly separated, as a stream of sulpho-hydric acid gas affords only very slight traces of sulphuret of arsenic in the filtered and acidulated liquid. When the substances are previously heated, or the arsenious acid is exposed in small por- tions to the precipitating agent, the reaction is still slighter. If a few drops of ammonia be added to water in which the oxyhydrate of iron is suspended, and the mixture be digested with finely pow- dered arsenious acid, an insoluble arsenite of iron is formed ; a circumstance, which would encourage the belief — even had it not been sanctioned by experience — that freshly prepared oxyhydrate of iron may serve as an antidote to arsenic; — the union between it and arsenious acid forming — as has been seen — an insoluble com- pound, devoid of all poisonous influence on the economy, and only exciting gastric oppression when given in large doses. Accurate microscopical investigation, in experiments on ani- mals that had taken arsenious acid in the solid form mixed with the oxyhydrate, exhibited to the discoverer of the antidote, that 1 Procter, loc. citat. 9 Pharmacopoeia of the United States, p. 112. Philad. 1842. FERRI OXIDUM HYDRATUM. 367 under the influence of animal heat and the peristaltic motion, it had become completely converted into subarseniate of protoxide of iron, and thus rendered innocuous. Such was the 'result of the observations of Boulet, 1 Orfila, Chevallier, Lassaigne, Soubeiran and Miquel, 3 Nonat, Borelli and Demaria, 3 Lesueur, Boulay, fils, 4 Monod, 5 Von Specs, Mackenzie, 6 D. Maclagan, 7 and others. 8 On the other hand, the experiments of Brett, 9 Reginald Orton, 10 and Cramer, were unfavourable ; but Messrs. Bunsen and Berthold remark, that the experiments of those gentlemen could not be ex- pected to be successful, as they were made with doses of arsenic of from two to nine grains; and the stomach of the rabbit cannot retain more than from one-ninth to one-half the quantity of the an- tidote, prepared according to their formula, which is necessary to neutralize that quantity of the poison. 11 Messrs. Bunsen and Berthold, from the results they have ob- tained, recommend the oxy hydrate as the chief antidote in all cases of poisoning by arsenic; and they advise emetics to be associated with it — along with the agents hitherto employed; first, when the quantity of the poison taken has been considerable, and, therefore, a very large quantity of the antidote is demanded ; secondly, when, at the same time, substances containing tannic acid, as infusion of green tea, or sulpho-hydric acid developed after the eating of eggs, may be suspected in the alimentary canal, — as these sub- stances are closely related to the antidote, and may weaken its action; and, thirdly, when, prior to taking the poison, the stomach has been overloaded with food, and is, therefore, capable of re- ceiving only a small quantity of the antidote. But, whether vomit- ing maybe excited or not, recourse must be had to the oxyhydrate as speedily as possible. Tepid mucilaginous drinks may also be given to envelop the particles of arsenic that may exist in the compartments of the stomach. If the quantity of the poison taken be unknown, the antidote may be administered in a considerable dose, and if the patient should vomit, it may be given after- wards in smaller quantity. But, if no vomiting should arise, it is recommended that he should continue to take the oxyhydrate until the arsenite of iron formed has had time to pass into the intestinal tube; and even after this it may be persevered with in small doses for a time, as portions of arsenic may possibly remain behind un- changed. With the same view, the oxyhydrate may be thrown up 1 Gaz. Med. de Paris, 1834. 8 Bullet. General de Therap. Dec. 1834. 3 Br. and For. Med. Rev. April, 1836, p, 594. 4 Journal Hebdom. des Progres des Sciences Medic. 14 Mars, 1835. s Gazette Medicale, 22 Aout, 1835, and Annales d'Hygiene, &c. xiv. 13 '). 6 London Lancet, April 4, 1840. ' Edinb. Med. and Surg. Journal, July, 1840. 8 T.R. Beck, Amer. Journ. of the Medical Sciences, July, 1841, p. 90. 9 London Medical Gazette, xv. 220. 10 Lancet, JNV. 8, 1834. u See, also, Maclagan, op. cit. 368 • FERRI OXIDUM HYDRATUM. in the way of clyster, whenever it is presumable that the com- pound, formed by the oxyhydrate and the arsenic, has reached the lower portion of the bowels. To aid this, cathartics may be ad- ministered. Of these, castor oil, which would first suggest itself, might interfere, it has been conceived, with the operation of the antidote. Sulphate of magnesia, or any of the neutral salts, should have the preference. The antidote may be given suspended in w^ater. Experience has shown Messrs. Bunsen and Berthold, that from ten to twenty parts of hydrated oxide of iron are more than sufficient to convert one part of arsenious acid into the basic salt of iron. As the quantity of arsenic in the stomach and intestines can scarcely ever be appreciated, it is considered by them advisable, to allow the patient to take as large doses of the oxyhydrate as the stomach can tolerate ; and it is of essential importance that it should be taken as hot as it can be borne. When the arsenious acid has been swallowed in the undissolved state — in the form of powder, or in larger or smaller pieces — it is necessary, in order to aid its solution, and to effect a speedy union with the oxide of iron, to add a small quantity of pure ammonia to the antidote, until a slight alkaline re-action is evinced. As the ammonia does not enter into the composition of the salt formed, and, consequently, only plays a secondary part, ten or twenty drops may be sufficient for the purpose. In the uncertainty as to the precise quantity of poison that has been taken, it has been recommended, that to an adult a table-spoonful, and to children a dessert-spoonful should be given every five or ten minutes until relief from the urgent symp- toms is obtained. 1 The various experiments that have been instituted on animals have showm the protective power of the hydrated oxide: it must be borne in mind, however, in all such experiments made on dogs, that they readily reject the poison by vomiting; but if the poison be retained in the stomach by a ligature passed round the oeso- phagus, it exerts its accustomed deleterious effects. 3 It would seem, also, that the same result occurs if the dose of the arsenic be too small to induce vomiting. The animal may then die of the poison. 3 It w r ould appear, that cases have occurred, in which this anti- dote has saved the lives of some who might have been destroyed without its agency. Buzorini 4 had a case in which about thirty- five grains of arsenic had been swallowed, and where it was suc- cessful, although twenty-four hours had elapsed since the poison had been taken; but this cannot be regarded as very satisfactory, 1 T. R. Beck, Amer. Journ. of Med. Sciences, July, 1841, p. 05. - MM. Miquel and Soubeiran, Bullet. General de Therapeutique, Dec. 1834. See,on this subject, l)r Joseph E. Muse in Amer. Med. Intelligencer, for April 2, 1838. 3 Robert B. Hall, in Amer. Med Intelligencer, for Sept. 15, 1838, p. 181. * La Laucette Francaise, Nov. 17, 1835. FERRI OXIDUM HYDRATUM. 369 inasmuch as the patient might probably have been saved by ordi- nary means. In another case, which was also treated by the anti- dote at a late period, marked alleviation of the suffering was in- duced. Three cases are related by Majeste, two by Bineau, 1 one by Benoist, and one by Geoffroy 2 of Paris, which were treated suc- cessfully in the same manner. The subject of the last was a hair- dresser, thirty-five years of age, who, in a paroxysm of delirium tremens, swallowed a dram and a half of arsenic. Half an hour afterwards, the antidote was given suspended in water. He drank, in twelve hours, all the hydrated oxide produced by the decom- position of five ounces and five drams of the sulphate of iron. He had no violent colic; and, twenty-four hours afterwards, experi- enced scarcely any uneasiness. A successful case has, also, been related by Mr. John Robson, house-surgeon to the Warrington Dispensary. 3 Dr. Richard H. Thomas, of Baltimore, 4 has published a case, in which it was believed that twenty grains of arsenic had been taken, which was relieved by the hydrated oxide, administered six hours after the poison was swallowed: there was no vomiting; but thirst, burning pain, and exquisite tenderness at the epigastrium existed, denoting endo-gastritis. Half a fluidounce of hydrated oxide, which was in the wet state, and about the consistence of thick cream, was given in a tumbler of cool water, and the dose was directed to be repeated every ten or fifteen minutes in tw T o ounces of water, eight ounces of the suspended oxide were taken in the twenty-four hours, after w T hich the patient seemed free from disease. " The length of time — six hours" — says Dr. Thomas, " before any very severe symptoms supervened, and before the antidote was administered, at first caused me to think that the patient might have been deceived. Professor Von Specs, of Vienna, however, asserts, 'that a dram of arsenic, in powder, does not produce its deadly effect on the system in Jess than six or eight hours, while the same quantity, dissolved in warm water, destroys life in a much shorter time. 5 In the present instance, it was swallowed in a dry state, covered with sugar. The prompt relief which followed the exhibition of the peroxide is also con- firmatory of the impression that the poison w 7 as really taken." A case has been published by M. Deville, 5 which was treated by this remedy, but as the patient vomited much, and the vomited matters were not examined, it is doubtful what was its agency. i Journal des Connalssances Medico-Chirurgicales, Nov. 1835. 2 Journal de Med. et de Chirurg. Pratiq. Sept. 1835; cited in Brit, and For, Med Rev., April, 1836, p. 572. 3 Lond. Med. Gaz. Nov. 5, 1836. 4 American Medical Intelligencer, for July 16, 1838, p. 167. 1 Revue Medicale Franq. et Etrangere, Sept. 1838; see, also, Br. and For. Med. Rev. and Johnson's Med.-Chir. Rev. for April, 1839; and Amer. Journ. of the Med. Sciences, May, 1839, p. 243. 370 FERRI OXIDUM HYDRATUM. Between five and six hours elapsed before it could be procured. These remarks apply still more forcibly to a case reported by Dr. Chaloner, 1 the subject of which took at eight o'clock, p. m. about half an ounce of arsenic, after which he vomited incessantly, and did not take the hydrated oxide until three p. m. on the day fol- lowing. He got well; and the vomiting appeared to be relieved by it. More recently, several cases of the successful exhibition of the hydrated oxide have been published ; one by M. Ansroul, of Brussels; 2 seven by Puchelt, 3 of Heidelberg; one by Dr. Mac- donald; 4 one by Dr. Chilton; 5 and one by Dr. Murray, 6 of India, Drs. Smiley and Wallace, 7 of Philadelphia, administered it to a family of eight persons. Death followed in two cases. The antidote could not be retained by them, but was rejected imme- diately. In all the other cases, which recovered, the symptoms were mitigated. As recommended in the Pharmacopoeia of the United States, the hydrated oxide should be kept in the shops, ready mixed with a definite quantity of water, in order that it may be always at hand, so as to be administered without delay ; and the recommen- dation is good. Even if not to be trusted to alone, the evidence is quite sufficient to show, that it ought to be regarded as an im- portant element in the treatment of every case in which arsenic has been taken. A commission of the Academie Royale de Medecine, 8 composed of MM. Deville, Sandras, Nonat and Guibourt, recommend that four ounces of dry hydrated oxide of iron, the subcarbonate of iron of the shops, or sesquioxide of iron, should be suspended in twenty-four ounces of water, and a good glassful of the mixture be taken every ten minutes. After four ounces are consumed, fresh doses of the same mixture may be administered in like manner, and the patient should not be considered out of danger, until he has taken at least half an ounce of the peroxide for each grain of arsenious acid supposed to have remained in the stomach. Instead of pure hydrated oxide, Von Specs 9 employed sub- stances in which the peroxide is known to exist in considerable quantity, and which require no previous preparation, as rust of iron, and haematite, {red iron ore,) and, from his experiments, he is led to conclude that although these substances do not prevent 1 Medical Examiner, April 18, 1840, p. 251. 7 Annales de la Societe de Medecine de Gand, Avril, 1840, cited in Encyclographie des Sciences Medicales, Mai> 1840, p. 494. , 3 Heidelberg Medicinisch. Annal. B. v.; cited in Encyclographie des Sciences Medi- cales, Mai. 1840. * New York Journal of Med. and Surg. iii. 205. s Ibid. p. 54. 6 Calcutta Med. Journ. Dec. 1837, cited in Amer. Journ. of the Med Sciences, Feb. 1839. p. 503. ' Philad. Med. Examiner, iii. 679. 8 Revue Medicale, Mai et Juin, 1839. 9 Med. Jahrbucher des k. k. 6. St., B. xix. S. 621. Wien, 1836; and Ibid. B. xx. S. 149. Wien, 18:56. Cited in Brit, and For. Med. Review, July, 1837, p. 237. FERRI PROTOCARBONAS. 371 all the bad effects of arsenic on the system, they may — in the absence of the hydra ted oxide — be employed as antidotes to that poison. The rust of iron has the advantage of being readily pro- curable. A case has been published by M. Batilliat, 1 which induced him to infer, that the hydrated oxide, dried in the air, is as jefflcacious as that which is kept moist. It certainly would seem that the dry hydrated oxide — the Ferri Subcarbonas of the Pharma- copoeia of the United States, (1842,) — possesses the power to a considerable extent, of neutralizing arsenious acid; 2 and hence it ought to be used in the absence of the moist and fresh prepa- ration. The latter, however, as already remarked, may be ob- tained in a condition fit for use in ten or fifteen minutes, by using a solution of the persulphate of iron. 3 The experiments of M. Guibert 4 would seem to show, that the subcarbonate of iron, as ordinarily prepared, is about three times less active in neutralizing arsenic than the dry hydrate prepared with ammonia, and six times less active than the same hydrate in the moist state. A case has been reported by Dr. Spath, of Esslingen, 5 in which the hydrated oxide was administered as an antidote to Scheele's green — Jirseniate of Copper. A boy, three years of age, poi- soned himself by licking a shell covered with the poison. Half an hour afterwards, he became pale: violent vomiting soon came on, with diarrhoea, pain in the abdomen and burning thirst. The hydrated oxide was given in divided doses in warm water, and in half an hour the vomiting, diarrhoea, colic and thirst ceased, and the next day all the symptoms had disappeared. LXXXIX. FERRI PROTOCAR'BONAS. Synonymes. Ferri Carbonas, Protocarbonate of Iron, Carbonate of Iron. French. Protocarbonate de Fer. German. Kohlensaur e s Eisen. Precipitated carbonate of iron contains but little carbonic acid, — the remainder being chiefly peroxide of iron. The name has indeed been changed — in the last London Pharmacopoeia — to " sesquioxide of iron." The protocarbonate readily absorbs oxy- gen, and, consequently, becomes converted into the sesquioxide; and this is an objection commonly urged both against the Mis- 1 Journal de Chimie Medicale, Janvier, 1.840. 2 T. R. Beck, loc. citat. 3 W. Procter, Junr., Amer. Journ. of Pharmacy, April, 1842, p. 37, and the Report of the Committee of the College of Pharmacy on his paper, Ibid. p. 39. 4 Bullet. General deTherap., Dec, 1841, cited in Amer. Journal of the Med. Sciences, Oct., 1842, p. 490. 5 Journal des Connaissances Medico-Chirurg., Mars, 1840. Archives de Medecine, Fevrier, 1842; cited in Journal de Pharmacie, Mars, 1842, p. 269. 372 FERRI PROTOCARBONAS. tura Ferri Composita, and the Pilulas Ferri Composite, of the Pharmacopoeias. M. Vallet has discovered a method of ob- viating the objection, which consists in mixing the protocarbonate with saccharine matter. METHOD OF PREPARING. The following method is given by Mr. Procter 1 as a simplifica- tion of M. Vallet's process. Take of Protosulphate of iron, (pure,) sixteen parts; Carbonate of Soda, (crystallized,) nine- teen parts; Pure honey, nine parts; Syrup, a sufficient quantity. Dissolve the sulphate in half a gallon of water, at the temperature of 180° Fahrenheit, and the carbonate of soda in a like quantity; to each of these solutions add four ounces of syrup; and then mix them in a jar, which should afterwards be entirely filled with sweetened water, and the access of air be prevented. After the precipitate has subsided, decant the supernatant fluid, and wash it with sweetened water, in the jar, until deprived of the adhering sulphate of soda. After the carbonate is thus purified, throw the precipitate on a flannel cloth ; express forcibly, and mix it with the honey. The mixture should then be reduced by eva- poration as rapidly and carefully as possible, to a pilular consist- ence. The mass constitutes the "Ferruginous Pills" of M. Vallet. The following form, founded on the above, has been introduced into the Pharmacopoeia of the United States, (1842.) Pilnlae ferri carbonatis. Pills of carbonate of iron. (Vallefs Ferruginous Pills.) Take of Sulphate of iron, 3iv.; Carbonate of soda, %v.; Cla- rified honey, ^iiss. ; Syrup, Boiling water, each a sufficient quantity. Dissolve the sulphate of iron and carbonate of soda, each, in a pint of the water, and to each solution add a fluidounce of syrup; then mix the two solutions in a bottle just large enough to contain them, close it accurately with a stopper, and set it by that the carbonate of iron may subside. Pour off the supernatant liquid, and having washed the precipitate with warm water, sweetened with syrup in the proportion of a fluidounce of the latter to a pint of the former, until the washings no longer have a saline taste, place it upon a flannel cloth, and express as much of the water as possible; then immediately mix it with the honey. Lastly, heat the mixture by means of a water bath, until it attains a pilular consistence. A formula for the Ferri Carbonas Saccharatum is intro- duced into the last edition of the Edinburgh Pharmacopoeia. On the continent of Europe the preparation is known under the name 1 Amer. Journ. of Pharmacy, Jan., 1839, p. 272. FERRI PROTOCARBONAS. 373 of Klauer's Ferrum Carbonicum Saccharatum. 1 It is in the Pharmacopoeia of Baden. 2 When prepared'in this manner, the protocarbonate has a dark olive colour, strong ferruginous taste, contains about 30 per cent. of protoxide of iron, and, if carefully prepared, dissolves wholly and directly in acids. EFFECTS ON THE ECONOMY. The pills of M. Vallet have been prescribed in most of the dis- eases in which chalybeates in general are considered to be indi- cated; and especially in chlorosis and amenorrhea. 3 It has been affirmed, that in cases in which the alterative effects of iron are proper, Vallet's preparation is superior to any other derived from that metal. 4 This can only be decided therapeutically; and as yet the trials have been too few. The author has exhibited it freely, but has not had reason to assign it any pre-eminence. It is certainly preferable to any other form of preparing the proto- carbonate for medical use, in consequence of its stability, but it has to be determined, whether the conversion into the sesquioxide renders it less efficacious as a medicine. Blaud, as will be seen presently, says distinctly not. Fifteen grains of this preparation have been observed to occasion sickness; and ten grains, twice a day, have produced headach and a sense of fulness in the head. 5 The author has never witnessed such effects from its administra- tion. MODE OF ADMINISTRATION. The mass of pilular consistence, described above, may be made up into pills, each weighing three grains, and containing some- what less than a grain and a half of proto-carbonate. They may be given to the extent of eight or ten pills daily, and be continued for weeks, if necessary. A medicine which greatly resembles the Pilulse Ferri Com- positde of the Pharmacopoeias, and in which the iron, when it is newly prepared, is in the state of protocarbonate, has acquired great celebrity in the south of France on account of its beneficial effects in chlorosis. It is given in the form of pill, and is called after its inventor, — M. Blaud, senior physician to the Hospital of ' Beaucaire, — " Blaud's Pills." Blaud's formula for the prepara- tion of his pills is as follows: — Take of Gum tragacanth, in powder, six grains; Water, one dram. Macerate in a glass or 1 Pereira, Elements of Materia Medica, &c, 2d edit., p. 861. London, 1842, or 2d Amer. edit. Philad. 1846. 9 Oesterlen, Handbuch der Heilmittellehre, S. 457. Tubing. 1845. 3 Soubeiran, Rapport surles nouvelles pilules ferrugineuses de M. Vallet, in Bulletin General de Therapeutique, Mai, 1838, cited in Amer. Journ. of Pharm., x. 244. See, also, Berthemot, in Bull. General de Therapeut. Juillet, 1839. 4 Wood and Bache's Dispensatory of the United States, 8th edit. Phila. 1849. * Christison, Dispensatory, p. 426. Edinb., 1842. 374 FERRI PROTOCARBONAS. porcelain mortar, until a thick mucilage is formed; and if it be de- sired to prevent the formation of peroxide of iron, and to make the pills similar to those of Vallet, substitute — says M. Blaud — a dram of powdered sugar for the mucilage. Add, afterwards, of Sulphate of iron, in powder, half an ounce. Beat well, until the mixture is quite homogeneous; and add, of Carbonate of potassa, half an ounce. Beat until the mass, which soon becomes of a yel- lowish-green colour, passes to a deep green, and assumes a soft consistence. Divide into 48 pills or boluses; which M. Blaud considers sufficient for the cure of a chlorotic patient. 1 M. Gui- bourt substitutes the bicarbonate for the simple carbonate or sub- carbonate; and he gives as reasons: First, the avoidance of a very alkaline salt, an excess of which may prove prejudicial to the stomach; and, Secondly, the formation of a double carbonate of potassa and iron, which is, of all the compounds of iron, the most fitted for absorption by the economy, as it is not only soluble, but not astringent. His form is the following: — Take of pure crys- tallized sulphate of iron, crystallized bicarbonate of potassa, each four drams; powdered gum Arabic, one dram; powdered marshmallows, half a dram. Mix and divide in ninety-six pills. 2 A proper objection made to Blaud's pills is their excessive size; and farther it has been urged, that a chemical change quickly occurs in the mass; the carbonate of the protoxide being, after a short time, converted into the sesquioxide of iron. 3 Blaud, 4 however, maintains properly, that the virtue of medicines cannot be appre- ciated from chemical experiments: " It is," he remarks, " to thera- peutical trials, and not to chemical experiments that we must have recourse, to learn accurately the medical properties of any agent. What signifies it to practitioners that my pills contain little or no protoxide of iron, provided they cure chlorosis?" To prove that they .do possess this power, Blaud adduces a long list of cases in which a cure was obtained in three or four weeks. To prevent, however, the change to which the chemists object, but which Blaud appears rather to regard with favour, M. Adorne has sug- gested the addition of sugar, and the pulvis althaeae according to the following form: — Take of Sulphate of iron, recently pre- pared, according to the method of BonsdorfT, 5 which is a pure sul- phate; Carbonate of potassa, or, what is better, Carbonate of soda; Powdered root of marshmallow and Sugar, each, half an ounce; Mucilage of gum Arabic, as much as is sufficient. — Make into ninety-six pills, which must be covered with a very fine layer of gum and sugar, aromatized with essential oil, to cor- rect the disagreeable odour. 6 With similar views, M. Simonin, 1 Revue Medicate, Mars^ 1832, Dec. 1838. 3 Pharmacopee Raisonnee, i. 383; cited in Amer. Journ. of Pharm., April, 1839, p. 61. 3 Soubeiran, Bull. General de Therap., Mai, 1838. " Ibid. 8 See Wood and Baches Dispensatory, 4th edit, p. 906. Phila., 1839. 6 Bulletin Medical du Midi, Janvier, 1839; cited in Encyclographie des Sciences Medicales, Mars, 1839. FERRI PROTOCARBONAS. 375 of Nancy, has proposed the following formula for the preparation of Bland's pills, which, he considers, has the double merit of prompt and easy execution, and of furnishing pills which keep without undergoing alteration. Take of Protosulphate of iron and Pure carbonate of potassa, each equal parts. Reduce them separately to a fine powder; mix accurately by triturating them together until they begin to liquefy; then add enough clarified honey to give the mixture complete liquidity: afterwards, heat the mass over a very gentle fire, until it has acquired the pilular consistence. This process was repeated by M. Felix Boudet, 1 by employing pure crystallized sulphate of iron, 100 grammes; 2 pure carbonate of potassa, 100 grammes ; white honey, 50 grammes ; from which he obtained 130 grammes of a deep green mass, very duc- tile, and easily rolled into pills, as M. Simonin had said. The ad- dition of the honey prevents the farther oxidation of the iron. Dr.W. H. Robert, of Madison, Georgia, 3 who considers Blaud's pills to be a capital remedy in chlorosis, the best he has ever used, recommends that after pulverizing the sulphate of iron and the carbonate of potassa, they should be mixed intimately, and be formed into a pilular mass with freshly made corn bread. If fluid be added, the mass will be entirely too soft to be divided into pills. M. Blaud commences with his " antichlorotic pills," in the dose of one a day; and, in the course of a few days, gives two, and afterwards, three, daily. Mr. Donovan 4 recommends the protocarbonate of iron to be administered in the following manner, for extemporaneous use: — Blue sulphate of iron, in fine powder, half an ounce; Calcined magnesia , two scruples; Water, six ounces; Tincture of quas- sia, two drams. Divide into six draughts, one to be given night and morning. Mr. Carmichael, 5 of Dublin, has advised the following mode of exhibiting the precipitated carbonate: — Take one dram of Bi- carbonate of soda, dissolved in four ounces of Spring water, and add a dram of tincture of chloride of iron. This draught to be taken three times a day during effervescence. Mr. Car- michael remarks, that although the quantity of carbonate of iron formed is not considerable, yet it is in such a state of minute sub- division, and combined with a solution of chloride of sodium equally minute — " the saline most congenial to the system of red- blooded animals, as it renders the hematosine active and vivifying," that, thus given, he always found it answer the object of a chaly- beate much better than the large doses of from one to two drams 1 Journal de Pharmacie, Mars, 1841, p. 153. 3 A gramme is gr. 15.444 Troy. 3 Southern Med. and Surg. Journal, July, 1846. 4 Dublin Journal of Medical Science, March, 1840, p. 159. 8 Dublin Medical Press, March 4, 1840. 376 FERRI SUBCARBONAS. of the subcarbonate. If ulceration existed, it was very generally improved ; and he has seen many cases of lupus attacking the face cured by its joint internal and external use. He formerly thought the phosphate of iron, administered internally, possessed superior advantages to the carbonate; but now thinks the carbonate given during the precipitation answers every purpose of a chalybeate, without causing any derangement of stomach. Dr. Stegmann 1 has recommended the carbonate in the treatment of hooping cough, in the dose of half a grain at least, to be taken every three hours with sugar, and increased to as many grains as, and even more than, the number of years in the child's age. It should not, he advises, be administered in the first stage of the disease; and in all cases should be preceded by an emetic. Similar testimony is said to have been afforded by Ghisholme, 2 and recently it has been strongly advised by R. Froriep, 3 who gives it in the same doses in which it is prescribed in chlorosis, and has succeeded in removing the disease in two weeks, or, at the farthest, in six. XC. FERRI SUBCARBONAS. Synonymes. F. Carbonas seu Carbonas Praecipitatus, Ferrum Carbona- tum PraBcipitatum seu Carbonicum Oxydulatum, Oxydum Ferri Fus- cura, Ferri Oxidum Rubrum seu Sesquioxidum, Deutocarbonas Ferri Fuscus, Crocus Martis Aperiens, Subcarbonate of Iron, Sesquioxide of Iron, Peroxide of Iron. French. Souscarbonate de Fer, Safran de Mars Aperitif. German. Kohlen sau res Eisenoxydul, Kohl en saures Eisen, Kohlensaures Eisenoxyd, Braunes Eisenoxyd. This preparation, which is officinal in the British, United States and other Pharmacopoeias, is formed by adding a solution of car- bonate of soda to a solution of sulphate of iron: the precipitate is the subcarbonate, or — as it is now called in the London Pharma- copoeia — the sesquioxide of iron, which must be washed with water, and dried. EFFECTS ON THE ECONOMY. Subcarbonate of iron possesses the properties of chalybeates in general, and has been highly recommended as a tonic, wherever such remedies are indicated. It is introduced here mainly on account of the favour which it has received, of late years, as a remedy for neuralgia. Nearly forty years ago, its use was strongly advised in cancer and carcinomatous ulcerations of the uterus, by 1 Horn's Archiv., 1835, Juli and August, S. 651; and Medicin. Correspondenzz BlatJ, cited in Gazette Medicale de Paris, 20 Juin. 1838. 3 Trousseau and Pidoux, Traite de Therapeutique, &c.,3me edit. i. 26. Paris, 1847. 3 Tassberichte, Mars, 1850, No. 48; cited in Keller and Tiedemann's Nordamerikan- ischer Monatsbericht fur Natur und Heilkunde, Sept, 1850, S. 104. FERRI SUBCARBONAS. 377 Mr. Carmichael, 1 and, subsequently, by Rust,V6Iker, and Kopp; as well as in a case of lupus of the ala nasi, by Key : 2 but, in similar cases, it proved unsuccessful in the hands of Clarke, El. Yon Sie- bold, Meissner, Richter, and others. 3 In chronic nervous diseases, of a spasmodic nature, and especially in tic douloureux of the face, it was first highly extolled by Dr. Benjamin Hutchinson, about thirty years ago, 4 who published several cases of cure effected by its agency. Soon afterwards, cases, equally fortunate in their termination, were published by various observers, by Drs. A. T. Thomson, 5 Stewart Crawford", 6 R. Macleod, 7 Mr. J. E. Beale, 8 and many others, and its efficacy is now almost universally admit- ted. Dr. Rowland 9 has often witnessed the most happy results from its exhibition, even after various powerful medicines had been tried in vain. Dr. Elliotson 10 published several cases, in which it had been efficacious in large doses; and he remarks, that true chro- nic neuralgia, not arising from cold, and coming on in a violent, stabbing, plunging form, aggravated by the least shake of the patient, and by touching the surface, is best treated by subcarbo- nateof iron. He observes, however, in a more recent publication, 11 that he does not recollect that he ever cured the disease, but in almost every case improved it, and caused it to disappear for a time. In one of the severest cases of neuralgia under the form of hemi- crania, which the author ever witnessed, and which had rendered the patient's life miserable for years, the subcarbonate, in large doses, proved entirely successful. The patient had been bled re- peatedly; and when the author saw her, she was under the, most favourable circumstances for the exhibition of the remedy, — with the surface pale and cool; the pulse small; complaining much of debility, and yet suffering under the most intense headache, which the least light and noise rendered almost intolerable; yet, after she had persevered in the use of the remedy for a month, in large doses, the symptoms gradually disappeared, and she has since re- mained entirely well. It need scarcely be said, that where ple- thora exists, or febrile irritation supervenes, it must be removed: the subcarbonate rarely, however, disagrees with the stomach, and where it does, the inconveniences are removed by the addition of an aromatic, or the administration of a cathartic. Subcarbonate of iron, in large doses, has, likewise, been found I An Essay on the Effects of the Carbonate and other Preparations of Iron upon Can- cer, 2d edit. Dublin, 1809. 2 Lancet, xiv. 92. 3 Osann, in Encyclop'ad. Worterb. der Medicinisch. Wissensch. x. 424. Berlin, 1834. 4 Cases of Tic Douloureux successfully treated. Lond. 1820. 5 Medical and Physical Journal. Feb. 1 823. 6 Ibid. \ Ibid. June, 1823. 8 Ibid. Sept. 1823. 9 Treatise on Neuralgia, by Richard Rowland, M. D. p. 84. Lond. 1838; or the reprint in the author's American Medical Library. 10 Medico-Chirurgical Transactions, xv. 161. II Principles and Practice of Medicine, &c by John Elliotson, M. L\; with Notes. &c. by Nathaniel Rogers, M. D. p. 507. Lond. 1839, 378 FERRI SUBCARBONAS. a valuable agent in a kindred condition of the nervous system — chorea. Dr. Elliotson 1 affirms, that he has had — he should sup- pose — forty eases, in succession, all cured by it; but perseverance in its use is demanded, the affection generally disappearing when the remedy has been given about six weeks or two months; but in some obstinate cases it has been necessary to continue it for twelve weeks. Like other tonics, it has been prescribed in intermittents, and not long ago, M. Gimon, 2 physician at Thouars, published two cases elucidative of the effects of large doses in long protracted intermittents, complicated with ascites and enlargement of the spleen. One of these occurred in a boy, nine years old, and the other in a young man of twenty-one. Both had taken the sul- phate of quinia, in large doses, but ineffectually. To the former, he prescribed twelve grains of the subcarbonate in the twenty-four hours, augmenting the dose by six grains daily. The treatment was commenced in the latter end of July, 1835, and the quantity taken in the day was pushed progressively to one ounce. In six months the traces of ascites and splenocele had disappeared, and the cure was complete. The medicine was discontinued by gra- dually diminishing the dose. In the second case, the same dose was prescribed in the first instance; and it was ultimately carried to six drams, with complete success. The great efficacy of this preparation — as of every tonic — in dis- eases that are paroxysmal, appears to consist in the new impres- sion which it makes upon the nerves of the stomach, and, through them*, upon those of the whole system; but to effect the revulsion to the requisite extent, it appears to be necessary — as in the cases of artemisia and indigo in epilepsy — to keep up the effect of the remedy by gradually increasing the dose. MODE OF ADMINISTRATION. The dose of subcarbonate of iron, in cases of neuralgia and chorea, should be large. Dr. Hutchinson prescribed it in the quantity of 3ss. to 3ij., twice a day, but where it fails to remove the complaint in those doses, Dr. Elliotson recommends, that it should be increased gradually to one or two ounces. The best vehicle for it is molasses. The following formulae have been re- commended : 3 Pulvis ferri snbcarbonatis. Powder of subcarbonate of iron. R. Ferri subcarb. gr. x. Pulv. aromat. gr. v. M. Fiat pulvis mane et meridie sumendus. ' Op. citat. p. 515. 2 Journal des Connaissances Medico-Chimrjricales, Mai, 1837. ■ Brande, Dictionary of the Materia Medica" p. 248. Lond. 1839. FERRI TANNIS. 379 Boli ferri snbcarbonatis. Boluses of subcarbonate of iron, R. Ferri subcarb. gr. x. Valerianae pulv. gss. Syrup, zingib. q. s. Fiat bolus. Pilulse ferri subcarbonatis* Pills of subcarbonate of iron. R. Ferri subcarb. Extract, anthemid. aa. gss. Misce et divide in pilulas xij. quarum somat binas ter quotidie. R. Ferri subcarb. 3j. Pilul. aloes cum myrrha, gss. Misce et divide in pilulas xviij.: duse bis terve indies sumendae. P i 1 u 1 8B ferri sobcarbonatis et hydrargyri. Pills of subcarbonate of iron and mercury . . R. Ferri sufocarbonat. gj. Hydrargyr. gij. Confect. rosea, giij. Rub until the globules are no longer seen. This formula is proposed as a substitute for blue pill. It is made in five minutes, whilst blue pill requires a week. Dr. Collier 1 recommends it as especially eligible for the strumous, the irritable, and for reduced anxmic constitutions requiring mer- cury. Five grains of the subcarbonate are sufficient to amalgamate and divide a large quantity of mercury ; but Dr. Collier proposes the larger quantity as a remedy. Electuarium ferri snbcarbonatis. Electuary of subcarbonate of iron. R. Ferri subcarb. Confect. aurant. aa. ^j. Syrupi zingib. q. s. ut fiat electuarium cujus sumatur cochleare minimum bis vel ter die. XCI. FERRI TANNIS. Synonymes. Ferrum Tannicum. French. Tannate de Fer, Tannate de Peroxyde de Fer. German. Gerbesaures Eisen oxy d . Tannate of iron has been recently employed internally in dis- eases in which chalybeates are indicated. 1 From his second edition of the London Pharmacopoeia, cited in Lond. Lancet, Mar. 24, 1843 380 FERRI VALERIANAS. METHOD OF PREPARING. To a boiling solution of 90 parts of pure tannic acid add gradually 440 parts of subcarbonate of iron prepared from pure sulphate of iron and carbonate of soda dried at a moderate heat. Agitate the solution until the effervescence ceases. Evaporate at 176° Fahr., in a porcelain vessel, until it becomes thick; and spread it on glass or porcelain to dry in a stove at 95° Fahr. It is usually obtained, however, by adding a solution of a salt of sesquioxide of iron, as the persulphate, to a decoction of nut- galls. The result is a tanno-gallate of iron, as in common ink. Tannate of iron is of a blue colour, tasteless, and insoluble in water. It is possessed of tonic and astringent properties; and has been highly extolled in chlorosis by Benedetti, 1 and been used wherever chalybeates, especially astringent bhalybeates, are indi- cated ; but it does not appear to possess any special virtues. As an external application in herpes circinnatus or ringworm, ink has been long a popular remedy. MODE OF ADMINISTRATION. The dose of tannate of iron is from 10 grains to half a dram in the day, given in syrup or in the pilular form. Syrupns ferri tannatis. Syrup of tannate of iron. R. Syrup, gxij^ aceli ^iv. Ferri oxidi magnetici citrat. gijss. Ext. gallse. gj. M. This preparation was first proposed by MM. Trousseau and Pi- doux, 2 and as the iron, they remark, "is in the state of ferroso- ferric tannate, and associated with an acid, it is soluble, sapid, and susceptible of useful applications." XCII. FERRI VALERIA'NAS. Synonymes. Ferrum Valerianicura, Valerianate of Iroo, Valerianate or Sesquioxide of Iron. French. Valerianate de Fer. German. Bald riansau res Eisenoxyd. This salt may be formed, according to Ruspini, 3 by putting clear iron filings into a wedgewood mortar, adding gradually an equal weight of valerianic acid, and stirring continually. In an hour, add distilled water; pour the whole into a flask; warm gently, and filter. The surface exposed to the air becomes co- 1 Bouchardat, Annuaire de Therapeutique, pour 1847, p. 186. Paris, 1847. * Traite de Therapeutique et de Mat. Medicale, Seme edit. i. 7. Paris, 1847. * Bouchardat, Annuaire de Therapeutique pour 1847, p. 54. FILIX MAS. 381 vered with a crystalline layer of valerianate of iron. Collect this on a filter, and repeat the process as long as crystals are formed. It is a dark, brick-red, loose, amorphous powder, of feeble taste and smell of valerianic acid. It is insoluble in water. 1 It has been given in the form of pill, in the dose of from two to four grains in hysterical symptoms complicating chlorosis. The salt is officinal in the last Dublin Pharmacopoeia. 2 XCIII. FILIX MAS. Stnonymes. Filix, Nephrodium seu Aspidium seu Athyrium sen Poly- podium seu Polystichum Filix Mas, Male Fern, Male Shield Fern. French. Fougere Male. German. Farrenkraut, Johanniswurz el , Mannlicher Far- renkraut, Fa rr enkr autmannlein, Mannlicher Nieren- farrn, Band wurm waldfarrn, Mannle in wur m tiipfelfarrn. The rhizoma of male fern, which is indigenous in this country, and in the secondary list of the Pharmacopoeia of the United States, has long been celebrated — since the time of Dioscorides indeed — as an anthelmintic; and especially for the destruction of taenia? For these properties, it has been introduced into most of the Pharmacopoeias. It was the basis of Madame Nuffer's or Nouffer's celebrated remedy for taenia, which was purchased by Louis XVI., in 1775, for 18,000 francs. 4 It is noticed here on account of the proposition of Peschier, 5 of Geneva, to administer the ethereal extract, which has since been carried into effect, and apparently with the best results. 6 It appears to possess the advantage of being by no means unpleasant to the taste, and to be accompanied by none of the disagreeable effects that are associated with the action of most of the other vermifuges. To prepare the extract, the root is cut small, and digested for ten or twelve days, in the cold, in a sufficient quantity of sulphu- ric ether: the tincture is then pressed, concentrated by distillation, and the ether thereby fully removed. From a pound of the root, about eighteen drams of a brownish-green thick extract are ob- tained, which possesses the repulsive odour of the plant, and has an acrid taste. 1 Aschenbrenner, Die neueren Arzneimittel und Arzneibereitungsformen, S. 1 32. Er- langen, 1848. a The Pharmacopoeia of the King and Queen's College of Physicians in Ireland, 1850, p. \m. f Dublin, 1850. * Merat and De Lens, Diet, de Mat. Med. art. Polypodium. * For the various forms in which it has been given as an anthelmintic against taenia, as well as for the methods of Von Beck, Herrenschwand, Matlhieu, Measeed, Nuffer, Odier, and Wawruch: see Linke, Vollstandiges Recept-Taschenbuch, u. s. w, i. 232. Leipzig, 1840. s Nouvelle Bibliotheque Medicale, Sept. 1823, p. 151, and Biblioth. Univer. 324, 1826. 6 Rayer, Annal. de Therap., Mai, 1847, cited in Schmidt's Jahrbiicher, u. s. w. No, 5, p. 162. Jahrgang 1848. 25 382 FILIX MAS. In Germany, the extract is generally prepared according to the formula of the Prussian Pharmacopoeia, which is as follows: — Take an ounce of the powdered root, and pour thereon eight ounces of the sulphuric ether of commerce; close the vessel, shaking it occasionally, and let it stand until the fluid has acquired a yellow- ish colour; then separate the fluid as before described; distil off the sulphuric ether until only a third remains, and evaporate the remainder in a water bath, until a thin brownish-yellow coloured extract remains. This extract contains not only the volatile oil of the fern, but also a fixed oil, tannic acid, acetic and gallic acids, a muco-saccha- rine matter, green and red colouring matter, and a semi-resinous substance. By some it is called oleum filicis maris. The ac- tive constituents of the fern are highly concentrated in it ; and as the result of numerous trials, it was found, that from eighteen to twenty grains, given at night, and the same quantity in the morn- ing, fasting, destroyed taenia ; so that, on the administration of a cathartic, the parasite was discharged — often in the form of a ball. Not unfrequently, indeed, it was voided before the cathartic was given. In Germany, this new preparation has been chiefly recommend- ed by Hufeland, who maintained, that in rapidity, certainty, and gentleness of action, it exceeds all known means, and many other physicians have testified to the accuracy of this opinion. Radius, 1 who frequently prescribed it, says he never gave it without bring- ing away large pieces of the worm, but frequently the head re- mained behind. 2 Peschier had found it to be successful in one hundred and fifty cases when he wrote; 3 Ullersberger had used it in sixty cases, and a medical friend of his in two hundred cases, with invariable success. It is affirmed to have proved more suc- cessful in cases of Bothriocephalus latus than of Taenia solium; and a part of the discrepancy of results amongst observers has been ascribed to this circumstance. For example, it has not been found as effective in the treatment of taenia at Paris, and the taenia most common there is Taenia solium* Buchner 5 thought, that the extract might be prepared with al- cohol, but many physicians have objected to this menstruum — that it does not dissolve the fixed oil. The male fern is preferred by M. Rouzel 6 to the bark of pome- granate root in the treatment of taenia. 1 Auserlesene Heilformeln, u. s. w. Leipz. 183(5. 2 See, also, Ebers, in Hufeland und Osann's Journal, Ixvi. St. 1, S. 43, cited in Gazette de Sante, Sept. 25, 1828. 3 Merat and De Lens, loc. cit. 4 Christison, Dispensatory, p. 451. Edinb. 1842. * Repertorium fur Pharmacie, xxiii. 433, xxvii. 337, and Funk, in Medicin. Zeitung. 17 Mai, 1837, S. 102. s Revue Me" ale, Oct 1840. See, also. M. Wawruch, Oesterreich. Med. Jahrbuch. cited in Encyc. dcs Sciences Med. Nov. 1841, p. 264; Brit, and For. Med. Rev. Oct 1844; and M. Daumerie, Archives de la Med. Beige, Sept 1841, p. 5. FUCUS AMYLACEUS. 383 MODE OF ADMINISTRATION. The extract is commonly given in the form of pill : an emulsion does not answer, because the active constituents are apt to be en- veloped and masked in this form. In Geneva, it is now frequently united with castor oil, which renders it unnecessary to give a ca- thartic after it. For the cathartic, when needed, they advise, in Bern, infusion of senna with Epsom salts, manna, and aniseed. 1 To children, it maybe given in syrup. An ethereal tincture of the buds (one part of the buds to eight of ether) has been used with advantage as an anthelmintic; 2 and a decoction (one ounce of the rhizoma to a pint of water) has been occasionally prescribed. Mel filicis maris. Honey of male fern. R, Ext. aether, filicis maris gss. Mel. rosae ^ss. M. Half of this to be taken on going to bed ; the other half early in the morning fasting. XCIV. FUCUS AMYLA'CEUS. Synonymes. Plocaria Candida, Gracilaria seu Sphaerococcus seu Gigartina seu Fucus lichenoides; Ceylon Moss, Marine Moss, Jaffna Moss, Edi- ble Moss. The attention of physicians has been directed to this vegetable by Messrs. Sigmond and Farre, 3 and by Dr. O'Shaughnessy, of Calcutta. 4 Like Chondrus, (p. 210,) it belongs to the Natural Order Algse, and was first introduced, some years ago, into Eng- land from India. As met with in commerce, it is white, filiform, and fibrous, and has the usual odour of sea-weeds. "When analyzed by Dr. O'Shaughnessy, it was found to be composed as follows : — Of vegetable jelly, 54.50; true starch, 15; wax, a trace; ligneous fibre, 18; gum, 4; sulphate of soda, and chloride of sodium, 6.50; sulphate and phosphate of lime, 1; iron, a trace; loss, 1: — Total, 100. When boiled in water, a liquid results, which gelatinizes on cooling. It has also been examined chemically by Guibourt, Wonneberg and Kreyssig, Bley and Riegel. 5 EFFECTS ON THE ECONOMY. The medical properties of fucus amylaceus are similar to those of chondrus. The decoction is an agreeable, light, nutritious arti- cle of food. According to Dr. O'Shaughnessy, its nutritive quali- ties are best obtained in the following manner : — Put into a clean stew-pan a table-spoonful of prepared marine moss, add to it a 1 Hufeland und Osann's Journal lxiv. St. 1, S. 133. 3 London Lancet, for 1834-5, ii. 597. 3 The Ceylon Moss. Lond. 1840. * Medico-Botan. Transactions, vol. i. pt. iv. p. 184. 8 Cited in Pereira, Elements of Mat. Med. and Therap. 3d edit. ii. 913. Lond. 1850. 384 FUCUS AMYLACEUS. pint and a half of hot or cold water, and boil gradually for twenty minutes; then take a little in a spoon, and let it cool for a minute or two, to see if the liquid is sufficiently boiled to congeal firmly ; if not, let it boil until it is; then strain it through a cloth into an- other stew-pan while it is warm, so as to draw all the liquid from the sediment produced by the moss. The sediment must be well squeezed. Add to the liquid a table-spoonful of fine loaf sugar, half a table-spoonful of lemon juice, a table-spoonful of honey, or not, at the option of the maker ; add a small piece of lemon peel, and a very small piece of cinnamon: boil the whole gradually for ten minutes, and pass it once or twice through a piece of flannel into a basin or tumbler, and in ten minutes it will be fit for use. Should it be required to be very clear and transparent — which is not considered necessary for an invalid, as by clarifying it partly loses its strength — add the white of an egg, well beaten into froth, before the second boiling; taking care, that after the second boil- ing it rests for some minutes by the fire-side, with some hot char- coal on the cover of the stew-pan so as to render it perfectly clear; otherwise, by adding the whole of an egg, it will have a milky- white appearance, which is not so pleasing to the eye, although its quality may be the same. When clear, and of a lemon colour, it may be passed two or three times through a flannel bag. It may then be suffered to cool, or be taken in a liquid state, if preferred by the patient. The jelly is as good for the table as for the sick chamber. Blanc- manger and Italian cream can be made with it without isinglass; but in such case, the jelly must be made much stronger before it is mixed; and at all times it must be blended whilst warm. The quantity it takes for a mould of either is two table-spoonfuls of moss to a quart of water, which must be reduced to half a pint. Ceylon moss has the advantage over isinglass and the other mosses, that it will stand firm and good for twenty -four hours in the hottest clays of India; whilst neither isinglass nor any other jelly will stand firm for half an hour, even with the aid of ice. It also possesses the advantage, that a delicious jelly can be made from it in about fifteen or twenty minutes. It has been pro- nounced by all the medical faculty of Calcutta to be unequalled for its delicate and nutritious qualities, and has been especially and highly recommended for the use of the sick. When all other nou- rishment has failed, this has proved successful; and Dr. O'Shaugh- nessy says he has no doubt, that when the article is better known by the faculty in England, it will be much more appreciated, and receive the same patronage and support, which it has done from the whole of the faculty in India for the last fifteen or sixteen years. 1 1 Braithwaile's Retrospect of Pract. Med. and Surg. No. 1, Jan. to June, 1840, 3d edit jw 70. Lond. lo42; and Sigmond and Farre on the Ceylon Moss. Lond. 1840. FULIGO. 385 XCV. FULIGO. Synonymes. Fuligo Splendens seu Fornacum seu Ligni, Soot, Woodsoot. French. Suie. German. Glanzruss, Spiegelruss ? Kaminruss, Ofenruss, Russ. The discovery of creasote, and its extensive application to the treatment of disease, gave occasion to the resuscitation of this article — much employed by the ancients, but subsequently fallen into oblivion. The older physicians frequently used it as an ex- citing diaphoretic agent in cachexia of every kind, in chronic rheu- matism, cutaneous affections, and especially in the evil results of their sudden repercussion ; in glandular indurations, rickets, exos- toses, &c. It has also been employed as a domestic remedy, in colic, and in the simple and dysenteric diarrhoea, and cholera of children. Several modern recommendations — as by Schutte and Weisen- berg — remained unheeded until the attention of physicians was drawn to it, especially by Blaud. 1 He is of opinion, that the costly — and by no means easily prepared — creasote may be wholly replaced by soot. Both are products of the dry distillation of organic substances; their odours are analogous, and as soot; is much cheaper and more easily obtained, it deserves, he thinks, to be tried more extensively in therapeutics. Soot has a nauseously empyreumatic, more or less bitter, and acrid, saline taste. EFFECTS ON THE ECONOMY. Blaud 2 has exhibited soot in different diseases, especially in the form of ointment, or in decoction, with excellent and rapid effects, in herpes, itch, tinea, gutta rosea, and pruritus vulva; and he asserts, that he even healed cancer of the breast by frequent ablu- tions with a tepid decoction of it, and an ointment composed of equal parts of lard and soot with one-eighth part of the extract of belladonna ; but the same applications were of no benefit in a case of cancer of the nose, and in one of cancer of the uterus. He also cured a scabby eruption of the mucous membrane of the nose by an ointment of it. In diphtheritis, he used, in two cases, a de- coction, as a mouth-wash, with the best effects. In confirmation of Blaud's remarks, Voisin asserts, that he cured a case of cancer of the face by soot ointment. Dr. J. R. Marinus 3 has found it very efficacious in chronic eruptions {dartres,) and in tinea; and his observations have been confirmed by MM. Nobele* and Le Montagnier. 5 M. Nobele's 1 Revue Medicale, Juin, 1834, et Janvier, 1835, and E. Grafe, in Grafe und Wal- ther's Journal, xxiii. 310. Berlin, 1835. 3 Journal des Connaissances Medico-Chirurg. Mai, 1 834. 3 Bulletin Medical Beige, Nov. 1838, p. 289. For farther testimony in its favour, see London Lancet, Nov. 25, 1 843. 4 Annales de la Societe de Medecine de Gand, Gazette Medicale, or Encyclographie des Sciences Medicales, Mars, 1840, p. 540. 5 Bullet. Gener. de Therap. Nov. 1840, or Encycl. des Sciences Med., Fev. 1841, p. <69y. 386 FULIGO. conclusions are, — 1. That it cannot be applied, with any expec- tation of success, until the crusts have been removed, and the ir- ritation of the parts has been diminished by means of emollient applications. 2. That the gray layer, left by it on the skin, whe- ther it be used in the form of ointment or of decoction, should be removed by a weak wash of soap and water. 3. That in chil- dren an ointment, made with equal parts of soot and lard, is fre- quently too irritating for the small wounds exposed by the falling off of the crusts ; that it is better to commence with one part of soot to three parts of lard ; and lastly, that wood soot is alone useful, — soot from coal being devoid of any agency. Dr. Ebers, of Bourdeaux, 1 has employed a decoction of soot with great advantage in a case of severe burn in which the pa- tient was suffering from the profuse discharge. A handful of soot was boiled in eight pounds of water, until the fluid was reduced to two pounds. Lint was then soaked in it and applied to the granulating surface. Carron du Villards 3 advises a collyrium prepared from soot in cases of strumous ophthalmia. He infuses two ounces in boiling water, filters and evaporates to dryness ; the shining residuum is then infused in very strong boiling vinegar, and to every twelve ounces of the liquid, twenty-four grains of extract of roses are added. A few drops of this solution, in a glass of tepid water, form an excellent resolutive collyrium, which may be made stronger or weaker at pleasure. He has, also, in cases of spots on the cornea ,used soot — either blown into the eye alone, or mixed with powdered sugar-candy, and has seen good effects from it. United with butter, it forms an eye-salve, not inferior perhaps, he says, to any other. As in the treatment of specks on the cornea , by dropping laudanum into the eye, the organ quickly becomes ac- customed to it, Carron du Villards advises, that the eye should be excited to a more lively action by means of the combination of soot and tincture of opium given below. It is, he says, an energetic agent, and may be applied by means of a pencil to granulations on the cornea. He likewise recommends a decoction of soot as an injection in discharges, v)hich are the consequence of chronic inflammation of the vagina. M. Andre Gibrin 3 has detailed to the Academie Royale de Medecine of Paris, six cases of chronic inflammation of the Madder, in which soot was beneficially used in the way of injection. M. Gibrin took from the chimney two ounces of compact soot, broke it up, washed it, and boiled it in a pound of water. The decoc- 1 Journ. de Med. et Chirurg. Pratiq. Juin, 1841, cited in Amer. Journ. of the Medical Sciences, Jan. 1842, p. 231. 1 Gazette Medicale, Janvier, 1831; see, also, Baudelocque, on its Use in Scrofulous Ophthalmia, in Bulletin General de Therapeutique. Mars, 1834. 3 Bulletin de 1' Academie, 15 Mars, 1837. FULIGO. 387 tion was filtered through paper, and injected into the bladder twice a day. The good effects supervened so closely on the administra- tion of the remedy, that there could be no doubt as to the cause. The pain ceased, and the patient obtained sleep, to which he had been for some time a stranger. The urine gradually became clear, and recovered its natural appearance. To these remarks may be added, that, according to Schiitte, an ointment composed of two parts of fresh butter or hog's lard, and one part of soot — is a popular and efficacious remedy on the Rhine for cases of porrigo, itch, and herpes ; not more than a dram being rubbed in at a time. Weisenberg ascribes to the soot a protective power against contagious affections of the skin, and recommends, especially, lotions of soot water, — partly, as a pre- ventive agent, and partly as a therapeutical application in itch. Employed as an injection, an infusion of soot was found by Dr. Hewson, of Philadelphia, an efficacious remedy in ascarides vermiformes. 1 But soot has not been used, of late, externally only ; its in- ternal use, in the form of the old "tincture of soot/' has been re- vived. This was long known under the name of "soot drops," "hysteric mixture" and "Jit drops," and was employed as an anti-spasmodic in hysterical and other affections ; but its em- ployment has been extended, and it is given in chronic rheuma- tism, chronic affections of the chest, suppressed cutaneous eruptions, — in many cases under precisely the same notions that prevailed years ago. From thirty to sixty drops of the following tincture are given several times in the course of the day. MODE OF ADMINISTRATION. Mistura fuliginis. Mixture of soot. Tinctura Fuliginis Clauderi. R. Fulig. gss. Potassse carbonat. ^iss. Ammonise carb. gij. Aq. sambuc. f %ix. Digere leni calore, et filtra. Dose. — From thirty to sixty drops, several times a day. A similar preparation has been used in Philadelphia, under the names medical lye, soot tea, alkaline solution, and dyspeptic lye, as a popular remedy in dyspepsia. It is made by infusing a pint of clean hickory ashes and a gill of soot in half a gallon of boiling water, allowing it to stand for twenty-four hours, and then decanting. Of this, a small wine glassful is taken three or four times a day. 1 United States Dispensatory, 6th edit. p. 1297. Philad. 1845. 388 FULIGO. Lotio f ul i gin is . Lotion of soot. R. Fulig. manip. maj. ij. Coque cum aq. Oi. per semihoram. Cola cum expressione. Used as a wash, several times a day, in herpetic, psoric and syphilitic ulcers. Blaud. Unguentnm fuliginis. Ointment of soot. R. Fulig. Adipis aa. ^ ss. Extract, belladon. 3J. M. exacte. To be spread upon lint or tents in case of cancer. Blaud. R. Adipis. Fulig. aa. gij. Coque leni igne per horas vj. As a dressing in cases of tinea and of foul ulcers. Blaud. R. Fulig. Ciuchon. flav. aa. ^ss. Carbon, pulv. Sulph. aa. §j. Cerati simplicis q. s. ut fiat unguentum. A dram to be rubbed in, once or twice a day, in cases of tinea. Carron du Villards. R. Fulig. Jss. Opii §ij. Caryoph. 3j. Aq. cinnam, f ^viij. Alcoholis f ^iv. Digest in a gentle heat for six days; filter and express the residuum. Applied in cases of specks of the cornea. Carron du Villards. R. Fulig. 3iss. Zinci sulphat. ^vj. Adipis ^iv. M. Applied in cases of tinea. It is the Pommade contre la teigne, of Bories. 1 Cataplasma fuliginis. Cataplasm of soot. R. Folig.gij. Alb. ovi No. vj. Tere simul. As a dressing for herpes and tinea. It is the Pommade reso- lutive of Sainte Marie. 2 1 Formulaire de Montpellier. Montpellier, 1822. 3 Nouveau Formulaire Medicale et Pharmaceutique. Paris et Lyon, 1820. FULIGOKALI. 3S9 XCVI. FULIGOKALI. Synonyme. German. Russkali. This new remedy called from fuligo, 'soot,' and kali, ' potassa,' has been introduced as an analogous preparation to anthrakokali (p. 80.) 1 METHOD OF PREPARING. Fuligokali is prepared as follows : — Take of Potassa, 20 parts ; Shining soot, in powder, 100 parts ; Water, a sufficient quantity. Boil for an hour; suffer the decoction to cool ; dilute with water so that filtration may be better accomplished ; filter, evaporate, and dry, in order to obtain the fuligokali in scales or powder ; and en- close it in dry and warm bottles. A sulphuretted fuligokali has been prepared as follows : — Take of Fuligokali, 60 parts ; Potassa, 14 parts ; Sulphur, 5 parts. Dissolve the sulphur and potassa in a little water ; then add the fuligokali ; evaporate, dry, and enclose in dry and warm bottles. EFFECTS ON THE ECONOMY IN DISEASE. Fuligokali has been employed by M. Gibert at the Hopital Saint-Louis of Paris, both internally and externally, but chiefly in the latter mode, in various chronic cutaneous diseases. An ointment may be made of either the simple or the sulphuretted article, by mixing one or two parts with thirty of lard. M. Gi- bert ascribes to these ointments resolvent, detergent and slightly excitant virtues. 2 Mr. E. Wilson 3 thinks it probable, that both anthrakokali and fuligokali owe much of their therapeutic value to the alkali which forms their basis. He has employed fuligokali in several cases, and especially in psoriasis palmar is, and with better success than he has obtained by the usual remedies. The preparation referred to on the last page but one, as having been used in Philadelphia under the names of medical lye, &c, may be regarded as a weak solution of fuligokali. 4 1 Journ. des Connaiss. Med. Chir. and Encyclogr. des Sciences Med., Juillet, 1842, p. 9. 3 See, also, Duhamel, Amer. Journ. of Pharmacy, Jan. 1843, p. 284, and Deschamps, in Bouchardat, Annuaire de Therapeutique, pour 1843, p. 153. Paris, 1843. 3 A Practical and Theoretical Treatise on the Diagnosis, Pathology, and Treatment of Diseases of the Skin, p. 397. Lond. 1842 ; or Amer. edit. Philad. 1843. 4 Duhamel, op. cit. 390 GALEOPSIS GRANDIFLORA. XCVII. GALEOPSIS GRANDIFLORA. Synonymes. Galeopsis Ochroleuca seu Prostrata seu Villosa seu Segetum seu Angustifolia seu Dubia, Herba Sideritidis. German. Grossbluthiger Holzahn, Grossblumige Hanf- nessel, Gelbe grossbliit hige Hundsnessel, Katzermaul. This plant, which belongs to Natural Family Labiatse, Sex- ual System Didynamia Gymnospermia, grows in the western part of Germany, in sandy corn-fields. 1 EFFECTS ON THE ECONOMY. The fresh plant has a peculiar, feeble, balsamic smell, and a somewhat bitter and saltish taste, and has been considered, in Germany, to be worthy of a distinguished place amongst the " bitter resolvents." It has been much sold as a nostrum under the name of " Blankenheimer Tea," (Blankenheimer Thee,) or " Lieber's pectoral and phthisical herbs," (Liebersche Brust oder Auszehrungskrauter,) and enjoyed great repute. In the Ardennes also, particularly in the district of Malmedy, it has been long employed as a popular remedy. In the year 1828, Lejeune 2 directed attention to its therapeutical im- portance. According to his observation, it is very useful in dis- eases of the mucous membrane of the respiratory and digest- ive organs, and especially in chronic pulmonary catarrh, even when it exists to such a degree as to merit the name Phthisis mucosa (Schleimschwindsucht.) In actual phthisis, the affection seemed to him to be diminished by it; the hectic being moderated, the expectoration rendered easier, or the cough assuaged. Lejeune generally boiled half an ounce of the plant in a pint of water down to half; sweetened the decoction with sugar or honey, and directed the whole to be taken in the twenty-four hours. In other cases, in which a milk diet was ap- propriate, the decoction was made with an equal quantity of milk. Wesener 3 found it advantageous in phthisis mucosa and chronic pulmonary catarrh. Giinther, who had many opportunities for observing the action of the remedy, affirms that the L i e b e r - schen Krauter not unfrequently produced some amelioration in phthisis, especially in scrofulous phthisis, but he never saw any actual recovery therefrom. It seemed to him to moderate the colliquative sweats, and to facilitate and diminish the expectora- tion. In one case especially, of scrofulous phthisis in the last stage, it appeared to be of essential service, and to prolong life; and from all his observations he is disposed to infer, that if it be not the sole or the main remedy to be employed in every stage of 1 Von Schlechtendal, in Encyclop'ad. Worterb der Medicin. Wissenschaft. xiii. 115. Berlin, 1835. a Annales Generates des Sciences Physiques, p. 331, Sepr. 1820. 8 Hufeland und Osann's Journ. der Pract Heilk. 1823, 1824. GALEOPSIS GRANDIFLORA. 391 phthisis, it may be used with advantage throughout the disease as a supporting agent. Riecke 1 asserts, that he has seen many cases in which the Lieberschen Krauter were of great service in thoracic affections threatening phthisis. In one case, which promised to terminate unfavourably in a short time, owing to the complica- tion of violent hemoptysis with hectic fever, and in which an experienced physician had exhausted every effort of art, they were given with the best effect. The thoracic affection ceased, and at that time — a period of five or six years since the use of the remedy — the patient — an officer — was capable of performing his military duties without difficulty. On the other hand, Richter affirms, that in two cases in which he administered the galeopsis, no benefit resulted from it. In this country, it has not been em- ployed ; so that we have chiefly the testimony afforded by the German writers. This, as they themselves admit, 2 is not yet suf- ficient to enable them to lay down any positive rules as to the exact indications and counter-indications that must regulate its employment. It is probably of no farther service than as a mild bitter; and its place may be supplied, perhaps advantageously, by many of the tonics that are admitted into the lists of our remedial agents. Geiger 3 subjected it to analysis, and found in it 2.765 parts of fatty matter, wax and chlorophyll; 0.247 of a brown, bitterish resin, insoluble in ether; 0.312 of a yellowish, stimulating and bitter resin, soluble in ether; yellow, bitter extractive matter, soluble in ether, and a brownish matter, insoluble therein ; phos- phate and malate of lime ; salts of potassa ; muco-saccharine mat- ter and fecula, and 65.882 of ligneous matter. MODE OF ADMINISTRATION. Decoctum galeopsidis grandifloree. R. Galeopsid. grandifl. summitat. ^j. Coque in Aquae Oj. per minut. xv. et cola. To be used in the twenty-four hours. Wesener. R. Galeop. grandifl. summitat. Althaeae aa. ,§]. Glycyrrhiz. gij. M. A fourth part of this to be boiled in a pint and a half of water : to be used daily in chronic catarrh, and in the expectoration produced by the softening of pulmonary tubercles. — Radius* Galeopsis versicolor, and galeopsis villosa, which have also been examined by Geiger, 5 appear to be possessed of the same virtues as galeopsis grandi flora* 1 Reicke, Die neuern Arzneimittel, u. s. w. S. 241. Stuttgart, 1837. 2 Ibid. 3 Magaz. fur Pharmacie, ix. 134. 4 Auserlesene Heilformeln, u. s. w. S. 274. Leipz. 1836. 8 Allgem. Med. Annalen, S. 1 141. 1825. 6 Richter's Specielle Therapie, B. x. S. 397. Berlin, 1828. 392 GALVANISMUS. XCVIII. GALVANISMUS. Synonymes. Electricitas Animalis seu Galvanica seu Metallica, Irrita- mentum Metallorum seu Metallicum, Galvanism, Voltaism, Galvanic Electricity. French. Galvanisme. German. Galv anismus, Volta'sche El e c t r i c i t a t . The ordinary effects of common and galvanic electricity and of electro-magnetism are so well known as to require but little com- ment. They are decidedly excitant ; and, like all excitants, when applied to a part of the frame, are counter-irritant or revellent. All have been employed in paralysis, — general and local, — amaurosis, deafness and dumbness 1 of recent duration, asthma, rheumatism, neuralgia, amenorrhoea? incontinence of urine} sprains,* &c. The effect, however, which galvanism exerts on the contractility of the muscular fibre, and the great simi- larity in its agency to the nervous influence, 5 has led to its employ- ment more frequently in the various nervous and spasmodic diseases referred to, and in others belonging to the same class. 6 Resting on his views of the absolute identity between the nervous and gal- vanic fluids, 7 Dr. Wilson Philip employed it in many diseases, and especially in asthma. In a paper read by him before the Royal Society of London, in January, 1816, he details some experiments, which he made on rabbits. The eighth pair or pneumogastric nerves were divided by incisions made in the neck. After the operation, the parsley, which the animals had eaten, remained un- changed in their stomachs, and, after evincing much difficulty of breathing, they seemed to die of suffocation. But when, in other animals, whose nerves had been divided, the galvanic agency was transmitted along the nerve, below its section, to a disc of silver, placed closely in contact with the skin of the animal, opposite to its stomach, no difficulty of breathing occurred. The galvanic action being kept up for twenty-six hours, the rabbits were killed and the parsley was found digested. The removal of dyspnoea, in these cases, led Dr. Philip to em- ploy galvanism as a remedy for asthma ; and, by transmitting its influence from the nape of the neck to the pit of the stomach, he gave decided relief in every one of twenty-two cases, of which four were in private practice, and eighteen in the Worcester Infirmary. 1 See a case of aphonia cured by galvanism, cited in London Lancet, May 27, 1843. a G. Bird, Guy's Hospital Reports, April, 1841, p. 84. 3 Froriep, cited in Edinb. Med. and Surg. Joum., 1844, p. 491. 4 Raciborski, Gaz. Med. Chirurg.; cited in Med. Chir. Rev., April, 1846. 5 See the author's Human Physiology, 7th edit, i. 118. Philad., 1850. s Pereira, Elements of Mat. Med., 2d edit., p. 42. Lond. 1842; or 2d Amer. edit, Philad. 1846. See, also, the author's General Therapeutics and Mat Med., 4th edit., i. 509. Philad. 1850. 1 Experimental Inquiry into the Laws of the Vital Functions. London, 1817. GALVANISMUS. 393 The power employed varied from ten to twenty-five pairs of plates. Since then, galvanism has been repeatedly used in such cases, and at times with manifest relief. Commonly, however, the plates, described hereafter, are employed for this purpose. The disease, in the majority of cases, appears to be dependent upon erethism of the pneumogastric nerves ; all the phenomena indi- cating that there is a spastic constriction of the small bronchial tubes, occasioned by irritation at the extremity, or in the course of the nerve. The new impression, made by the galvanic agency, breaks in upon the concentration of nervous action, by exciting other portions of the nervous system, in the same manner as we observe spasms or ordinary cramp relieved, or paroxysmal dis- eases warded off, by agents that are capable of suddenly impress- ing some part of the nervous system. Not long after these researches of Dr. Philip, galvanism was employed satisfactorily by Mr. Mansford 1 in a congenerous dis- ease — epilepsy — and his plan was afterwards — although tardily — extended to some other paroxysmal disorders. The mode of ap- plication recommended by him is as follows. A portion of the cuticle, of the size of a sixpence, is removed by means of a small blister on the back of the neck, as close to the root of the hair as possible, and a similar portion is removed from the hollow beneath, and on the inside of the knee, as the most convenient place. To the excoriated surface on the neck, a plate of silver, varying— according to the age of the patient— from the size of a sixpence to that of half a crown, is applied, having attached to its back part, a handle or shank, and to its lower edge — and parallel with the shank — a small staple, to which the conducting wire is fas- tened. This wire passes down the back, until it reaches a belt of chamois leather, buttoned round the waist; it then follows the course of the belt to which it is attached, until it arrives opposite the groin of the side on which we desire to employ it ; it then passes down the inside of the thigh, and is fastened to the zinc plate in the same manner as to the silver one. The apparatus, contrived in this way, is thus applied. A small piece of sponge, moistened in water, and corresponding in size to the blistered part of the neck, is first placed directly upon it; over this, a large piece, of the same size as the metallic plate, also moistened, is laid, and next to this, the plate itself, which is secured in its situation by a strip of adhesive plaster passed through the shank on its back; another above, and another below it. If these be properly placed, and the wire which passes down the back be allowed sufficient room, that it may not drag, the plate will not be moved from its position by any ordinary motion of the body. The zinc plate is fastened in the same manner, but in place of the second layer of * Researches into the Nature and Causes of Epilepsy, &c. Bath, 1819. 394 GALVANISMUS. sponge, a piece of muscle answering in size to the zinc plate is interposed ; that is, a small piece of moistened sponge being first fitted to the exposed surface below the knee, the piece of muscle moistened, or — what has been found equally effectual and less inconvenient — a piece of moistened flannel 1 follows, and on this the plate of zinc. The apparatus, thus arranged, will continue, according to Mr. Mansford, in gentle and uninterrupted action from twelve to twenty-four hours, according to circumstances. " This last is the longest period that it can be allowed to go unremoved ; the sores require cleaning and dressing, and the surface of the zinc becomes covered with a thick oxide, which must be removed to restore its freedom of action : this may be done by scraping or polishing ; but it will be better if removed twice a day, both for the greater se- curity of a permanent action, and for the additional comfort of the patient." The adoption of this plan of treatment in cases of tic doulou- reux; the confidence reposed by Laennec in the use of plates on the breast and back in angina pectoris, and similar neuralgic affections of the chest; and the communications of Drs. Thos. Harris and Chapman, brought it into extensive use, so that ample trial was given to it in this country, both in public and private practice. In three cases, it was — to employ the language of Pro- fessor Chapman 2 — " triumphantly directed" by Dr. Harris ; but it was only found effectual in affections of the face ; and in these cases it had to be persevered in for some time before any marked benefit was experienced. 3 About the same period, this mode of applying galvanism was recommended by Dr. Miller, 4 formerly of Washington University, Baltimore, and a case of paraplegia and another of general paralysis, were published by him, in which it was found efficacious. A similar arrangement, employed for the purposes of counter-irritation, has been described by Dr. Golding Bird 5 under the title of the " electric moxa." It w r as long ago observed by Humboldt, and afterwards by Grapengiesser, that when a simple galvanic arc was applied to a blistered surface, the part opposed to the most oxidizable metal was more irritated than that to w T hich the negative plate was applied. In adopting such an arc in the treatment of paralysis, Dr. Bird was struck with the re- markable effects produced, and such a combination of its results induced him to propose the following ready mode of establishing a discharge from the surface of the body. Two small blisters, the size of a shilling, are applied to any part, one a few inches below the other. When the cuticle is raised, it must be snipped, and to 1 Dr. Chapman says soft buckskin or parchment. American Journal of the Medical Sciences, Aug. 1834, p. 311. a Op. citat. p. 311. 3 Dr. Harris, in American Journal of the Med. Sciences, Aug. 1834, p. 384. 4 Ibid. p. 321. * Lond. Med. Gazette, June, 1847. GALVANlSMtlS. 395 the one whence a permanent discharge is required, a piece of zinc foil must be applied ; and to the other a piece of silver. They are then connected by a copper wire, and covered with a common water-dressing and oiled silk. If the zinc plate be raised in a few hours, the surface of the skin will look white, as if rubbed over with nitrate of silver. In forty-eight hours, a decided eschar will appear, which, if the plates are still kept on, will begin to separate at the edges in four or five days. A common poultice may now be applied, and a healthy sore, freely discharging pus, will be left. Confirmation of the advantage to be derived from this method of applying galvanism has been afforded by Mr. Wells, 1 who re- cords the results of his treatment in the Civil Hospital at Corfu. The cases, in which its efficacy was tested, were thirty of ulcers; five of fistulas; five of fungous growths; and five of nervous disorders. Mr. Hinton, 2 however, does not give so favourable an account as Mr. Wells of the action of the galvanic plates. The scar left by the slough, he says, has a very uneven surface, and would not be borne in many cases. The effect of galvanism on the uterus has been referred to under Electro-Magnetismus. M. Matteucci, 3 from his researches, is induced to think, that/?#- ralysis and tetanus are the diseases in which galvanism is most likely to prove beneficial. In its application, however, in these diseases, he considers it necessary to bear in mind two electro- physiological facts. The first is, that an electric current, if trans- mitted through a nerve for a certain time, destroys the sensibility of the nerve, or in other words paralyzes it; but if the nerve be allowed to remain at rest, after a certain interval it recovers its ex- citability. But it has been ascertained by M. Matteucci, that the excitability may be restored in a much shorter period by passing a second current through the nerve in the reverse direction. The second fact to be borne in mind is, that if the nerves of a living animal be subjected to the passage of an electric current, renewed at short intervals, tetanic contractions are excited ; and if the ex- periment be continued for some time, the nerves entirely lose their excitability. "These facts," says M. Matteucci, "independently of all theory or hypothesis, should guide us in the therapeutical application of the electric current to paralysis. It may in fact be admitted that, in some cases of paralysis, the nerves of the affected limb are in a condition similar to that produced by the continued passage of an electric current. We have seen, that to restore the excitability to a nerve which had been deprived of it by an electric 1 Lond. Med. Gazette, May 26, 1848. a Ibid,, July, 1848, and Ranking's Half-yearly Abstract, July to Dec. 1848. Amer. edit. p. 216. 3 Cited in Med. Chirurg. Rev. April, 1845. 396 GALVANISMUS. current, it is requisite to conduct the current in the opposite direc- tion. Hence, to cure the paralysis, the current should be passed in a contrary direction to that which has produced it. In a para- lysis of motion, the inverse current should be employed ; whilst, on the contrary, in a. paralysis of sensation, the direct current should be used. In a case of complete paralysis — that is, of both motion and sensation, there is no reason to prefer the one current to the other. Theory also teaches a rule in its application: never to continue the passage of the current too long, lest we augment the disease we wish to cure. The more intense the current, the shorter should be its duration ; and as we have seen that the passage of the electric current in the nerves, repeated at short intervals of time, considerably enfeebles their sensibility when continued for a long time, we must take care and not pass from one extreme to another. Theory advises us to apply the electric current of an in- tensity which should vary with the degree of the malady, and con- tinue its passage for two or three minutes at intervals of some se- conds. After these two or three minutes, during which we shall have communicated from twenty to thirty shocks, we should leave the patient at rest for some time, and then renew the treatment." It is affirmed that Dr. Krusell, 1 of St. Petersburg, has employed galvanism successfully in the treatment of syphilitic ulcers. To this method he gives the name " electrolytic." It is not clearly described by the translator — and the author does not possess the original article; but it would appear, that of forty-three patients whose treatment commenced between the 4th of July and the 11th of September, 1844, inclusive, twenty-one w T ere free from all ap- pearances of disease on the loth of September, and all the others, with the exception of three or four, were in the best condition, — the sores being nearly healed. Dr. Krusell employs an uninter- rupted current. Dr. Hays has stated, that the most useful remedy in certain cases of amaurosis, which fell under his care, 2 was unquestiona- bly galvanism. This was evinced not only in the improvement which followed its application, but in the u still more striking fact," that the patient saw better whilst subjected to the galvanic action. Dr. Hays found a Cruikshank's battery of fifty pairs of plates three inches square — when in full activity — too powerful for the purpose, so that only one-half or two-thirds of the plates were usually employed. The connexion was made by means of leaden wire conductors, to one end of which was soldered a slip of copper, and to the other a hemisphere of brass, the flat surface of which was filed into grooves crossing at right angles, so as to form a number of sharp points. Over these were tied thin discs 1 Journ, for Chirurg. und Augenhcilkunde von Walther und Amnion. Bd. v. S. 92: cited in Lond. Med. Gaz. June 5, lt46, p. 1015. * American Journal of the Medical Sciences, Aug. 1840, p. 283. GALVANISMUS. 397 of sponge, which were kept moist with a solution of common salt, and when it was considered desirable to introduce strychnia into the system, the sponge attached to the negative pole — and some- times that to the positive pole, also — was moistened with a solu- tion of it. When the whole force of the battery was not wanted, instead of putting the slips in the extreme cells, they were placed in cells more or less remote, according to the power required; and the force was easily regulated. The galvanic current may be made to pass from the mastoid process to the superciliary ridge. Dr. Hays expresses his persuasion, that galvanism, properly em- ployed, is a valuable and effective remedy for certain forms of amaurosis. There are doubtless — as already observed — cases of disease, in which the excitant and revulsive agency of galvanism may bs employed with advantage, but they are not so numerous as was at one time believed. The author has used the plates ex- tensively — in neuralgic cases especially — but has not experienced so much success as to induce him to advise them frequently, under the inconveniences that necessarily accompany their employment. The ordinary modes of applying galvanism are referred to in another work. 1 An apparatus has been devised by Mr. Coad, of Philadelphia, which enables galvanism to be communicated either continuously, or in an uninterrupted manner, and the dose to be re- gulated according to the wishes of the practitioner. It is conve- nient, and well adapted for all cases in which it may be deemed advisable to apply galvanism. 2 Recently, M. Duchenne, 3 of Boulogne, has published a long memoire on what he terms a rrew method of galvanization, Gal- vanisation localises He states, that if the skin and the excitors (excitateurs) — as he terms metallic bodies communicating with the poles of a galvanic apparatus, which are placed on parts to be galvanized — are perfectly dry, and the epidermis of considerable thickness, the two electric currents are recomposed at the surface of the epidermis, without traversing the derma; and cause sparks and a peculiar crepitation without physiological phenomena. But if we place on the skin one excitor moist and the other dry, the individual experiences, in the point where the second excitor had developed only physiological effects, a superficial sensation evi- dently cutaneous. This is owing to the contrary electricities be- ing recomposed in the point of the dry epidermis, but after having traversed the skin by the moist excitor. Again, if we moisten very slightly the skin w 7 here the epidermis is very thick in the points on which the metallic excitors are placed, a superficial sensation is experienced, stronger than the preceding, without sparks or 1 General Therapeutics and Materia Medica, 4th edit. i. 500. Philad. 1850. a Art. Galvanism, in Cyclop, of Practical Medicine, Amer. edit, by the author. Philad. 1845. * Archives Generates de Medecine, Juillet, 1850, p. 257, and Aout, 1850, p. 420. 26 398 GALVANISMUS. crepitation. Here the electric recomposition takes place in the substance of the skin. Lastly, if the skin and excitors are very moist, neither sparks, crepitation, nor sensation of burning is expe- rienced, but very variable phenomena of contractility or sensibility present themselves, according as we act on a muscle or a fasci- culus of muscular fibres ; on a nerve or a bony surface. In the last case, an acute pain of a very peculiar character is experienced ; and consequently great care ought to be had not to place moist ex- citors over bony surfaces. M. Duchenne infers from these phe- nomena, that the electric power may be arrested at will in the skin ; and that, without any incision or puncture, it may be traversed, and the action of electricity be limited to the organs which it co- vers, to the nerves, muscles and even the bones. Some years ago, Professor Von Hildenbrand, of Pavia, 1 recom- mended, in cases of frontal neuralgia, an anodyne metallic or galvanic brush, which appears to have been as effectual in his hands as the galvanic plates in those of Dr. Harris. It consists of a bundle of metallic wires not thicker than common knitting-nee- dles, firmly tied together by wire of the same material, so as to form a cylinder of about four or five inches long, and an inch or three-fourths of an inch in diameter. This is applied to the pained part, which has been previously moistened with a solution of com- mon salt; and, according to Von Hildenbrand, it at times produces relief so instantaneously, that it appears to the patients to act like a charm. In his first experiments, he employed brushes construct- ed of two kinds of metal, — for instance, of silver and copper wire, copper and zinc wire, or zinc and brass wire, the individual wires being mutually commingled ; but he subsequently ascertained, that bundles of wires of one and the same metal produced an effect scarcely less speedy, and that solid metallic bodies act in a similar manner, but in a much feebler degree. The nature of the metal, he thinks, occasions no difference. It is not probable, that, in these cases, galvanism is the agency concerned. Like the metallic tractors of Perkins, the effect is probably induced by the new nervous impression made through the excited imagination of the patient. Jlnimal Magnetism, Mesmerism, Neurogamia, Biogamia, Biomagnetismus, Zoomagnetismus, Tellurismus, Exoneu- rism, as it has been termed— exerts an anodyne influence in pro- bably the same manner. In highly impressible persons, more or less prolonged impressions made upon the senses— as by the ope- rator looking steadfastly in the eyes of the patient, holding the thumbs or hand at the same time, or making passes in front of the patient— will induce an hysteric or hysteroid condition, in which 1 Edinburgh Medical and Surgical Journal, April, 1833. GENTIANA CHIRAYITA. 399 the patient may fall into what is called "magnetic sleep" of a very sound, and at times cataleptic character. During the existence of this sleep, the patient may be insensible to certain irritants, and yet extremely alive to others, so that operations — as the ex- traction of teeth, and even some of a more serious character — may be performed without eliciting the ordinary evidences of feeling. In cases of delirium tremens, accompanied by watchfulness, in which the whole nervous system is extremely impressible, sleep may be at times induced by the employment of this agency, which had resisted the ordinary anodynes. 1 It has been proposed to introduce into the rectum, in cases of constipation, a kind of galvanic suppository, made of two metals — zinc and copper — and various forms of instruments have been devised by the prolific imaginations of the inventors; those in- tended for the rectum simply were doubtless of advantage, at times, by virtue of the excitation they induced in the nerves of the mucous membrane. Others, shaped somewhat like a bassoon — and so arranged as to have one metal in the mouth and the other in the rectum connected together by metal — did not appear to act differently from those of the simpler form. Both have gone into disuse, and if their efficacy on the frame has not been well marked, they have not failed to administer to the pockets of the inventors. XCIX. GENTIANA CHIRAYITA. Synonymes, Henricea Pharmacearcha, Swertia Chirayita, Agathotes Chi- rayta, Chiretta, Chirayita, Chirayta. Gentiana chirayita is a native of the northern part of India, whence it is imported into England, tied up in bundles. It has been long in use there. EFFECTS ON THE ECONOMY. The herb and root are intensely bitter, and produce on the eco- nomy the ordinary effects of the pure bitters. They strikingly resemble gentian, and are employed in India in dyspepsia, and as an antiperiodic in intermittents. 2 The plant has been highly ex- tolled by Drs. Currie, Sigmond, and others. These gentlemen consider that the secretion from the liver improves under its use ; and the latter advises it not only in torpor of the digestive fundi on, but he prefers it to sarsaparilla where the latter is considered to be indicated : as after large quantities"of mercury have been taken, or where profuse salivation has been induced. Dr. Jackson, for- merly of Calcutta, informed Dr. Christison, that he found it often have the effect of restoring the healthy alvine evacuations in costive 1 Dr. Vedder, American Medical Intelligencer, Feb. 1, 1839, p. 331 2 J. Johnson, Influence of Tropical Climates, 3d edit. p. 58. 400 GLYCERINA. habits; and he adds, that frequent trials made in Edinburgh con- firm all that has been said by the practitioners of Bengal as to its efficacy as a tonic and stomachic. 1 It has also been advised in atonic leucorrhcea. MODE OF ADMINISTRATION. Gentiana chirayita yields its virtues to alcohol and water. (Gent, chirayit. sss. ; Aq. bullient. Oj.) Dose, f §j. to f §ij. The tincture is made by macerating five ounces of the chirayita for fourteen days in two pints of diluted alcohol. Dose, a teaspoonful. The dose of the powder is one scruple. 4 C. GLYCERINA, Synonymes. Glycerinum, Glycerine, Glycerin: — improperly cited as Glycyrrhine, 3 Hydrate of oxide of Glyceryl. French. Glycerine. German. Glyzerin, Glyceryl oxyd ; Oelsiiss, Scheel' sches Sus s. This substance forms a base to the oleic, stearic, and margaric acids of the fat oils and tallow, and is separated when these acids are made to combine with an alkali, or any metallic oxide in the saponification of the oils. METHOD OF PREPARING. Glycerin is obtained by heating together olive or other suitable oil, oxide of lead, and water, as in the manufacture of the common lead plaster: an insoluble salt of lead is formed, and the glycerin remains in the aqueous liquid. This is treated with sulphohydric acid ; digested with animal charcoal j filtered, and evaporated in vacuo at the temperature of the air. In a pure state, glycerin forms a nearly colourless and very viscid liquid; s. g. 1.27. It has an intensely sweet taste, and mixes with water and alcoholin all proportions: but is insoluble in ether. 4 EFFECTS ON THE ECONOMY. Glycerin has been introduced by Mr. Startin, 5 as a new re- medy for the cure of certain cutaneous diseases ; and its useful- ness is presumed to be most probably dependent upon its property of resisting evaporation even at a considerable temperature. Mr. Startin affirms, that a common plate wetted with it may be kept in an oven, side by side with a joint of meat, till the meat is cooked, 1 Dispensatory, Amer. edit. p. 364. Philad. 1849. * See •' Note upon Gentiana Chirayita," by Dr. Carson, in Amer. Journ. of Pharmacy, new series, vol. vi. No. 1, A pi. 1840, p. 20. ■ Braithwaite's Retrospect, xiii. 306, Amer. edit. New York, 1846. 4 Graham's Elements of Chemistry, Amer. edit, by Dr. Bridges, p. 596. Philad. 1843, and Fownes's Elementary Chemistry, Amer. edit, by the same, p. 399. Philad. 1845. » Med. Times, Feb. 8, 1846. GLYCERINA. 401 without any sensible diminution in the quantity of the liquid. Hence, when applied to the skin it remains moist, forming a coating or varnish, which is not distinguishable from the ordinary secretion of the part. A lotion composed of half an ounce to ten fluidounces of water effectually prevents the skin from becoming dry. When employed in its pure state, it makes the part stiff and uncomforta- ble; and consequently answers best diluted. It is also added with advantage to poultices, and even to baths. Mr. Startin speaks of its use chiefly in psoriasis, pityriasis, lepra, and ichthy- osis, in all which diseases he describes it as producing excellent palliative effects; and in such cases the author has employed it with marked advantage. It keeps the part moist, and prevents the formation of scabs. It is probable, that glycerin might be used with much advantage in burns, and wherever it is desirable to prevent the desiccative in- fluence of the air from irritating an exposed surface. In consequence of the publication, by Mr. Yearsley, 1 of some cases of deafness, in which the tympanum had been perforated by ulceration, having been astonishingly benefited by the insertion of wetted cotton into the meatus, Dr. Turnbull 2 and Mr. Thomas H. Wakley, 3 under the idea that the benefit resulted from the moisture and not from the cotton, thought of glycerin as an agent, which would retain its moisture and lubricate the auditory canal. Mr. Wakley accordingly used it in three hundred cases, and in a num- ber of them the power of hearing was restored. "Contrary," he says, " to what might have been anticipated, the use of the remedy was successful in persons in whom the deafness had been of many years 5 duration — one, for example, thirty years; and also in cases where the existence of the malady could be traced to the eruptive fevers of childhood. In instances of deafness caused by inflamma- tion, followed first by suppuration, and then by a horny dry con- dition of the auditory canal, the application of glycerin has been attended with signal advantage. Equally marked and peculiar is the success when it is used in cases where there is a partial or total absence of ceruminous secretion. In many instances of deafness belonging to these classes of cases, the employment of glycerin has been followed by a perfect restoration of the power of hearing. In other examples of deafness, where the membrana tympani had evi- dently become thickened and hardened, and an examination with the speculum denoted a whitish or pearly appearance, the use of the glycerin was followed by strikingly beneficial and gratifying effects. It is evident, therefore, that the application of glycerin is equally admissible, whether the tympanum [membrana tympani,] be in a sound state, or whether it has been destroyed by ulcera- tion." 1 Lancet, July 1, 1848. 2 Lond. Med. Gazette, June 1, 1849, p. 962. * Lancet, cited in Med Examiner, Sept, 1849, p. 561. 402 GRANATUM. Dr. Paterson, 1 of Edinburgh, obtained some improvement in one of three cases in which he used it. MODE OF ADMINISTRATION. R. Glycerin, f gj. Tragacanth. pulv. ^ij. ad 3SS. . Liquor, calcis f ^iv. Aq. ros. f Jiij. M. As a liniment or embrocation in 'prurigo, lichen, strophulus, lepra, psoriasis, pruritus, &c. Startin. R. Glycerin, f 3[ss. Acid, nitric, dilut. f ^ss. ad gj. Bismuth, subnit. gss. Tinct. digital, f gj. Aq. rosse f ^viiss. M. As a lotion; to be used by dabbing the part for chapped nipples or hands, fissures of the lips, irritation of the skin of any kind, as after shaving, exposure to the sun, in pityriasis, &c. Startin. R. Glycerin, f ^ss. Sodse borat. gss. ad gj. Aq. ros. ^viiss. M. To be used by dabbing the affected part in alopecia following fevers; in dryness or want of action ofthescalp,thinnessofthehair, &c. Startin. R. Glycerin, f tfss. Sp. amnion, aromat. f %]. Tinct. cantharid.f^j. ad f ^ij. Aq. rosmarin. f ^vij. M. As a lotion to be used with a wet hair-brush once or twice a day in rheumatism or gout, neuralgic pains, sprains, bruises, stiffness, &c. R. Glycerin, f gss. Lin. sapon. comp. f ^iss. Ext. belladon. gj. M. As an embrocation; to be used twice a day in the ordinary man- ner. Startin. CI. GRANATUM. Synonymes. Punica Granatum, Malogranatum, Pomegranate. French. Grenadier, Balaustier. German. Granatbaum, G ranatapf e lbaum, Apf elg ranate. Punica Granatum appears to be a native of the northern coast of Africa, whence it was transported to Italy at the time of the Carthaginian wars. It is now cultivated in all civilized regions, where the climate is sufficiently warm to allow the fruit to ripen. 1 Monthly Retrospect, Aug. 1849 ; cited in Amer. Journal of the Med. Sciences, Oct. 1849, p. 4lil. GRANATUM. 403 It belongs to the Natural Family Myrtaceee, and, in the Sexual System, to Icosandria Monogynia. All the parts of the plant contain more or less tannic acid. The bark of the root is externally of a yellowish-gray or ash colour; internally yellow, and has an astringent taste. According to La- tour de Trie, 1 it contains wax, chlorophyll, a considerable quantity of resin, gallic acid, tannic acid, fatty matter, and a peculiar matter called Grenadin; in German, Granatin. Grenadin, in its pure state, is of a white colour; inodorous, and of a sweetish taste; so much so, indeed, that according to Magendie, it might be presumed to be a variety of sugar, except that it differs from ordinary sugar in being devoid of the property of fermenting. According to the degree of its purity, it crystallizes in grains, tufts or stars. When thrown on red hot coals, it consumes without any residuum, and smells like burnt bread. It is fusible, and by a mo- derate heat may be almost wholly sublimed. It neither reacts as an acid nor an alkali, and is readily soluble in water. Cold alcohol dissolves only traces of it, but boiling alcohol dissolves it readily: a property which is to be taken advantage of in the formation of crystals. In ether it is insoluble. Nitric acid, with the assist- ance of heat, converts it into oxalic acid. An ounce of the bark yields six grains of grenadin ; but it is not settled, whether it con- tains the whole of the medical properties of the bark. Cenedella, 2 from whom we have the most recent analysis of the bark of the pomegranate root, also found the grenadin discovered by Latour. This substance is readily prepared. The bark in powder is treated with ether, and afterwards with boiling alcohol, and the fluid is evaporated to the consistence of a soft extract. By treating this extract with water, grenadin is dissolved without difficulty, and it may be purified by suffering it to crystallize frequently from al- cohol. EFFECTS ON THE ECONOMY. The therapeutical properties of the different parts of the pome- granate tree were known to the writers of antiquity. They em- ployed not only the bark of the root as a remedial agent, but also the flowers, (Flores Balaustiorum, Balaustes, Balaustia, Balaus- tine Flowers,) the whole fruit, (Poma Granati, Malogranata, Granata, Mala Punica, Pomegranate: Fr. Grenades,) the rind of the fruit (Malicorium, Malichorium, Malacorium,) and the seeds. Dioscorides, Pliny, Celsus and Marcellus Empiricus speak of the employment of the bark of the root in taenia. 2. In more modern times, Punica granatum had been greatly neglected, al- . i Journal de Pharmacie, Fev« 1828, p. 109. a Giornale de Farmacia, Agosto, 1831, p. 55. See, also, Journal de Pharmacie, ix. 219; x. 352 ; and xvii. 503; and Dierbach, in Heidelberg Klin. Annalen, B. x. H. 3, S. 365. Heidelb. 1834. 8 Merat and De Lens, Diet, de Mat. Medical, art. Punica Granatum. 404 GRANATUM. though the juice of the fruit was recommended by Frederick Hoff- man against worms in children. In India, it has been long held in great estimation as a remedy in tapeworm; and its efficacy having been noticed by some English physicians, it was recom- mended to the attention of Europeans, especially by Buchanan, 1 Fleming and Breton. 2 About the same time, a monograph was published by Gomez, a Portuguese physician, which appears to have had considerable agency in extending the reputation of the remedy, especially in Germany, where the monograph was translated into the Journal of Gerson and Julius. 3 Gomez di- rects two ounces of the fresh rind of the root to be boiled in a pint and a half of water down to a pint; and of this decoction two or three spoonfuls to be taken for a dose; the first, early in the morning, fasting, and then every half hour until the whole is used. The efficacy of this preparation he tested in fourteen cases, from which it appeared, that the worm could not withstand its action more than forty-eight hours. He found it exert most efficacy when portions of the worm were perceptible in the evacuations, a period when the patient generally suffers most inconvenience. If the exit of the worm did not take place on the first day after the use of the agent, the decoction was continued on the second day, when the worm was generally discharged. Did this not happen, however, a farther continuance of the remedy was of no avail; and he thought it better to intermit it until the appearance of fresh portions of the worm in the evacuations. Gomez also administers the dried rind in pills. If the dose be too large, or the appropriate dose be too frequently repeated, nausea, vomiting and diarrhoea at times supervene: should this be the case, the proper course is obvious. In countries where the fresh rind can be obtained, Gomez ad- vises, that it should be used; in colder countries, the dried rind, which is obtained from more southern regions, will have to be em- ployed. According to Breton, the latter acts more powerfully. The dried rind loses more than half its weight, and two ounces of it may be esteemed equal to three of the fresh. The strong testimony adduced in its favour by Gomez, gave occasion to numerous trials with it in England, France, Germany, and Italy, which were generally attended with favourable results. Such testimony has been afforded by Boiti, Marchese, Calabro, Majoli, Chevallier, Deslandes, Merat, 4 Pichonnier, Mandrux, Claret, Bayle, Delaporte, Gendrin, Grimaud, Chapotin, Bour- 1 Edinb. Med. and Surg. Journal, iii. 22, 1827. a Medico-Chirurg. Transact, xi. 31. * Maarazin, u. s. w. vi. 427, or Journal Complenientaire des Sciences Medicales, xvi. 24, 1823. * Du Taenia, &c., et de sa cure radicale par 1'ecorce de la racine de Grenadier. Paris, 1832; and Merat and De Lens, op. cit.; and in Supplement au Dictionnaire, vol. 7, Paris, 1846. GRANATUM. 405 geoise, Housson, Goupil, Ferrus, Wolff, Kostler, Meisinger, Ber- thold, Schmidt, Miiller, 1 and others. 2 On the other hand, Keibel 3 complains of its uncertainty; and in the Polyclinical Institute of the University of Berlin, it was given without advantage; but Osann, in his report of that institution, is disposed to refer the want of success to some imperfection in the rind employed, which, he remarks, is found to vary greatly in its character, as met with in the shop of the apothecary. It would appear, also, that it is not unfrequently mixed with the rind of the root of the Box tree and Guelder rose. To introduce more precision on this matter, Wolff recommends that the druggists should purchase the bark of the root of the genuine East India, or, at all events, the Portuguese tree. Boiti 4 advises that the root should be obtained from mountainous regions, where the tree grows wild ; that it should be taken only from young trees, and that it should not be more than an inch thick; that it should be carefully separated from the woody portion, and be collected in the spring of the year, when the tree has most sap, and be dried in the shade. Chevallier, 5 also advises, that only the rind of the root of the wild tree should be used. Gendrin, Montault and Pichonnier affirm, that the fresh rind was alone cer- tain in its operation; the dry frequently disappointing them. Ac- cording to Breton, the rind of the trunk is to be preferred to that of the root, because it preserves its virtues longer. Chevallier recommends, before the decoction of the pomegranate tree bark is administered, that a gentle cathartic of castor oil with lemon juice should be premised. This may be taken the evening before, the patient fasting during the following day. He directs the decoction to be made of two ounces of the rind macerated for twenty-four hours in two pints of water, and then boiled until a pint of the strained liquor remains. This must be divided into three portions, which are taken in half hourly doses. The first and second doses with many persons excite vomiting, but this need not prevent the administration of the third, as it rarely pro- duces the same effect. This quantity of the decoction commonly occasions three or four evacuations, preceded by slight colic pains; at other times, but one evacuation is produced, with which the worm is usually expelled. The period that elapses between the administration of the last dose of the remedy and the commence- ment of its operation is from a quarter of an hour to a whole hour — rarely longer. M. Merck 6 states that, when properly administered, it never 1 Hannov. Annal., vii., 1847; cited in Schmidt's Jahrbucher, No. 8, S. 161. Jahr- gang 1848. 2 Riecke, Die neuern Arzneimittel, S. 247. 3 Rust's Magazin, xvi. St. 3, S. 566. * Revue Encyclop. xxxii. 234. * Journal de Chimie Medicale, i. 378; 1825. 6 Revue Medicale, cited in Medical Times, Jan. 11, 1845, p. 323. 406 GRANATUM. fails. The mode he recommends is the following. — Whenever a patient has evacuated portions of taenia, he must take, on the same day, or the next, a decoction of two ounces of the fresh bark in a pint and a half of water, reduced to a pint, in three doses, leaving an interval of half an hour between each dose. The worm will be evacuated at the utmost in twenty-four hours, and no relapse need be feared. Want of success, he affirms, is owing to the fact that sometimes the dry bark is employed; and sometimes it is adulterated with other kinds of bark ; or that it is taken too long after the portions of taenia have been expelled ; or because the dose was too weak, or combined with purgatives, &c. Where this bark is used, a purgative is not necessary. Filix mas, on the other hand, requires a cathartic. Cenedella advises, that the bark of the root should be macerated before boiling; that the decoction should be made in earthen, not in metallic, vessels, and that it should be filtered or strained whilst hot, — different constituents, which are probably efficacious, being deposited as the liquor cools. According to M. Constant, the decoction is commonly prepared in France in the following manner: — The rind of the fresh root — or the bruised root dried — is macerated through the night in from a pint and a half to a quart of water; the liquor is then boiled to one half; strained; and, in the morning, a third part is taken lukewarm, fasting, and repeated every three hours until the whole has been administered. The quantity of the rind, used for the decoction, is, in the case of the adult, 5j.; of children, from six to fifteen years old, ^vj.; and of those under six years of age, §ss. At times, however, it has been administered in much larger doses. A girl, twenty-four years of age, had suffered from taenia from her infancy, and had frequently passed fragments of worms in her evacuations. She took two ounces of the bruised bark of the pomegranate root, boiled in two pounds of water, at thrice, with half an hour's interval between the doses, but without effect. The dose was now increased to three ounces, and two tapeworms were expelled ; so that, in two days, and without any abdominal disturbance, the patient took the decoction of five ounces of the bark of the root. 1 To ensure the proper action of the decoction, it must be given as directed above, without the addition of sugar or syrup, which changes its properties. During its operation, the patient should drink nothing except when the tormina are urgent, and then a little of any aromatized water, without sugar, may be taken. The remedy should be given only on days in which portions of taenia are evacuated, or on the following morning; and the alimentary canal should be free from every evidence of inflammatory irrita- 1 Forget, in Gazette des Hopitaux, 19 Fevrier, 1839, or London Medical Gazette, April 20, 1839. GUACO. 407 tion. By some, as by Latour de Trie and Ferrus, an infusion of the rind has been found serviceable ; and Deslandes recommends an Extractum spirit uosum, and an Extract urn aquosum cor- ticis radicis granati. • MM. Ferrus, Berthold, Goupil, and others, have published cases in which, along with the expulsion of txnia, various neuroses were removed under the use of the rind, and accordingly it has been thought that it might be usefully employed in such affections where no taenia exists; in epilepsy and hysteria, for example. METHOD OF PREPARING. Decoctum granati radicis corticis. Decoction of pomegranate root bark. R. Granati radicis corticis ^ij. Aquae Oij. Boil to a pint and a half. Dose. — ^ij. every half hour. Three or four doses are usually sufficient to expel the worm. 1 The formula given by Dr. Ains- lie, 2 directs the decoction to be prepared with ^ij. of the fresh bark, boiled in a pint and a half of water, until only three quar- ters of a pint remain. Electuarium extra cti granati radicis corticis, Electuary of extract of pomegranate root bark. R. Extract, alcohol, granat. rad. cort. ^vj. Aquse riorum tiliee, 3 Succi limon. aa. f ^iij. Tragac. q. s. ut fiat electuarium. Dose.— One-half, from half hour to half hour. Deslandes. Mistura extracti granati radicis corticis. Mixture of extract of pomegranate root bark. R. Extract, alcohol, granat. rad. cort. gvj. Aqua? menthse, flor. tiliae, Succ. limon. aa. f ^ij. M. To be divided into four parts, one of which may be taken every quarter of an hour. Deslandes. CII. GUACO. Synonymes. Huaco, Eupatorium Huaco. It would appear, that owing to some extracts in the A 1 1 g e- meine Zeitung, the attention of the German physicians had been directed to this article as an important agent in the cure 1 Jourdan's Pharmacopee Universelle, i. 638. Paris, 1828. 9 Materia Indica, ii. 175. London, 1826. * Any simple aromatic water may be substituted for this. 408 GUACO. of epidemic cholera; and various testimonials have been brought forward in its favour, which, as Riecke 1 properly suggests, may not be confirmed by farther experience ; and yet the circumstance may have led to the introduction of a valuable article into the catalogue of medicinal agents. Many species of the genus Eupatorium, and of the kindred genus Mikania, — which has been recently separated from it, — be- longing to the Natural Family Compositse (Synanthereae, sub- division Corymbiferse,) and in the Sexual System, to Syngenesia iEqualis, have been prized in various parts of America, parti- cularly in cases of bites of serpents. This is especially the case with Eupatorium ayapana (E. triplhierve.) According to Von Martius, a quantity of the bruised leaves is applied to the scarified wound, and the application of fresh leaves is renewed, over and over again, until the patient is freed from the dangerous symptoms, and especially from the violent suffering. At the same time, a few spoonfuls of the expressed juice are administered every now and then. The Mikania opifera [Eupatorium crena- tum t ) — in Brazil termed Erva da cobra — and the Eupatorium saturejsefolium [Mikania saturejcefolia,) also belong to many Synanthereae, which, in South America, are reputed specifics against the bites of serpents. The most important species ap- pears to be that called in Peru Guaco or Huaco, which is held there in high consideration, as well as in New Grenada, and Venezuela, not only in these cases, but in the prevention of hydrophobia. 2 This is presumed to be the Mikania guaco of Humboldt. Dr. Hancock, however, afTirms, that the names Guaco and Bejuco de Guaco w T ere given — in the parts of America w T here he sojourned — to different species of Aristolochia. Guaco was made known, forty or fifty years ago, by Mutis, 3 who refers to its effects in cases of the bites of serpents. EFFECTS ON THE ECONOMY. Of the efficacy of the guaco in Indian cholera, M. E. de Chaniac, Officer de Sante in the French navy, and Dr. Chabert, physician to the military hospital in Mexico, have published the results of their experience. When the brig Adonis, on her voyage from Havana to Mexico, in the year 1833, arrived at Vera Cruz, some of her crew were attacked with cholera, which prevailed at the time in Mexico. Of all the remedies employed, the guaco was found most beneficial ; its effects, indeed, were so wonderful, that it was regarded almost as a specific. Its action is chiefly exerted on the heart and the circulation, which it renders more 1 Die neuem Arzneimittel, u. s. w. S. 250. Stuttgart, 1837. * See Prof. W. R. Johnson, in Silliman's Journal, xxiv. 272 and 388, New Haven, 1833; and ibid, xxvii. 171, New Haven, 1835; also, Dr. Hancock, in Quarterly Jour- nal of Science, &c, from January to June, 1830, p. 333. * Virey, in Bulletin de la Societe de Pharmacie, vL 241 ; and Riecke, op. cit 251. GUACO, 409 energetic. All the patients to whom it was exhibited in the com- mencement of the disease were saved, and even of those in whom the cholera had already reached a certain stage, the greater part were saved, as soon as a free and complete reaction was estab- lished. Dr. Chabert, who first administered guaco in cholera, as well as in yellow fever, observes on its use in the former disease: — In simple cases, a small teacupful of a warm decoction was given every half hour, until a general diaphoresis and proper warmth of surface supervened, which was kept up for some days, when the remedy was gradually discontinued. To allay the thirst, the decoction was given, diluted with two-thirds, or half, water* In dangerous cases of cholera algida, with coldness, loss of pulse, &c, a spoonful of the tincture was mixed with six or eight spoonfuls of water, and, every quarter of an hour, a spoonful of this mixture was given alternately with a small cupful of the decoction. When the pulse returned, the warmth became re- stored and the perspiration re-established, the tincture was omitted, and the decoction continued alone at longer intervals. In the majority of cases, after the cessation of the cholera symptoms, pain was experienced in the epigastrium, with burning thirst, which yielded when the decoction was diluted with half or two- thirds water. When the decoction could not be retained by the stomach, it was given in clyster. Blood-letting, general and local, was employed along with other external means, but nothing was given internally except the guaco. To make the decoction; — two drams of the stalks, and half a dram of the leaves, were boiled in two pints of the water, down to one. The tincture was prepared like other tinctures. In consequence of the communications of Chabert and De Chaniac, as well as of the parallel drawn by Harless 1 between the cholera and the effects of the bites of serpents, Professor Beckers of Munich recommended that experiments should be made w 7 ith guaco; and it was accordingly tried in Munich, but not with as favourable results as had been expected. Romerio asserts that it was given in the stadium asphycticum in the form of infusion, made of half an ounce of the stalks, but with uncertain results. It appeared to combine the effects of valerian and ipecacuanha, yet it excited less vomiting than the latter. The tincture appeared to render greater service. It was given in the dose of a coffee-spoon- ful every half hour, and, subsequently, every hour, and every two hours. It would appear, that in the district of Prague, its admi- nistration was attended with very favourable consequences. 2 To account for the different results, it is affirmed, that different drugs are met with in commerce under the name guaco. Riecke says, that M. Jobst had sent him two kinds, which w T ere evidently from 1 Die Indische Cholera, u. s. w. Braunschweig, 1831. a Riecke, op. cit. S. 256. 410 HIPPOCASTANUM. different plants: the one variety was obtained from Hamburg and Bourdeaux; the other, from Paris: descriptions of these are given by Riecke. The truth, probably, is, that this, like most of the cholera specifics which have been brought forward, is efficacious in certain cases of the disease, but that its agency has been egre- giously exaggerated. CIII. HIPPOCASTANUM (CORTEX.) Synontmes. jEscuIus Hippocastanum, Castanea Equina seu Pavina, Horse Chestnut, Buck Eye (the Bark.) French. Marronier, Marronier oVInde. German. Rosskastanie, Pf erde kastanie, Rosskeste, Pfer- dekeste. The tree whence this bark is derived is iEsculus Hippocasta- num or Horse Chestnut — of the Natural Family Hippocasta- nese; Sexual System, Heptandria Monogynia — which is wild on the mountains of Asia Minor and Persia, and grows in this coun- try as well as in Europe. The bark has a very astringent taste; is somewhat bitter, and contains a great deal of tannic acid. Canzoneri thinks he discovered a peculiar principle in it, which he calls asculine, but the existence of this is contested. EFFECTS ON THE ECONOMY. The Cortex hippocastani has long been advised as an astringent, but without receiving much attention. 1 In modern times, it has been proposed by Zannichelli, Hufeland, Voigtel, and others, as the best substitute for cinchona. These recommendations have caused the bark to be more frequently administered of late, in Europe, by which means it has been discovered to accord almost entirely in its effects with that of the willow: the latter, however, appears to be more effective, and to agree better with the digest- ive organs. In the wars of Napoleon, when bark was very scarce, it was much employed. Hufeland and Voigtel recommended it especially in intermittent l s. Sinogowitz 2 advises that it should be given after the removal of intermittents by quinia, to prevent a relapse; and, also, in combination with diuretic agents, in the cases of dropsy which often succeed to that disease. Knigelstein found it always extremely efficacious in atonic gout, and in removing the weakness of the digestive apparatus that remains after attacks of gout. The Austrian, Brunswick, Danish, Russian and Saxon Pharmacopoeias 3 have an aqueous extract of the bark, which Voigtel administered with good results in intermittent fever, and often found serviceable in chronic discharges from 1 Merat and De Lens, art. iEsculus Hippocastanum. 3 Rust's Magazin, B. xxix. H. i. p. 84. 3 Pharmacopee Universelle, ii. 14. Paris, 1828. HIPPOCASTANUM. 411 the mucous membranes. It agrees better with the stomach than the powder or the decoction. Externally, the decoction has been advised as a good astringent. MODE OF ADMINISTRATION. Pnlvis corticis hippocastani compositus, Compound powder of horse chestnut bark. Pulvis Chinse Factitius. Factitious Powder of Bark. R. Hippocast. cort. Salic, cort. Gentian rubr. cort. Calam. Caryophyll. aa. gij. Misce et fiat pulvis. Hufeland 1 affirms, that this powder is an adequate substitute for cinchona in three cases out of four. Hufeland, and Prussian Pharmacopoeia, Dec oc turn corticis hippocastani. Decoction of horse chestnut bark. R. Cort. hippocastan. ^iss. Coque cum aquae fgxviij. ad reman, colat. f ,^ix.; cui refrigerat. adde Spir. aether, sulph. f gj. — gij. Syr. cort. aurant. f^j. M. To be used during the apyrexia. Voigtel. Decoctum chinse factitiae. Decoction of factitious bark. R. Salic, cort. pulv. crass. Hippocast. cort. aa. ^ss, Calam. 4 Caryophyll. aa. £ij. Coque cum aq. fontan. f ^xvi. ad reman, colat. f ^fviij. Prussian Pharmacopoeia. Decoctnm hippocastani acidum. Jlcid decoction of horse chestnut. R. Hippocast. cort. pulv. gvj. Coque cum Acid, sulphur, dilut. f gj. Aquae f ^x. ad. colat. f ^vj. Used in the after treatment of intermit tents. — Sinogowitz. Electuarium corticis hippocastani. Electuary of horse chestnut bark. R. Hippocast. cort. pulv. §ss. Calam. gss. Roob. juniperi giij. M. ut fiat electuarium. A tea-spoonful to be taken every hour, or every two hours, in dropsies supervening on intermittent fever. — Sinogowitz. 1 Armenpharmacopoe 4te Ausgab. Berl. 1825. 412 HYDRARGYRI BROMIDUM. HYDRAR'GYRI PR^EPARA'TA. Synonymes. Preparations of Mercury. French. Les Preparations de Mercure. German. Quecksilberpraparate. CIV. HYDRAR'GYRI BROMIDUM. Synonymes. Hydrargyrum Bromatum. Broraetum Hydrargyrosum seu Hydrargyri, Protobromuretum Mercurii, Bromide of Mercury. German. Bromquecksilber, Quecksilberbromiir. Mercury unites with bromine in more than one proportion. A solution ol hydrobr ornate ofpotassa produces with a solution of nitrate of protoxide of mercury a white precipitate, which re- sembles calomel; and appears to be a bromide of quicksilver, an- swering to the proto-chloride (Hydrargyrum Bromatum, Hy- drargyri Protobromidum; German, Quecksilberbromiir, Bromquecksilber, Protobromure des Quecksil- bers.) On the other hand, the bromide, which is formed by the direct union of bromine with mercury, corresponds probably to the bichloride. A white substance results, which can be sublimed by heat, is soluble in water, alcohol, and especially in ether; is coloured red or yellow by the alkalies, and exhibits considerable resemblance to corrosive sublimate ; — (Hydrargyrum perbroma- tum, H. bibromatum, H. perbromidum, H. deutobrbmidum seu bibromidum; German, Quecksilber-deuto-bromur, Bromquecksilber in maximum.) EFFECTS ON THE ECONOMY. The effects of these preparations on the sound and diseased or- ganism are not yet well known. They have, however, been em- ployed by some physicians. The protobromide strongly resem- bles calomel in its properties. In the dose of one or two grains, it produces no effect in health, even when taken fasting. In a higher dose — four or five grains, and upwards — it purges mode- rately, augmenting, at the same time, the secretion of urine. When used in primary syphilitic affections, in the way of friction on the gums, or internally in pill, it removes them like calomel; but it does not seem to affect the mouth as speedily or as severely as it. 1 The deutobromide or bibromide, Hydrargyri perbromas seu bibromas, Hydrargyrum perbromatum, Brometum hy~ drargyricum, Bromidum seu deutobromuretum mercurii; German, Doppeltbromquecksilber, Quecksilber- b r o m i d , resembles the bichloride of mercury in its action, — producing, in too strong a dose, vomiting and purging, with colic 1 Bulletin General de Therapeutique, No. 14, 30 Juillet, 1837. HYDRARGYRI CYANURETUM. 413 and cramp of the stomach ; affecting the mouth, and exciting violent salivation. 1 Werneck, of Austria, has administered it frequently in syphilis. In recent cases, he prescribes it in the form of pill, beginning with one-twentieth of a grain. This close he increases by one-twelfth every two days ; the chancres being covered at the same time with compresses, wetted with a solution formed of six grains of the same substance to a pint of distilled water. After a few days' treatment, he remarked that the sores assumed a better appearance; and from twenty to thirty days were sufficient to effect their entire cicatrization. The total quantity of the bromide administered was about five grains ; it was rarely necessary to carry it as high as ten or twelve grains. It has been believed, that deutobromide of mercury is less liable to act on the salivary glands than the corrosive chloride, and to affect less severely the stomach and chest. 3 Desorgues has recommended the second (?) preparation as a prophylactic and curative agent in syphilis. It was doubtless, also — Riecke suggests — the second preparation which was admi- nistered with excellent effects by Prieger in porrigo favosa of an obstinate character. He terms the preparation hromas mer- eurii, but the true bromate is probably insoluble in ether. 3 The first of the following formulae is recommended by Prieger. Gnttse hydrargyri deutobroinidi. Drops of deutobromide of mercury : B.. Bromatis mercurii, (vel potius hydrargyri perbromidi,) gr. vj. Solve in Miher. sulphuric, f giij. M. Dose. — Ten to twenty drops, according to the age of the pa- tient, daily, in water. R. Hydrargyr. deutobromid. gr. j, Mthew sulphuric, f gj. M. Dose. — Ten to twenty drops in barley water, a short time after taking dinner ; — in syphilis. Werneck and Prieger. CV. HYDRARGYRI CYANURETUM. Synonymes. Hydrargyri Cyanidum seu Prussias seu Bicyanidum seu Borussias, Hydrargyrum Cyanogenatum seu Cyanatum seu Cyanicum seu Borussicum seu Zooticum seu Hydrocyanicum, Cyanuretum seu Oyanetum Hydrargyri, Mercurius Hydrocyanicus, Cyanidum Mercurii, Cyanide or Prussiate or Hydrocyanate or Bicyanide of Mercury. French. Cyanure ou Hydrocyanate ou Prussiate de Mercure. German. Cyanquecksilber, BlaustofTquecksilber, Blau- saures Queck silberoxy d, Qu e cksi lbe rcyani d . This mercurial preparation is contained in the Pharmacopoeias of the United States, Dublin, London, Belgium, Paris, Ferrara, &c. 1 Glover, Edinb. Med. and Surg. Journ., Oct., 1842. 2 Ibid. 3 Die neuern Arzneimittel, S. 261. Stuttgart, 1837, & 2te Auflage, S. 371. Stutt- gart, 1840. 27 414 HYDRARGYRI CYANURETUM METHOD OF PREPARING. According to Proust and Gay-Lussac, two parts of good and finely powdered Prussian blue must be boiled with one part of deutoxide of mercury and eight parts of water, until the mixture acquires a bright-yellowish tint. It is then filtered, and the fil- tered liquor, which is the hydrocyanate of deutoxide of mercury — containing, however, some iron— is digested or boiled with an excess of deutoxide of mercury, whereby the oxide of iron is com- pletely precipitated. As, however, the hydrocyanate is combined with an excess of oxide of mercury, this must be saturated with free hydrocyanic acid, and the solution be evaporated to induce crystallization. In this mode the cyanuret is formed. The formula of the Pharmacopoeia of the United States is the same as that adopted in the Codex Medicamentarius of Paris, which was recommended by Berzelius. It is as follows: — Take of Red oxide of mercury, three ounces, or a sufficient quantity; Ferrocyanuret of iron, four ounces; Distilled water, three pints. Put the ferrocyanuret of iron, and three ounces of the oxjde of mercury, previously powdered and thoroughly mixed together, into a glass vessel; and pour upon them two pints of the distilled water. Then boil the mixture, stirring constantly, and if, at the end of half an hour, the blue colour remains, add small portions of the oxide of mercury, continuing the ebullition until the mixture becomes of a yellowish colour; after which filter through paper. Wash the residue in a pint of the distilled water, and filter as before. Mix the solutions, and evaporate by the fire till a pelli- cle appears; then set the liquor aside that crystals may form. To purify the crystals, dissolve them in distilled water; filter; evapo- rate the solution, and set it aside to crystallize. 1 Dr. Christison 2 does not approve of this preparation. He regards it as' a " need- less incumbrance of the London and Dublin Pharmacopoeias." "It was introduced," he remarks, " into the latter, as the source of the hydrocyanic acid ; which may now be obtained more cheaply, and equally well, from other materials." Schrader directs it to be prepared by mixing a solution of red oxide of mercury with hydrocyanic acid, filtering and evaporating. 3 Cyanuret of mercury forms white, opake, four-sided prisms; is inodorous, and its taste is extremely disagreeable and metallic. It is decomposed by heat; is readily soluble in water, and becomes converted thereby into hydrocyanate of mercury. It is insoluble in alcohol. It contains, at times, ferrocyanuret of potassium, pro- ceeding from the Prussian blue, with which it has been prepared. 4 1 Pharm. of the United States, p. 118. Philad., 1842; see, also, Mr. Ellis, in Journal of the Philadelphia College of Pharmacy, vi. 24. Philad., 1834-5. 4 Dispensatory, p. 519. Edinb. 1842. * See a new process for its preparation, by MM. Chevallier and Deleschamps, in Journ. de Chimie Medicale, Janv. 1830. • Orfila, Toxicologic, i. 331. HYDRARGYRI CYANURETUM. 415 EFFECTS ON THE ECONOMY. According to Coullon, the poisonous action of this salt is as rapid as that of hydrocyanic acid. A fatal case has been pub- lished. 1 In the dose of from two to five grains, M. Ittner found it produce on dogs only signs of indisposition, tremors, &c. 2 It is one of the substances which Magendie, 3 in his experiments, found to promote the coagulation of the blood. Parent, 4 who frequently used this preparation, prefers it greatly to corrosive sublimate, in consequence of its greater solubility, and the capability of more readily affecting the organism by it. Ac- cording to his experience, syphilis yields more readily under its use, than under that of any other of the mercurials. He did not observe pains in the abdomen accompanying its protracted em- ployment, which he so frequently witnessed when the corrosive chloride was taken. Another advantage which it possesses is, that it is not so readily decomposed. No salt, no alkali — not even caustic alkali — disturbs it; neither do substances that contain nitro- gen or gallic acid, which speedily convert the corrosive chloride into calomel. Moreover, cyanuret of mercury appears to act on the animal textures differently from the corrosive chloride. When the latter is placed in contact with flesh, it becomes quickly changed, in part, into calomel; whilst the cyanuret preserves the flesh equally well, without being decomposed. The hydrocyanic acid appears to play no important part in the action of the re- medy. According to Olivier's experiments, 5 the cyanuret, like the corrosive chloride, acts as a powerful excitant to the tissues on which it is applied. He saw a man destroyed by inflammation of the intestines, who had taken twenty-three grains of it. Cyanuret of mercury was first, perhaps, recommended in Italy, by Brera, and in Spain. Mendoza especially made many trials with it, from which he was induced to conclude, that it is the best agent we possess in venereal affections— an opinion in which he was joined by several of his professional brethren in Malaga. He advises, that laudanum should be added to it, on account of its liability to excite vomiting. When too large doses were adminis- tered, or when the patient was unusually impressible, he found that the nervous system became especially disordered — as indicated by syncope, oppression, anxiety, and convulsions. Chaussier, likewise, as well as Thaer and Horn, proposed the cyanuret as a remedial agent at an early period. On the other hand, Wendt, 1 Thibert, cited by T. R. Beck, in Amer. Journ. of the Med, Sciences, April' 1842, p. 490. * Merat and De Lens, Diet, de Mat, Med., art. Cyanogene. 3 Legons sur le Sang; and translation in Lend. Lancet, Jan. 20th, 1839, p. 636. * Journ. de Chimie Medicale, viii. 473. 8 Journ. de Chimie Medicale, i. 269 ; see, also, Letheby, Lond. Med. Gaz., Jan. 9, and Feb. 14 and 17, 1845. 416 HYDRARGYRI CYANURETUM. Cullerier and Plisson complain of its little efficacy ; whence it has been inferred that the preparation must differ. 1 Neumann 2 advises it in chronic inflammation of the lungs, of the membranous organs of the chest and abdomen, and of the ovaries. In particular cases, its use has to be soon pre- termitted, in consequence of its powerful action on the salivary glands, even in small doses — as one-eighth of a grain, three times a day. In other cases, it can be continued long without the supervention of any unpleasant consequences. In the Charite, at Berlin, it was used with advantage in a case of obstinate cepha- lalgia, the origin of which was syphilitic. Biett has employed it externally — in the form of the ointment given below — in humid tetter, accompanied with inflammation and itching. Parent re- commends it to be applied in chancre, and Brera uses it in solu- tion, as a gargle, in syphilitic ulcerations of the fauces. Dr. StrohP cures chancres, even when complicated, usually within twelve days, with an ointment composed of two grains of the cyanuret to a dram of lard. The ointment is spread upon a piece of lint of the size of the sore: the dressing is apt to be painful at first, and it must be taken off occasionally, after it has been on for an hour or two, and be applied in a weaker form. The pain is said to be most violent in half an hour or an hour, and frequently ceases in two or three hours. When the chancre is extensive and painful, after the ointment has been on for from four to ten hours, according to the sensibility of the patient, it is dressed with mercurial ointment or opium cerate. By Carron du Villards it was used in the form of ointment in scrofulous con- junctivitis; and by Desmarres in the blepharitis glandnlosa of scrofulous individuals : and Fischer and Duhrsen observed good effects from the use of an ointment composed of it in the hydro- cephalus of children. 4 Such is the chief testimony recorded in favour of the medical action of the cyanuret of mercury. Dr. Christison 5 thinks, that " the few trials hitherto made of its effects in disease scarcely jus- tify its introduction as a remedy." Although, however, it has been but little used in Great Britain, many trials have been made with it, on the continent of Europe more especially. MODE OF ADMINISTRATION- Cyanuret of mercury may be given in pills or in solution. Horn prescribed it in powder, but this form is less appropriate. The 1 Riecke, Die neuern Arzneimittel, u. s. w. S. 264. Stuttgart, 1837, & 2te Auflage, S. 3/0. Stuttgart, 1840. 8 Hufeland and Osann's Journal, Iv. 66. 3 Oesterreich, Med. Worhen^chrift, cited in Lond. Med. Gaz., Nov. 1842. Gaz. Med. de Strasbourg, Nos. 15, 17; or Encycl. des Sciences Med, Sept. 1841, p. 525. 4 Aschenhrenner, Die neueren Arzneimittel, u. s. w. S. 147. Erlangen, 1848. 5 Dispensatory, p. 519. Edinb. 1842. HYDRARGYRI CYANURETUM. 417 dose is from one-sixteenth of a grain to a grain, several times a day. As a gargle, half a grain to a grain may be dissolved in f ^j. of water; as an ointment, from one and a half to two grains may be united with 3j- of lard. Chaussier used it in friction on the soles of the feet, in the same way as the corrosive chloride. Liquor hydrargyri cyanureti, {Liqueur Antisyphilitique de Chaussier.) R. Hydrargyri cyanur. gr. viij. Aquas destillat. Oj. Each ounce contains half a grain of the cyanuret. Chaussier 1 and Parent. R. Hydrarg. cyanuret. ^ss. Solve in Aq. destillat. Oj. Adde Tincturse opii f gj. M. Dose. — Morning and evening, a spoonful, in a decoction of sar- saparilla or barley. Mendoza and Parent. Pilulae hydrargyri cyanureti. Pills of cyanuret of mercury. R. Hydrarg. cyanuret. gr. v. Opii 9ss. Micse panis gj. Meiiis q. s. ut fiant pilulae xcvj. Dose. — One to four, three times a clay. Parent. Gargarisma hydrargyri cyanureti. Gargle of cyanuret of mercury. R. Hydrarg. cyanur. ^ss. Decoct, ten. sem. lini ; (vel rad. althasae,) Oj. M, et fiat gargarisma. Parent. R. Hydrarg. cyanur. ^ss. Decoct, hordei Oj. Mellis rosse ^j. M. et fiat gargarisma. Unguentum hydrargyri cyanureti, Ointment of cyanuret of mercury. R. Hydrarg. cyanur. gr. xij. Adipis ,§j. M. ut fiat unguentum. Br era. Brera, R. Hydrarg. cyanur. gr. xvj. Adipis^j. 01. limonis gtt. xv. M. From half a dram to a dram, to be rubbed in, in cases of tetter. Biett. 1 Rattier, Formulaire Pratique des Hopitaux Civils de Paris, 3eme edit. Paris, 1823. 418 HYDRARGYRI IODIDUM. CVI. HYDRARGYRI IODIDUM. Synonymes. Hydrargyri Proto-iodidum seu Protoioduretum seu Subiodi- dum, Hydrargyrum Iodatum flavum, Iodidum seu Ioduretum Hydrar- gyrosum, Hydrargyrum Iodidulatum seu Subiodatum seu Iodatum, (in contradistinction to the Periodatum,) Iodidum seu Iodetum Hydrargy- rosum, Proto-ioduretum mercurii, Protiodide, Proto-iodide, Proto- ioduret or Subiodide of Mercury. French. Proto-iodure de Mercure. German. Gelbes oder einfachlodquecksilber, GelbesQueck- silberiodid, Protoiodur des Quecksilbers, Quecksilberio- didul, Quecksilberiodiir, Iodquecksilber in minimum des Iod s. METHOD OF PREPARING. According to Tunnermann, the best method of preparing the iodide is the following: — Take of nitrate of protoxide of mercury (not tinged yellow by the admixture of nitrate of peroxide,) 28.25 parts; iodide of potassium, 16.5 parts; rub them together for some minutes in the dry state, and afterwards with a little distilled water, gradually adding the water so as to dissolve the saltpetre formed. The mixture is then passed through the filter, and the yellowish-green precipitate of iodide of mercury is well washed, and dried by a gentle heat. The objection to this process is the diffi- culty of obtaining the mercurial salt at a minimum of oxidation, and the consequent liability of the resulting compound to contain uncertain quantities of the red iodide. M. Boutigny, 1 to avoid these disadvantages, recommends the following form: — Take of mild chloride of mercury, three ounces and five drams; iodide of potassium, two ounces and four drams: pulverize the iodide in a glass mortar, and add the calomel; place the mixture in a porcelain capsule, and pour over it ten or twelve ounces of boiling distilled water. After cooling, decant the fluid, collect the precipitate on a filter, and wash with distilled water. Dry in the shade, and keep in a well-stopped bottle. The iodide, thus prepared, may, according to M. Boutigny, sometimes contain a minute portion of free mercury or of the mild chloride, but the quantity of either is so small as to be of no mo- ment. In the London and United States Pharmacopoeias, it is pre- pared by rubbing together an ounce of mercury and five drams of iodine, adding gradually as much alcohol as may be sufficient until globules are no longer visible. The powder is dried immediately by a gentle heat, access of light being excluded ; and it is kept in a well-stopped vessel. 2 Iodide of mercury, according to Thomson, consists of 250 parts 1 Bulletin General de Therapeutique, cited in Amer. Journ. of Pharmacy, 2d vol. 2d series, p. 326. Philad. 1837. a Pharrh. of the United States, p. 119. Philad. 1842. HYDRARGYRI IODIDUM. 419 of mercury, and 156 parts of iodine. It has a greenish-yellow colour, and is a preparation holding the same relation to iodine and mercury, that the mild chloride holds to chlorine and mer- cury; it is more volatile, however, than the mild chloride, but like it is almost insoluble in water. EFFECTS ON THE ECONOMY. This preparation has been less used than the red iodide to be described next. Tunnermann remarks, as the results of his expe- rience, that its action in respect to the mercury is analogous to that of the mild chloride, except that it appears to excite more the lymphatic and glandular systems. When given in conjunction with a generous animal diet, he found it very efficacious in a case of scrophulosis, where colliquative sweats had appeared ; and in a second case, also, it rendered essential service. In one of the cases, he gave it internally in the dose of from one-twelfth to half a grain, three times a day ; in the other, of from half a grain to a grain. He directed it also to be rubbed, in the form of ointment, on tume- fied glands of the neck. Pelletan found it serviceable in the cure of obstinate glandular swellings, when used in the form of oint- ment in combination with morphia, as well as in obstruction of the liver. Biett recommends an ointment of the iodide in the treat- ment of chronic venereal ulcers, the cicatrization of which it expe- dited ; Lugol 1 advises it in phagedenic scrofulous ulcers, which present a syphilitic aspect; and Poiret 2 recommends it strongly in cases of psoriasis; the patient using, at the same time, simple alkaline or water baths alternately. According to the experience of Ricord, 3 in the syphilitic affections of children, especially of a cutaneous character, it is to be preferred to other forms of mercu- rial, and is not apt to be followed by the bad effects, which, in adults, often supervene on the use of other preparations. 4 MODE OF ADMINISTRATION. On account of its insolubility it is given only in the form of powder or pill, to the extent of from a grain, gradually carried to three or four grains, twice or thrice a day. Externally, it is ap- plied, for the same reasons, in the form of ointment only. 1 Essays on the Effects of Iodine in Scrofulous Diseases, &c, by O'Shaughnessy, p. 170. Lond.l831. A . ; ' ? . * F a Gazette des Hopitaux, 20 Juillet, 1837; see, also, Bulletin General de Therapeu- tique, Juillet, 1837; and C. A. Porter, in Amer. Journ. of the Med. Sciences, Nov. 1839, p. 68. 3 La Lancette Francaise, No. 65, 1834. 4 Cogswell's Essay on Iodine, p. 158. Edinb. 1837. See, also, Ricord, Practical Trea- tise on Venereal Diseases, translated by Drummond, Philad. 1 843, and Hocken's Com- parative Value of the Different Preparations of Mercury and Iodine, &c. &c. in Edinb. Med. and Surg. Journ. April, 1844. 420 HYDRARGYRI IODIDUM. PilulsB hydrargyri iodidi. Pills of iodide of mercury. R. Hydrarg. iodidi gj. Confect. rossB caninae giij. Zingiberis pulv. 3J. M. Dose. — From five to ten grains. London Pharmac. Pilule hydrargyri iodidi composite. Compound pills of iodide of mercury. R. Hydrarg. iodid. gr. vj. Extract, opii gr. iv. Lactucarii gr. xxiv. Ext. guaiac. gr. xlviij. M. Fiant pilulae xlviij. Dose. — For a child, half a year old, one pill; for older children., two, three, or four. In the syphilis of children. Ricord. R. Hydrarg. iodid. gr. j. Ext. junip. gr. xij. Glycyrrhiz. pulv. q. s. Divide in pil. viij. Dose. — At first, two, morning and evening : afterwards, three or four. Magendie fy Biett. R. Hydrargyri iodid. ^ij. Guaiac. pulv. gj. Thridac. gss. M. et divide in pil. xlviij. Dose. — One a day in scrofula, syphilis, &c. Biett. 1 Pulveres hydrargyri iodidi. Powders of iodide of mercury. R. Hydrarg. iodid. gr. i. (iv. 5 vj., vel viij.) Magnes. gj. M. et divide in pulv. xij. Dose. — A powder, three times a day. Unguentum hydrargyri iodidi. Ointment of iodide of mercury. R. Hydrargyr. iodid. 3J. Cerge albs §ij. Adipis §vj. M. R. Hydrarg. iodid. gr. vj. Morphise acetat. gr. viij. Adipis gj. M. In obstinate glandular swellings. R. Hydrarg. iodid. T)j. Adipis §iss. a M. In old venereal ulcers. Lond. Pharm. Pelletan. Magendie # Biett. 1 Duhamel, Amer. Journ. of Pharm. July, 1841, p. 105. 3 Tunnermann uses only gss. HYDRARGYRI IODIDUM RUBRUM. 421 R. Hydrarg. iodid. 9ij.J (vel iij. vel iv.) Adipis ^ij. M. As a dressing to phagedenic and scrofulous ulcers. Lugol. When this salve is first prepared, it is of a canary-yellow, sometimes of a greenish colour. By time, it becomes of an orange hue, when it must be thrown aside, as owing to the formation of the red iodide, it becomes as corrosive as the ointment of the cor- rosive chloride. R. Hydrarg. iodid. gj. Adipis 3j. M. To be rubbed morning and evening on the parts affected. Poiret. R. Hydrarg. iodid. ^i. Sapon. medicin. gss. Aquae rosse gij. Unguent, rosse gvj. M. This ointment is said not to turn rancid so rapidly as the com- mon ointment. Biecke. 1 CVIT. HYDRARGYRI IODIDUM RUBRUM. Synonymes. Hydrargyri Deuto-iodidum seu Deuto-Ioduretum sen Perio- didum seu Biniodidum, Hydrargyrum Iodatum Rubrum seu Biiodatum seu Periodatum,Iodidum seuIodetumHydrargyricum, Deuto-ioduretum Mercurii, Red Iodide, Deutiodide, Biniodide or Periodide of Mercury, French. Deuto-Iodnre de Mercure, Period ure de Mercure. German. Rothes Iodquecksilber, Iodquecksilber in Maxi- mum, Quecksilber-iodid, Deuto-IodiirdesQuecksilbers, Doppelt Iodquecksilber, Quecksilberdeutiodiir, Iod- quecksilber in Maximum. METHOD OF PREPARING. The process of the Pharmacopoeia of the United States consists in dissolving an ounce of corrosive chloride of mercury in a pint and a half of distilled water ; and ten drams of iodide of potas- sium, in half a pint of distilled water. The solutions are then mixed, and the precipitate is collected on a filter, washed with dis- tilled water, dried with a moderate heat, and kept in a well-stopped bottle. The following is the process recommended in the London Phar- macopoeia : — An ounce of mercury and ten drams of iodine are to be rubbed together, alcohol being gradually added until the globules are no longer visible. The powder is to be dried with a gentle heat, and kept in a well-stopped vessel. ' Bouchardat, Annuaire pour 1844, p. 140. Paris, 1844. 422 HYDRARGYRI IODIDUM RUBRUM. The Edinburgh Pharmacopoeia triturates two ounces of mercury with two ounces and a half of iodine, adding occasionally a little alcohol till a uniform red powder is obtained. The product is re- duced to fine powder, and dissolved in a concentrated solution — a gallon by measure — of chloride of sodium, with the aid of brisk ebullition. It is then filtered, if necessary, through calico, keep- ing the funnel hot. The crystals, which form on cooling, are then washed and dried. Red iodide of mercury is a beautiful vermilion-coloured pow- der, which, when moderately heated, becomes yellow, but, when exposed to the air, is gradually restored to red, and is volatilized. When volatilized, it crystallizes in beautiful rhomboidal leaves, which, at a higher temperature, are of a golden-yellow hue; but at the ordinary temperature, of a shining red. It is insoluble in wa- ter; but soluble in alcohol and ether; and in solutions of iodide of potassium, and chloride of sodium. It contains 250 parts of mer- cury, and 312 of iodine. EFFECTS ON THE ECONOMY. This preparation, which was introduced into practice by the French physicians, has been particularly recommended in syphilis complicated with scrofula. Biett found it very efficacious in scrofulo-venereal ulcers, in syphilitic swellings of the lympha- tic glands, and in inveterate itch. He administered it also in- ternally, dissolved in alcohol or ether, in scrofulous affections com- plicated with syphilis, and with advantage. In its effects, it re- sembles the corrosive chloride, whilst the iodine resembles the mild chloride. Rayer, 1 indeed, considers the red iodide more active than the corrosive chloride. Paillard found it very efficacious in chronic cutaneous eruptions. He dipped a camel's hair pencil in a weak solution of it in ether, and pencilled the parts with it three or four times a day. In this way, he cured several squamous, tu- berculous, and other eruptions. It scarcely excited any pain. As, however, this mode of applying it often failed, he employed 3j. mixed with ^j. of oil of almonds in the same manner. If the cor- rosive action was considerable, a sense of heat soon arose in the part, which gradually terminated in burning pain. The neigh- bouring parts were also hot, painful, and tumefied ; and, in the course of an hour, an infusion of serum took place ; but in four or five hours, the pain always disappeared. If applied on the cheeks or lips, salivation at times ensued suddenly. Scabs formed, which fell off in a few days, and exposed a red surface much disposed to cicatrize. When frequently applied, symptoms occurred, which 1 Treatise on Skin Diseases, by Dr. Willis, p. 79. See, also, Puche, Journal des Con- naissances Medicales, Octet Nov. 1838, and Janvier, 1839. HYDRARGYRI IODIDUM RUBRUM. 423 were probably the consequences of its being absorbed, — namely, fever, colic, diarrhoea, and dysentery. Breschet 1 applied it, in the form of ointment, with great success, in a case of obstinate ulcera- tion at the angle of the eye, presumed to be carcinomatous. BJasius advises it internally and externally in lupus, and it has been recommended highly by Dr. J. W. Schmidt, Junr., of New York, 2 in cases of the same affection, and especially in the dartre venerienne. Both the iodide and red iodide were given internal- ly. These cases, as well as syphilitic sore throat of long stand- ing, which had been previously treated by mercury without suc- cess, Dr. Schmidt found to yield invariably to a pill of a quarter of a grain of the iodide, and a grain of extractum conii, given night and morning, and afterwards three times daily. After using these pills for from four to eight weeks, he substitutes the solution of iodide of potassium, — changing, in the first place, the action of the parts by cauterizing the throat with the. solid argenti nitras. Dr. Schmidt has not found it necessary to carry the iodide so far as to touch the mouth, but should it accidentally do so, he stops the mercury, and goes on with the iodide of potassium. Tunnermann used it with advantage, in the form of ointment, for the removal of furuncular inflammation of the glands of the neck. Riecke, 3 likewise, employed it, with great success, as a discutient, (gr. xvj. to |j. of lard,) in a case of ganglion in the region of the knee, from which violent pain proceeded along the nerves when it was pressed upon — and in two cases of goitre. When- ever it has to be applied over an extensive surface, as in the dis- ease last mentioned, it has generally to be discontinued soon, in consequence of the supervention of inflammation of the cutaneous surface. In the form of a weak ointment — composed of red iodide gr. ij., cerate 9ij., almond oil 3j. — it has been used in opacity of the cornea. 4 Kopp has published some favourable cases of the therapeutical application of the red iodide. The ointment, given below, he found very efficacious in luxuriant, chronic, scrofulous, and syphilitic sores, as well as in condylomata, and venereal blotches. No less useful did he find it in many other skin dis- eases, and particularly in herpes. In one case, in which he ad- ministered it in the last affection, he found a co-existent goitre, which had been there for several years, almost wholly disappear; and he, consequently, afterwards prescribed it frequently for the latter affection. He also used it, with excellent effect, in ophthal- 1 Lugol's Essays on Iodine, by O'Shaughnessy, p. 204. s American Journal of the Medical Sciences, Feb. 1840, p. 301. * Die neuern Arzneimittel, u. s. w. S. 270. *Gr'afe und Walther's Journ. fur Chirurg. Bd. xiii., cited by Fereira, Elements of Materia Medica, 2d edit. i. 762. Lond. 1842. or 2d Amer. edit. Phila. 1846. 424 HYDRARGYRI IODIDUM RUBRUM. mia tarsi, and, where there was a disposition to the formation of hordeolum, a little of the second ointment, the form for which is given hereafter, was applied at bed time to the edges of the eye- lids. Lastly, he advises friction with the first ointment in chronic rheumatic pains, and in cases of induration of the glands, especially of the liver. After the friction has been continued for some time, an eruption occasionally appears. Both the iodide and red iodide, in the form of ointment, have been found, by Dr. Moj'sisovics, 1 of Vienna, exceedingly useful in promoting absorption. The strength of the ointment of the iodide, recommended by him, is gr. x. to 3ij. of simple ointment, which quantity is to be daily rubbed into the part affected. The strength of the ointment of red iodide used by him is 3j. to Jj. of simple ointment. This ointment spread upon leather vesicates; and the cuticle separates in the form of a crust. Its efficacy has been great in bronchocele: according to M. Moj'sisovics, on the falling off of the dried cuticle, the size has been found to be sensibly di- minished. No preparation of iodide, he thinks, is comparable in this disease to the red iodide. "It performs in one month what the other forms will scarcely do in three or four." He has treated goitres of enormous size with it, and at the first application all the threatenings of suffocation or apoplexy — where they existed — ceased. Condylomata about the anus and perineum, or even within the rectum and vagina, were cured by this ointment; and unless they were very extensive and indurated, a single applica- tion — which is very painful— combined with the internal use of iodine, has been found sufficient. The author has frequently administered the red iodide in pub- lic and in private practice, in cases where an active modifier of the system of nutrition appeared to be needed, and where a com- bination of remedies so potent as mercury and iodine suggested itself. In chronic glandular enlargements, especially of the liver and spleen, and in habits where the use of mercury was not contra-indicated, both the red iodide and iodide have, in his hands, proved extremely serviceable. Perhaps there are no preparations, which, under the circumstances in question, merit more attention. MODE OF ADMINISTRATION. Red iodide of mercury is given internally in the form of pow- der or pill, or dissolved in alcohol or ether, in the dose of one-six- teenth to one one-fourth of a grain, gradually increased daily. Ex- ternally, it is applied in the form of ointment. 1 DaTstellung einer sicheren und schnellen Heilmethode der Syphilis durch Iodpra- parate, Wien, 1845: noticed in Brit, and For. Med. Rev., April, 1845, p. 516. HYDRARGYRI IODIDUM RUBRUM. 425 Pilulse hydrargyri iodidi rubri. Pills of red iodide of mercury. R. Hydrarg. iodid. rubr. in syrup, commun. pauxill. terendo bene distribuend. gr. v. Micas panis alb. Sacch. pulv. aa. q. s. ut fiant pilulse lx. Dose. — Two, morning and evening, drinking afterwards a cup- ful of oatmeal gruel. The dose to be raised gradually. Blasius, Tinctura hydrargyri iodidi> rubri, Tincture of red iodide of mercury . R. Hydrarg. iodid. rubr. 9j. Alcohol 36° (.837) f giss. M. Dose. — Ten to twenty drops, in a glass of distilled water. Magendie fy Biett* Syrupus hydrargyri iodidi rubri compositus, Compound syrup of red iodide of mercury. R. Hydrarg. iodid. rubr. gram. i. (gr. 15.44 Troy.) Potass, iodid. gram. 50. Aquae, gram. 50. Dissolve, filter through paper, and add Syrup. (30° when cold,) gram. 2400. A table-spoonful of this syrup is a dose. It represents, provided it holds 25 grammes of the syrup, a centigramme of red iodide of mercury, and 50 centigrammes of iodide of potassium. Gibert. 1 jEtlier sulphuricus cum hydrargyri iodido rubro, Sulphuric ether with red iodide of mercury. R. Hydrarg. iodid. rubr. £)j. iEther. sulph. f Jiss. M. Administered like the last. Magendie fy Biett. Unguentum hydrargyri iodidi rubri. Ointment of red iodide of mercury . R. Hydrarg. iodid. rubr. in pulv. subtiliss. gr, vj. Adipis gvj.' M. Hop p. R. Hydrarg. iodid. rubr. in pulv. subtilissim. gr. J- to £. Adipis §ij. Cerse albse gr. ij. M. fiat unguentum. For an eye-salve. Kopp. R, Hydrargyri iodid. rubr. gr. xv. Adipis §ss. M, exactissime. Fiat ung. As a dressing in lupus. Blasius. 1 Journal de Pharmacie, Oct. 1841, p. 634, 426 HYDRARGYRI NITRAS. R. Hydrarg, iodid. rubr. gr. xv. Adipisgij. 01. bergamot. gtt. x. M. To be rubbed on the parts in chronic cutaneous affections. Biett. R. Hydrarg. iodid. rubr. 9j. Adipis^iss. M. Biett. To be spread on lint in old venereal ulcerations. The unguentum hydrargyri biniodidi of the London College is prepared like the ung. hydrarg. iodidi. CVIII. HYDRARGYRI NITRAS. Synonymies. Hydrargyrum nitratum. French. Nitrate de mercure. German. Salpetersaures Quecksilber. > There are two nitrates of mercury employed in medicine: I. HYDRARGYRI PROTONITRAS. Synonymes. Hydrargyrum nitricum oxydulatum, Mercurius uitrosus fri- gore paratus, Nilras hydrargyrosus ; Protronitrate of mercury. Neutral Nitrate of suboxide of mercury. French. Protonitrate de mercure. German. Salpetersaures Quecksilberoxydul, Kaltberei- tetes Salpetersaures Quecksilber. METHOD OF PREPARING. This salt is formed by digesting excess of mercury in cold di- lute nitric acid, until short prismatic crystals are formed. It is soluble without decomposition in a small quantity of water ; but in much water its crystals are decomposed into a yellow powder — bibasic nitrate of suboxide of mercury, and an acid liquor, which contains a soluble supernitrate. EFFECTS ON THE ECONOMY. The effects of protonitrate of mercury, according to Dr. Perei- ra, 1 may be considered intermediate between those of calomel and corrosive sublimate; and he considers it probable, that after its ingestion it becomes converted into calomel by the action of the alkaline chlorides in the alimentary canal; and Mialhe 2 states, that if atmospheric oxygen and an excess of alkaline chloride be present, a portion of corrosive sublimate is formed. Sundelin 3 em- ploys it in all cases in which the corrosive chloride is used, and 1 Elements of Mat. Med. and Therap. 3d edit i. 873. Lond. 1849. 2 Traite de l'Art de Formuler, p. 72. Paris, 1845. 3 Horns Archiv., Jahrgang. 1827, St. 1, p. 164; cited in Dierbach,Die neuesten Ent- deckungen in der Mat. Med. 3er Band, lste Abth. S. 302. Heidelb. und Leipz. 1845. , HYDRARGYRI NITRAS. 427 especially in the different forms of chronic syphilis ; and Caze- nave extols it as an excellent antisyphilitic. It is not often given, however, internally. Externally, it has been used by Biett and others in chronic cutaneous diseases in the form of ointment. MODE OF ADMINISTRATION. The dose of the protonitrate of mercury is from one-sixteenth to one-eighth of a grain in the form of pill, made with extract of liquor- ice. Sundelin gave it in the dose of from one-eighth of a grain to a grain. Liquor hydrargyri protonitratis. Solution of protonitrate of mercury. (Liq. Hydrargyri Nitrici, Ph. Boruss. 1847.) R. Hydrargyri protonitrat. |jj. Aquee destillat. 5viij. Acid, nitric, ^iiiss. Mix the acid and water before the protonitrate is added ; filter, and add water, if necessary, to make the liquor of the sp. gr. 1.100. Preserve it carefully in a stopped vessel. Dose, three drops. Pilulae hydrargyri protonitratis. Pills of protonitrate of mercury. R. Hydrarg. protonitrat. gr. vj. Solve in Aquee destillat. pauxillo ; et adde Succ. glycyrrhiz. pulv. Rad. Althseee pulv. sing. gj. M. et fiant pilulse xcvj. Dose. Two pills twice a day. Sundelin. Unguentum hydrargyri protonitratis, Ointment of protonitrate of mercury. R. Hydrarg. protonitrat. gr. xv. Adipis ^j. M. In chronic cutaneous diseases. Biett §• Cazenave. II. HYDRARGYRI DEUTONITRAS. Synonymes. Hydrargyri Dipernitras seu Supernitras, Hydrargyrum Ni- tricum Oxydatum ; Mercurius Nitrosus calide paratus. Nitras Hydrar- gyricus. French. Deuto-nitrate seu Dipernitrate de Mercure. German. Salpe t ersaures Quecksilberoxyd, Heissbereitetes Quecksilberoxyd. METHOD OF PREPARING. A solution of this salt is formed by boiling mercury in strong nitric acid until the liquid, when diluted with water, ceases to yield a white precipitate (calomel) on the addition of a solution of common salt. By evaporating, crystals are formed. EFFECTS ON THE ECONOMY. This salt is more acrid and caustic than the protonitrate. It is 428 HYDItARGYRI NITRAS. , considered to be converted into corrosive sublimate by the alkaline chlorides with which it comes in contact in the intestinal canal; and the action of the two substances may, therefore, be regarded as the same. It is scarcely ever administered internally ; but when so, the dose may be one-sixteenth of a grain. It is often, how- ever, used externally, and especially in the form of Liquor Hy- drargyri Supernitratis seu Pernitratis, Nitras Hydrargy- ricus Acido-Nitrico Solutus, Solution of Supernilrate of Mer- cury, Liquid Acid Deutonitrate of Mercury, Jicid Nitrate of Mercury : French, Deutonitrate Acide de Mercure Liquide, Nitrate Acide de Mercure; which is made, according to the Pa- risian Codex, by dissolving 100 parts by weight of mercury in 200 parts by weight of nitric acid, sp. gr. 1.321, and evaporating the solution to 225 parts. 1 The following formula for the preparation of the Hydrargyri Pernitratis Liquor is given in the last Dublin Pharmacopoeia. 2 Take of pure mercury, §ij. (avoirdupois;) pure nitric acid, §iss; distilled water, ^iss. In the acid, first diluted with the wa- ter, dissolve the mercury, with the application of heat, and evaporate the solution to the bulk of two ounces and a half. It is chiefly as a caustic that this solution has been used, as by Biett, Petrequin, 3 and others, in lupus; and, by the French surgeons especially, for the purpose of cauterizing the ulcerated cervix uteri* Biett ap- plies it to the extent of a five- franc piece, by means of a cameFs- hair pencil ; and then applies lint dipped in the solution to the cauterized surface. The parts immediately become white, and a yellowish eschar forms, which apparently adheres strongly to them, but gradually separates. 5 By Chardon it has been employed suc- cessfully as an injection in gonorrhoea, a few drops being added •to a glassful of water, and thrown up four times a day. 6 By De- vergie it was applied beneficially in tinea favosa ; and by Camus in freckles. Godard used it successfully in herpes scrophulosus exedens; and in various obstinate cancerous ulcers, and other chronic cutaneous affections, it has been prescribed with good results; and Godemer 7 has strongly advised it as a cauterizing agent to the pharynx in cases w 7 hich require such applications. He employs a solution of one part of the acid nitrate to four or five of w T ater, and applies it, by means of a camel's-hair pencil, passed once over the part, and gargling immediately afterwards. 1 Traite de Therapeutique et de Mat. Med. 3e edit. i. 185. Paris, 18-17. 2 The Pharmacopoeia of the King's and Queen's College of Physicians, 1850, p. 89. Dublin, 1850. 3 Revue Medicale, Paris, 1848, cited in Brit, and For. Medico-Chirurg. Review, April, 1849, p. 538. 4 J. H. Bennett, A Practical Treatise on Inflammation, Ulceration and Induration of the Neck of the Uterus, Amer. edition, p. 100. Philad. 1847. s Dierbach.. Op. cit. S. 304. 6 Froriep's Notizen, B. 28, No. 3, p. 46, cited by Dierbach. * Journal de Medecine de la Cote d'Or, Mai, 1847, cited in Bouchardat, Annuaire de Therapeutique, pour 1848, p. 184. HYDRARGYRI ET ARSENICI I0D1DUM. 429 Constitutional effects are said to have supervened on its local employment. Breschet saw salivation induced by a single appli- cation of it to the neck of the uterus. 1 To prevent this the part may be washed well after it has been touched. The well-known Unguentum Hydrargyri Nitratis, Citrine Ointment, of the Pharmacopoeia of the United States, is formed of the deutonitrate of mercury. C1X. HYDRARGYRI ET ARSEN'ICI 10'DIDUM. Synonymes. Arsenici et Hydrargyri lodidum, Hydriodas Arsenici et Hy- drargyri, Iodide or Hydriodate of Mercury and Arsenic, Double Iodide of Arsenic and Mercury, lodo-arsenite of Mercury, Donovan's Solution. Mr. Donovan 2 has proposed this new compound, which he re- gards as more efficacious than either the iodide of mercury or the iodide of arsenic. METHOD OF PREPARING. Triturate 6.08 grains of finely levigated metallic arsenic ; 14.82 grains of mercury, and 49 of iodine, with one fluid ram of alcohol, until the mass has become dry, and, from being deep brown, has become pale red. Pour on eight fluidounces of distilled water; and after trituration for a few moments, transfer the whole to a flask; add half a dram of hydriodic acid, prepared by the acidifi- cation of two grains of iodine, and boil for a few moments. When the solution is cold, if there be any deficiency of the original eight ounces, make it exactly that measure with distilled water. Finally filter. 3 By the long continued trituration of arsenic, mercury, iodine, and alcohol, the metals are converted into iodides, which combine. The mass, by solution in water, is converted into a hydriodate of arsenic and mercury. The quantities of the two metals are so adjusted, that, when converted into protoxides by decomposition of a portion of the water in which they are dissolved, there will be eight grains of arsenious acid, and sixteen of protoxide of mer- cury. The quantity of water is such, that each dram by measure of the solution will contain exactly one-eighth of a grain of arse- nious acid, and one-fourth of a grain of protoxide of mercury. Mr. Donovan conceives, that the quantity of mercury ought to be double that of the arsenic, in order to ensure a slow, and mode- rate, yet adequate mercurial action, along with the proper effect of the arsenic. On repeating Mr. Donovan's process, M. Soubeiran 4 found, that a portion of arsenic remained undissolved, and he therefore pro- 1 Op. cit. p. 191. 3 Dublin Journal of Medical Science. Nov. 1839, p. 281. 3 Donovan, Dublin Journal, Nov. 1842, p. 171. 4 Journal de Pharmacie, xxvii. 744. Paris, 1841. 28 430 HYDRARGYRI ET ARSENICI IODIDUM. posed the following mode of preparation: — Take of teriodide of arsenic, gr. xxxv.; biniodide of mercury, gr. xxxv.; boiling dis- tilled water, f ^viij. Triturate until dissolved, and filter; and, if necessary, add sufficient water to make ^viij. of the solution. A similar formula has been recommended by Mr. Procter, 1 of Phila- delphia, who employs 36 grains of the teriodide of arsenic, and 34 grains of the biniodide to §viij. of water. Of the preparation above described, which Mr. Donovan calls liquor hydriodatis arsenici et hydrargyri, (liquor arsenici et hy- drargyri iodidi seu hydrargyri iodo-arsenitis,) each dram by mea- sure consists of water, one dram; arsenious acid, one-eiohth of a grain; peroxide of mercury, one-fourth of a grain; iodine, con- verted into hydriodic acid, about three-fourths of a grain. The colour of the solution is yellow, with a pale tinge of green: its taste is slightly styptic. It is incompatible with tincture of opium, or with sulphate, muriate, or acetate of morphia. The test of the perfection of the preparation, according to Mr. Donovan, 2 is, that the whole of the iodine, arsenic and mercury shall disappear, and be dissolved during the process of preparing it. This cannot happen unless the three elements employed have been chemically pure, and unless the trituration has been sufficiently long continued. EFFECTS ON THE ECONOMY. Numerous trials have been made with this preparation in cuta- neous diseases, especially in psoriasis, lepra and lupus ; and the testimony of some of the most eminent of Mr. Donovan's coun- trymen has been brought forward in its favour. Mr. Carmichael has given it in five or six cases of lupus, and in one of psoriasis, with decided benefit. 3 Mr. Colles administered it in two extreme cases of scrofulous ulceration in the adult with some benefit: Dr. Croker gave it internally, and applied it externally, with complete success, in a case of psoriasis guttata: Dr. Graves treated with it a very inveterate case of psoriasis with decided advantage; Dr. Irvine completely cured by it a most virulent case of the same affection; Mr. Cusack found, that venereal eruptions yielded rapidly to half dram doses, three times a day; and Sir Henry Marsh had a case of impetigo figurata, of strumous origin, covering the face, chest, arms, and thighs, but particularly well marked at the flexures of all the joints, which was cured by the administration of fifteen minims, twice a day, gradually increased to one scruple, and finally to half a dram. The treatment was cautiously pursued for some- 1 American Journal of Pharmacy. June, IS47, p. 93. A form for the preparation of the Arsenici ef Hydrargyri Hydriodatis Liquor has been introduced into the last edi- tion of the Dublin Pharmacopoeia, 1850. 2 Dublin Journal, Sept. 1840, p. 106, 3 Dublin Medical Press, Jan. 18, 1840. HYDRARGYRI ET ARSENICI IODIDUM. 431 what less than a month, with a gradual amendment of the disease, which subsequently disappeared entirely. s Since those cases were published, Mr. Donovan has given nu- merous others from the practice of Dr. Charles O'Reilly, Sir Henry Marsh, Dr. Robert J. Hickson, Dr. J. D. White, Mr. Richard Jones, Dr. Bigger, Mr. O'Ferrall, Dr. Ferguson, Dr. Osbrey, Dr. W. T. Hamilton, Dr. Graves, Dr. Kirby, Mr. Gabriel Stokes, and Dr. C. P. Croker, which lead him to infer, that the diseases in which the preparation has been found of most service are the va- rious forms of psoriasis, impetigo, porrigo, lepra, venereal erup- tions — both papular and scaly, pityriasis, sycosis, ephelis, lupus, sibbens, and some uterine diseases. 1 In several of the cases, slight ptyalism was induced. Dr. Isaac E. Taylor, of New York, 2 prescribed this preparation in a number of cutaneous diseases; and he testifies, that it pro- duces a more marked and prompt effect than the various remedies usually resorted to in lupus, rupia, psoriasis, secondary syphilis, &c. It is also spoken of in high terms by Dr. Gerald Osbrey, 3 in inveterate psoriasis, lichen urticatus, and scrofulous ophthalmia. MODE OF ADMINISTRATION. The dose of the liquor arsenici et hydra rgyri iodidi is from fifteen minims to half a fluidram, two or three times a day. Mr, Donovan 4 recommends the following form: — Hanstns liqnoris arsenici et hydrargyri iodidi. Draught of solution of iodide of arsenic and mercury, R„ Liq. arsenic, et hydrarg. iodid. gij. Aquse destillat. f ^iiiss. Syrnp.zingib.f^ss. M. Divide in haustus iv. Dose. — A draught, night and morning. The division into draughts, Mr. Donovan considers necessary — first, to ensure accuracy of the dose; and next, to prevent injury to the ingredients by the use of a metallic spoon, as a measure; — the general way in which doses of medicine are administered. When applied externally in cutaneous affections, it may be diluted w T ith an equal portion of water, or farther — should a weaker lotion be indicated. Mr. Donovan states, that the employment of this preparation was rapidly extending, as shown by the fact, that within two years and a half, about three hundred pints of it had been sent out of his establishment alone, which, as he properly remarks, is a vast quantity of an article prescribed in minim doses. 5 1 Dublin Journal of Medical Science, Nov. 1842. p. 199, and Ericbsen, London Me- dical Gazette, May 12, 1843. p. 238, and May 19, 1843, p. 241. 2 American Journal of the Medical Sciences, April, 1843, p. 319. 3 Dublin Journal of Medical Science, July, 1842. « "Ibid. Nov. 1839, p. 282. •Ibid. Nov. 1842, p. 199. 432 INDIGUM. A DOUBLE IODIDE OF MERCURY AND MORPHIA, French, IodufE double de mercure et de morphine, has been recommended by M. Bouchardat. 1 It is obtained by treating in boiling alcohol, a mixture of equal parts of red iodide of mercury, and iodhydrate or hydriodate of morphia. On cooling, crystallized grains are deposited of a double compound, having a white, slightly yellow- ish colour. According to M. Bouchardat, it is almost as energetic as the red iodide of mercury, and ought to be employed with great caution. A quarter of a grain is a dose, which may be given once a day in the form of pill in constitutional syphilis; gra- dually increasing the dose, especially in syphilitic pains of the bones. CX. INDIGUM. Synonymes. Indicum, Indicus Color, Pigmentum Indicum, Indiga. French. Indigo. German. Indig. This well-known colouring material is obtained from several species of the genus Indigofera (J. tinctoria, 1. anil, I. disperma, 1. argentea, and I. hirsuta,) belonging to the Natural Family Leguminosse, and, in the Linneean System, to Diadelphia Decan- dria. As we receive it, it is in small, solid, brittle masses, of a deep azure colour, without smell or taste, and assuming a coppery lustre on being rubbed. It is entirely soluble in sulphuric acid, and is wholly consumed on burning coals. According to the analysis of Chevreul, 100 parts of Guatemala indigo of commerce contain only 45 parts of pure indigo, or indigo-blue — w T ith which no therapeutical experiments have as yet been made: the greater part of the residue consists of a green matter soluble in spirit of wine {indigo- green;) and a red resin (indigo-red ;) the rest is ex- tractive matter, gum, and some carbonate of lime, oxide of iron, and argillaceous and siliceous earth. With hydrogen, pure indigo forms isatic acid, which has considerable resemblance to the hydro- cyanic. EFFECTS ON THE ECONOMY. The natives of the countries where the different kinds of indigo grow, employ it occasionally as a therapeutical agent, especially in diarrhea and intermittent fever . It is only within the last twenty years that attention has been paid to it in Europe. Prof. Von Stahly, 2 of Ofen, appears to have first employed it with suc- cess in various spasmodic diseases, especially in epilepsy. To these cases Lenhossek alludes, in detailing certain trials which he himself had made with it. In 1833, Grossheim 3 made known a 1 Nouveau Formulaire Magistral, p. 303. Paris, 1845. a Hecker's Neue Annalen, B. i. H. 1. Berlin, 1835. • Medicinische Zeitung, JNo.51, 1833. INDIGUM. 433 case in which he found it extremely useful. A lady, twenty-eight years of age, had suffered for eleven years with violent hysterical convulsive attacks, for which she had employed almost every re- medial agent. They began with a feeling of heaviness over the whole body, with slight convulsive twitchings of the limbs, which extended to the trunk; and were followed by total, or almost total, loss of consciousness: this, after an uncertain period, terminated in a comatose state, from which she was gradually restored — but in a languid condition — to perfect consciousness. Under the use of indigo for half a year, with pediluvia — which had been previously employed without advantage — she completely recovered. These results gave occasion to the institution of experiments, touching the remedial properties of indigo, in the Charite at Berlin, the results of which have been given by Roth. 1 In most of the cases, it excited nausea, and even vomiting, preceded by a metallic taste on the tongue. At times, the vomiting was so violent and prolonged, that it was necessary to discontinue it; but generally on continuing its use, the vomiting ceased in three or four days, and diarrhoea took its place. All the patients did not vomit, and many escaped the diarrhoea. When once diarrhoea occurred, how- ever, it commonly persisted as long as the indigo was used. The evacuations were seldom entirely fluid, but usually semifluid, and of a dark bluish-black colour. While the vomiting and purging continued, more or less uneasiness was experienced in the digestive apparatus. The vomiting and diarrhoea were frequently accompa- nied by pains in the stomach and bowels, which were commonly slight, but occasionally so violent that it had to be discontinued. In every patient at the Charite, the urine was of a dark violet hue. Von Stahly affirmed that the perspiration w T as coloured blue, but this Roth never observed. He remarked, moreover, that after its use for several weeks, certain patients were easily thrown into slight convulsions, similar to those caused by the use of nitrate of strych- nia, and that they were affected w T ith slight subsultus tendinum. Almost all the patients, indeed, who took it, were at first more frequently attacked with spasms than prior to the use of the re- medy. In the beginning, the attacks of the. disease were, in all cases, stronger, but of less duration, than previous to its employ- ment. These changes continued for one, two, three, and even as long as eight weeks, whether the patients took small or large doses. At the expiration of this time, all the epileptic symptoms were diminished in intensity and duration, until the last attacks were mere premonitions. The number of epileptic cases, treated by it, which Roth had an opportunity of observing in the Charite, was twenty-six; of these, nine were cured, eleven improved, and six remained. ■ Hecker's Neue Annalen, B. i. Heft. 1. Berlin, 1835. 434 INDIGUM. Dr. Ideler, 1 who instituted the experiments at the Charite, has also given publicity to the results; and his testimony accords with that of Roth. It is proper to observe, however, that, of the nine cases cured, three experienced relapses in from eight to twelve months; but from causes, according to Riecke, 2 which of themselves might have induced epilepsy. Dr. Strahl, 3 of Berlin, likewise experimented with indigo, but his results were by no means favourable. In ten cases of old standing epilepsy, it was not of the slightest service, and the same may be said of two cases of St. Vitus's dance. In four cases of hysteria, it excited violent nephralgia, and in one of the cases, only after the affection of the kidney was removed, was the pa- tient cured. It acted, however, markedly on the uterus; in two cases of spasmodic affections, complicated with amenorrhcea, the latter derangement was removed, whilst the spasms still continued, even after the recurrence of the catamenia. In the Charite, of Berlin, the purest Guatemala indigo of commerce was used, and it has been a question, whether Strahl did not employ one of feebler powers. It is worthy of remark, that he observed a dark green colour of the urine during its use, whilst in the cases in the Charite, a dark violet hue was constantly noticed. Favourable cases are also detailed by Drs. Mankiewicz of Nackel, 4 and Hohnhorst, of Frankfort. 5 M. Podreca 6 found it especially efficacious when associated with asafoetida and castor. Dr. Noble, of Versailles, 7 administered it in three cases, in which the disease had continued for four, twelve and twenty years respectively. At the time of making known the results, a month had elapsed in the first case, and two months in the second, since an attack had been experienced, and the last case he con- sidered entirely cured. In the first patient, who was eighteen years old, four drams occasioned vertigo, slight depravation of vision, and convulsions similar to those produced by strychnia; and in both the other cases, diarrhoea was induced, which ceased, however, as soon as the indigo was discontinued, or the dose re- duced one-half. He gave it in the dose of one dram gradually increased to four drams daily. The observations of Rech, of Montpellier, were not as favour- able to it. In none of the epileptics to whom he gave it was there any thing more than a slight amelioration. In the Hospice d'Hommes Incurables du Faubourg St. Martin, trials were made 1 Medicinische Zeitung, No. vi. cited in Lancet, June 6. 1835. 2 Op. cit S. 276, and 2te Auflage, S. 389. Stuttgart, 1840. 3 Hecker's Neue Wissenschaft. Annalen. 1836; cited in Edinb. Med. and Surg. Jour. 1837. 4 Medicin. Zeitung, 31 Mai, 1837, S. 109. 5 Ibid. S. 110, and Medicin. Zeitung des Vereins fur Heilkunde in Preussen, 1837, No. -2-2. 6 Bouchardat, Annuaire de Therapeutique. pour 1843, p. 69. Paris, 1843. 1 Bulletin General de Therapeutique, 1836. INDIGUM. 435 with it by Di\ Blanche. Of ten cases, five were either cured or improved. One of these had existed for three years, and the paroxysms recurred every five or six days; but after the adminis- tration of the indigo, he had no return at the expiration of five months ; in a second case, a youth, fifteen years old — who had been epileptic from birth, and had regularly one or two paroxysms a day, from the 19th of July, when its exhibition was begun with, until the middle of August, when the results were published — had only two insignificant attacks. The improvement in the other three cases was not as marked, yet it was unquestionable. The other five children experienced no improvement, yet no incon- venience was sustained, although the indigo was given in doses of four, six, and eight drams in the day. It was administered in water or in a tisane ; and in one or two cases it excited vomiting, but after having been discontinued, it was borne subsequently. In all it induced tormina, and acted upon the bowels, but did not interfere with the appetite or any of the other functions. Dr. Benjamin F, Hardy, 1 one of the senior resident physicians at the Philadelphia Hospital, published the results of some trials made with it, w T hich, so far as they go, confirm its antiparoxysmal power. Two of the seven cases reported were apparently cured, two ameliorated, and three without any decisive results — the medicine not having been continued perhaps for a sufficient length of time. In these cases, it was commenced in the dose of 3>, which was usually doubled daily until the patient took ^ijj daily, which quantity was persevered in for some weeks. In some of the cases, the faeces, urine, and perspiration were all coloured blue. In other trials, instituted in the same charity, w T ith indigo, the results were not as favourable. 2 It is obvious, indeed, that a wide difference must exist amongst cases of epilepsy, and that where the organic modifications are considerable, as indicated by concomitant mania, or idiocy, little can be expected from any remedy ; but even in such hopeless cases, the number of paroxysms appear to have diminished under its use. Where the cerebral affection is slight, and more functional than organic, like artemisia and other remedies extolled in epilepsy, it may be useful. Its main efficacy, perhaps — as has been said of the Ferri Subcarbonas (p. 378,) — consists in the new impression which it makes, in adequate doses, upon the nerves of the stomach, and through them upon those of the whole system; but to effect the revulsion to the proper extent, it is necessary that the dose should be augmented day by day, and the remedy be continued in large doses for a sufficient length of time. Dr. Pereira, 3 states that he has tried it in a considerable num- * American Medical Intelligencer for July 15, 1839, p. 122. 3 William H. M'Kee, in American Med. Intelligencer, Sept. 16, 1839, p. 177. 3 Elements of Materia Medica, &c, 2d edit. p. 1620. Lond. 1842; or 2d Amer. edit, Philad. 1846. 436 INJECTIONS INTO THE EUSTACHIAN TUBE. ber of epileptic cases at the London Hospital, but without de- riving the least benefit from it. MODE OF ADMINISTRATION. As indigo is extremely light, the powder is too bulky for admi- nistration; it is taken with disgust, and is apt to excite vomiting. On this account the form of electuary was selected in the Charite. It was generally combined with pulvis aromaticus, or pulvis ipecacuanhse et opii. As to the dose, Roth advises that it should be commenced in grains, but be elevated to drams, — nay, even to one or more ounces in the day. In the Charite, the following formulae were generally employed : — Pulvis indigi. Powder of indigo. R. Indig. in pulv. subtilissim. ^ss. Pulv. aromat. gr. v. M. et fiat pulvis. A powder to be given four times a day. Pilulae indigi composita. Compound pills of indigo. (Antiepileptic Pills.) R. Indig. gr. lxxv. Asafcetid. gr. xv. Castor, gr. vij. M. et divide in pilulas xx. One to be given every hour. Podreca. Electuariuin indigi. Electuary of indigo. R. Indig. pulv. aquae guttis nonnullis subact. gij. — ^ss. Pulv. aromat. ^ss. Syr. simpl. f £j. M. et fiat electuarium. To be used in the course of the day. Ideler. CXI. INJECTIONS OF AIR, VAPOUR OF ETHER, ETC., INTO THE EUSTACHIAN TUBE. An important improvement in the understanding and treatment of diseases of the ear has resulted from the attention that has been paid to the pathological condition of the Eustachian tube, and the means, through it, of rectifying certain morbid states of the organ of hearing. A mystery has been thrown, or attempted to be thrown, over the diseases of the ear, and, as a consequence, they have furnished largely to empiricism; so that an exclusive aurist has been, too often, perhaps, esteemed synonymous with an exclusive empiric. Now that the physiology of the outer and middle ear is better understood, their pathological relations are no INJECTIONS INTO THE EUSTACHIAN TUBE. 437 longer environed with the same difficulties. The attention of the surgeon has to be first directed to the meatus externus, and if he discovers any obstacle, — as hardened cerumen, — which prevents the vibrations of a sonorous body from reaching the membrana tympani, such obstacle must be removed. Should no defect exist there, he inquires into the state of the Eustachian tube, to detect whether it be pervious, so as to permit a free passage for the air from the throat to the middle ear — any impediment to which is a common cause of deafness ; and, lastly, if the tube be found in a state of integrity, his attention is turned to the condition of the nerve, to discover whether the defect — organic or functional — be seated there. Such are the main subjects of investigation in cases of deafness; although the condition of the membrana tympani, of the ossicles, and the mastoid cells, become interesting incidental objects of inquiry. Chronic inflammation of the Eustachian tube occasionally gives rise to stricture or narrowness of the tube; at others, to obstruction of the tube by means of mucus, or to ac- cumulation of mucus in the tympanic cavities. In the former case, catheterism is demanded ; in the latter, injections of air, in addition. For the purpose of catheterism, various instruments have been employed. The catheter of Itard is a conical silver tube, curved at the extremity, with a slight enlargement to prevent laceration of the membrane. Kramer's instrument is a modification of that of Itard; the curve is more gradual, and the enlarged or button point is omitted. It is made of silver, six inches long, and is of a calibre varying from the size of a small crow-quill to that of a large goose-quill. The extremity is well rounded, and it is curved only to the distance of five lines from the point, exactly at an angle of 144°, so as to correspond to the lateral situation of the OOddd Catheter of Itard, (Reduced one-half.) mouth of the Eustachian tube. It is nearly of the same calibre throughout its whole length, and provided with a funnel-shaped dilatation at the outer extremity, half an inch in length, to admit the pipe of the injecting syringe, &c. To this part is added a ring, on the same level with the beak of the catheter, by means of which the situation of the beak can be ascertained, when the instrument is introduced. The catheter is farther graduated in inches, which is convenient in repeated introductions. 1 When it 1 Kramer, on Diseases of the Ear, chap. 2, Amer. Med. Library edit. Philad. 1838. 438 INJECTIONS INTO THE EUSTACHIAN TUBE. is requisite to sound the Eustachian tube, a piece of catgut may be passed through the instrument. The catheter recommended by Mr. Pilcher 1 admits of being passed farther into the tube, and has a more gradual curve. De- leau 2 employs a flexible elastic gum catheter, which the patient learns readily to pass into the Eustachian tube, and by turning down the outer extremity, is able to inflate the tube with his own breath. This the author has seen repeatedly done. The silver instrument, slightly warmed and oiled, is introduced, with its con- vexity upwards, along the floor of the nostrils until the point reaches the pharynx ; it is then gently turned, so that the point shall be outwards and a little upwards, the aperture of the Eusta- chian tube being above the level of the floor of the nose: in this way the tube enters, and is readily felt by the operator to have done so. The instrument is then carried onwards, until its farther progress is prevented by the narrowness of the tube. Mr. Pilcher's instrument is of such dimensions as to frequently occupy three- quarters of an inch of the tube ; but if it be pushed beyond the fibro-cartilaginous portion — or that part of the tube which readily admits it — the mucous membrane may be lacerated, and pain will certainly be produced. 3 When Mr. Pilcher's catheter is fairly introduced, it will remain without support, an advantage it pos- sesses—in the opinion of its proposer — over those of Itard and Kramer, which requires a frontal bandage to retain them in situ. Itard's bandage is represented in the next figure. It consists of Frontal Bandage of Itard. a middle piece made of metal, bent so as to fit the arch of the fore- head, and slightly padded within; to this are attached two straps, which fasten with a buckle. To the centre of the middle piece, a pair of forceps are attached, which move in a ball and socket joint, and the blades of which are brought together by a screw. The bandage is applied before the catheterism is commenced; and when the instrument is introduced, the forceps are brought down, and screwed tight on the catheter, so as to retain it in posi- tion. Through the catheter, thus introduced, aurists were in the habit of sending lukewarm water through the Eustachian tube into the cavity of the tympanum; 4 but owing to certain objections 1 A Treatise on the Structure, Economy and Diseases of the Ear, p. 304. London, 1838. a Op. cit. p. 305. 3 Op. cit. p. 305. 4 See some cases of deafness relieved in this way, by John H. Dix, in Boston Medical and Surgical Journal, Sept. 25, 1839, p. 105. INJECTIONS INTO THE EUSTACHIAN TUBE. 439 that apply to the employment of fluids, Deleau 1 suggested the air- douche, or injections of air for the purpose of clearing the cavity; and this is regarded by Kramer 2 as a great improvement. With the view of increasing and regulating the force with which the air is sent into the cavity, both these gentlemen invented air-presses or condensers. The marginal figure represents that of Kramer. c b is a cylinder, 10| inches high, made of molten brass; the diameter of its calibre is 4-| inches, and it is fastened at b with strong screws, on a strong oaken stand of the height of an ordinary stool. Within the cy- linder c b is a pump barrel of wrought brass screwed into it, which measures 10i inches in height, and 2J inches in diame- ter, rising, at d a, 3 inches out of the cylinder, so that the whole machine a & is about 13 inches high. In the piston of the pump barrel, there is a valve for the passage of the air, which besides passes in at the opening situate at d. There is a second valve in the bottom of the pump barrel, through which the air is forced into the interior of the cylinder. Air-press of Kramer. When air is injected into the tympanum, it may be heard to strike against the membrane, and to rush through the cavity into the mastoid cells, and thus may become a means of exploring the condition of the middle ear. Mr. Pilcher 3 observes, that — from his daily experience of the great facility with which air and fluids may be introduced into the tympanum, and regulated, both as to quantity and force, by means of a common syringe accurately fitted to the catheter — he does not hesitate to declare his conviction, that the ceremony and inconvenience of the air-press may be dispensed with. He re- commends that the operator should merely steady the instrument with his left hand, whilst he uses the syringe with his right. By this means, any fluid or gas injected through the catheter may be brought into contact with the mucous membrane, and thus stimu- late the nerves of the cavity. Nor is the air-press entirely devoid of danger. Inflammation and even suppuration is sometimes caused by the air douche. This occurred, in seven cases, to M. 1 Sur le Catheterisme de la trompe d'Eustache, &c. Paris, 1828; Ttard, in Mem. de l'Academ. Royale de Medecine, Tom. v. Fasc. 4. Paris, 1836; and translation in Medical and Surgical Monographs, vol. i. p. 75, of Amer. Med. Library, p.8(i. Philad. 1838. a Op. citat. p. 164. 3 Op. cit. p. 307. 440 INJECTIONS INTO THE EUSTACHIAN TUBE. Itard; and Mr. Henry Savage 1 refers to five cases, which came under his cognizance, where perfect deliquium was caused, which continued for several hours. A case, too, has been detailed, in which, after " pumping air" four times through the nostrils into the Eustachian tube, immediately on removing the instrument from the nostril, the patient fell back in the chair and never spoke afterwards. 3 The sudden shock to the nervous system was pro- bably the cause of death; and it has been suggested that, to avoid too great a degree of pressure, the nozzle of the tube of the air- press should be held, during the operation, so loosely in the di- lated end of the catheter, that there may be room for air to regur- gitate, 3 and, likewise, that instead of sending in the air by douches or charges — it should be transmitted in a gentle and continued stream. Another circumstance, which shows the importance of care, is the fact, that the mucous membrane may be ruptured, and serious emphysematous tumefaction be occasioned. It is proper to observe, that the results of 258 cases, treated by Itard, 4 are far from encouraging. Of these, but two of cure are said to have been effected, and in this result, according to Itard, other causes concurred ; whence he infers, — first, that as a means of exploring obstructions of the tympanum by the crepitation which often accompanies them, douches of air can afford no cer- tain index ; and secondly, that as a mechanical agent for deterging or evacuating obstructing matters, they can only dislodge and force them together; and, consequently, that both in the second and first point of view, douches of air do not deserve the confidence of the profession. The vapour of acetic ether has been injected into the mid- dle ear in cases of nervous deafness, of which Kramer 5 makes two varieties ; noise in the ear constituting the essential point of dif- ference between them. This noise belongs, without exception, to the erethitic form ; whilst it is foreign to the torpid. In cases of nervous deafness, Itard proposes to introduce ethereous vapour through the catheter, and to generate this vapour in an apparatus in which the ether is dropped on a saucer of red hot iron, by the heat of which it is vaporized. The ether is, however, decom- posed in this manner, so that it is not ethereous vapour which enters the tympanum, but an acrid, very irritating kind of gas, which, according to Kramer, is well suited to the torpid form of nervous deafness, but is positively injurious in the erethitic varie- ty. He considers the attempt to vaporize acetic ether in a flask, 1 Lond. Med. Gaz. for July 20, 1839, p. 616. M. Lynch, in Lancet, Aug. 3, 1839, p. 683, and ibid. p. 690; and Joseph Williams, Treatise on the Ear; including its Anatomy, Physiology and Pathology. &c. p. 242. Lond. 1840. a Lond. Med. Gazette, July 6, 1839, p. 538. 3 British and Foreign Medical Review, July, 1839, p. 95. 4 Op. citat * See. on this subject, T. Wharton Jones, in Lond. Med, Gaz., Aug. 3, 10, 17, and 24: 1839. INJECTIONS INTO THE EUSTACHIAN TUBE- 441 placed in warm water, and connected by means of a tube with the cavity of the tympanum, to belong to the same class of methods which act in too irritating and injurious a manner, owing to the vapour being given off far too rapidly. This incon- venience he proposes to remedy in the erethitic form of nervous deaf- ness, in the following way : — A large glass flask — represented in the accompanying figure — holding about ten quarts, is firmly and closely stopped with a cork through which are passed two brass tubes, each provided with a cock; one of these tubes is connected above with a funnel for dropping in the fluid, and the other with an air- tight tube to conduct the vapour, generated and enclosed within the flask, into the cavity of the tym- panum. When the apparatus is to be used, the cork is to be firmly fixed into the neck of the flask,with two tubes attached, and the cocks closed; the proper quantity of ether is then to be poured into the funnel, and forced into the flask by a gentle expiration, where it is converted into thin vapour at the ordinary temperature of the room. This vapour fills the interior of the flask equably, and is, indeed, in a state of slight condensation, so that when the metallic tip of the tube is connected with the catheter, and the cock is opened, the vapour issues with a whizzing sound. Having previously introduced the catheter through the nose into the mouth of the Eustachian tube, and placed it in connexion with the tube of 1he vapour apparatus, the patient is to sit near a table, leaning his arm upon it, and with the corresponding hand he is to hold the tube of the apparatus, in such manner that it may remain in close connexion with the catheter. Each sitting occupies a quarter of an hour, and is repeated daily, applying the vapour alternately to the right and to the left ear. It is unne- cessary to make use of warm water to pour into the flask, as the ordinary temperature of the room is sufficient to vaporize the ether. In the torpid form of nervous deafness, this method of pro- cedure does not answer, owing to the necessity for greater excita- tion than it is capable of effecting. In such a case, a modification of the apparatus of Itard has been proposed by Kramer. Owing to the metallic saucer in Itard's becoming cool more than once during a single sitting, and requiring to be exchanged for a hot Vapour Apparatus of Itard. 442 INJECTIONS INTO THE EUSTACHIAN TUBE. one, as a necessary consequence the temperature of the vapour generated never remains for a moment the same, but varies ex- tremely; immediately after the insertion of the red-hot saucer, Vapour Apparatus of Kramer. the vapour issues burning hot into the ear, and in a few minutes sinks to a very low temperature. These evils Kramer proposes to rectify in the following manner. — For the floor on which the bell-glass of the apparatus rests, a thin metal plate is substituted, which is warmed at pleasure by an oil lamp placed beneath, so that the ethereous fluid falling on it is thus conducted through the catheter into the middle ear. Through the cover of the appa- ratus, a thermometer, with a metallic scale, passes down almost to the bottom, and indicates the temperature at which the ethere- ous vapour passes into the ear. After a sitting or two — if the individual is to be benefited by the plan in either form of deaf- ness — an improvement ought to be perceptible. This course of treatment, aided, occasionally, by attention to the state of the system, has, in Kramer's hands, been attended with satisfactory results, and has been adopted with advantage by others, with a more or less modified apparatus. 1 In a more re- cent work, however, 2 he states, that his mode of treating nervous deafness is essentially the same as that previously described by him — the introduction of stimulating vapours into the cavity of the tympanum; but, instead of the vapour of acetic ether, which he formerly recommended, but which, of late years, he had found too stimulating, and therefore not so well borne, he now advises 1 Pitcher, op. cit. p. 318. See some observations on this subject, with two. by no means satisfactory, cases, by T. Wharton Jones, in Lond. Med. Gaz. for Aug. 31, and Sept. 7, 1839. 5 Beitr'age zur Ohrenheilkunde, Berlin, 1845; cited in Brit, and For. Med. Review, July, 1847, p. 39. INDIGUM, 443 the vapour of Aqua assafetida simplex, of musk, of Aqua amygdal. amar. sine spirit u parata, and the like ; and, as else- where remarked, after all the revival that had taken place in re- gard to aural medicine and surgery, chiefly through the writings of Deleau, Itard, Kramer and others, it would seem that but little permanent benefit has resulted from the new methods of treatment; unless where there has been partial obstruction of the Eustachian tube ; and then perhaps the most valuable agent is the elastic gum catheter of M. Deleau, which the patient can be readily taught to pass into the tube through the nose, and if the outer extremity be bent down and inserted into the mouth, the middle ear can be inflated by the patient's breath. Temporary improvement in hearing follows the insufflation, and as a palliative method, where nervous deafness exists, it may be serviceable. " Every honest surgeon must, however, express his disappointment in the methods that were so strongly urged some years ago ; and admit that the benefit derived from them in nervous deafness has been exceedingly limited ; yet the mercenary and unprincipled have reaped a rich harvest, from the noise w 7 hich they created, by acting upon the credulity of the public." 1 A case of the successful application of the acetic ether in erethi- tic deafness was published by Dr. Bolton, of Richmond, Vir- ginia. 2 The hearing distance was amazingly improved by it, and the success far exceeded the operator's most sanguine expecta- tions. The vapour certainly proves at times, too irritating, or occasions results by no means to be desired. The author was applied to in one case in consequence of inflammation having supervened in the raucous membrane, which subsequently ex- tended, in the erysipelatous form, over the cutaneous surface. It yielded to appropriate treatment. On the whole, then, the treatment of deafness by injection is by no means so effective as was at one time supposed. CXII. lO'DINUM. Synonymes. lodinium, lodium, Iodum, Iodina ? Iodine, French. lode. German. I o d . Iodine was accidentally discovered, in the year 1812, by Courtois, a manufacturer of saltpetre at Paris, but it was chiefly through the labours of Gay-Lussac and Sir Humphrey Davy, 3 that the chemi- cal relations of this elementary body w T ere appreciated. The dis- coverer first detected it in the mother waters of soda obtained from 1 The author's Practice of Medicine, 3d edit, ii. 345. Philad. 1848, ' American Medical Intelligencer, April 1, 1839, p. 1. 8 Annales de Chimie, lxxxviii. xc. and torn. xci.,and Philos. Transact. 1814 and 1815. 444 IODINUM. sea-weed, {kelp;) and as it was found to exist chiefly in several of the sea-weeds, and especially in the sponges, it struck Coindet, 1 that experiments might be made with it in goitre : from these he obtained such striking results, that its reputation soon spread abroad, and it was employed in various other diseases,— often with the most marked advantage. By experience, too, the injurious effects which it is considered by many capable of inducing were appreci- ated, so that it could be administered more satisfactorily than at an earlier period. By the continued investigations of the chemist, iodine was found to be more largely distributed than was at first imagined. It was discovered in many of the marine mollusca, in sea-water, and in several mineral waters. METHOD OF PREPARING. Iodine is obtained from the mother waters of the soda derived from sea-plants, in which it exists — it is believed — in the form of iodide of sodium. The waters are procured by burning different kinds of weeds which grow on the sea-shore, lixiviating the ashes, and concentrating the liquor. To obtain iodine from this liquor, an excess of concentrated sulphuric acid is added to it, and the whole is boiled gently in a glass retort furnished with a receiver. The sulphuric acid lays hold of the base of the hydriodic salt, and of the hydrogen of the hydriodic acid; w T hence result sulphate of soda, water, sulphurous acid and iodine; the last passing over into the receiver in violet fumes with a little acid, and there becoming condensed. To purify the iodine, it may be washed with water containing a little potassa, and be redistilled. 2 It is manufactured in large quantity, in Scotland, from the kelp of the Hebrides and Orkney Islands. 3 According to Dr. Traill, the greatest quantity is produced by kelp made from driftweed, which is in a great measure composed of Laminaria digitata, and Himanthalia lorea; — cutweed, which consists of F. vesiculosus and F. serratus, yield- ing much less of it. One hundred tons of Caithness kelp afford, according to the experience of one manufacturer, one thousand pounds of iodine, or about a 224th pa"rt. 4 It is always prepared on the large scale, and hence is placed in the Materia Medica list of the Pharmacopoeia of the United States. Iodine is solid at the ordinary temperature; of a foliated appear- ance, and metallic lustre; of a grayish or bluish-black colour simi- lar to that of plumbago; and friable. It is soluble in 7000 parts of water, and the solution has an orange-yellow colour. Its specific gravity is 4.946 at 62° of Fahrenheit. Its smell is similar to that 1 Bibliotheque Universclle, Juillet, 1820, p. 190. * For the method employed by iSoubeiran, see Journal de Pharmacie, Janvier, 1837; and for that by Barruel, see Bussy, ibid. 8 Christison, Dispensatory, Arner. edit. p. 591. Philad. 1848. ' Christison, loc. cit. IODINUM. 445 of chlorine, with which it accords in its property of destroying vegetable colours. It possesses, in a high degree, electro-negative properties. It colours the skin yellow, which colour gradually disappears. It fuses at 220° Fahrenheit. The vapour is of a beautiful violet colour, whence its name (<»^>s, * blue.') It is soluble in ether and in alcohol ; forms an acid both with oxygen and hydrogen, and enters into numerous chemical combinations. 1 In consequence of its high price, iodine is very liable to adul- teration; and it is said, that coal, black lead, oxide of manganese, and charcoal have been added to it; but neither Dr. Christison 2 nor Dr. Pereira 3 has met with any of these impurities, which would remain behind when heat was applied, and admit, therefore, of easy detection. Water is the chief adulterant, and its unusual presence may be suspected if the iodine adheres to the sides of the bottle in which it is kept. Dr. Christison states, that until within the eighteen months before he wrote, he had not met with any British iodine that did not contain between 15 and 20 per cent. of water. EFFECTS ON THE ECONOMY IN HEALTH. Soon after the discovery of iodine, and the accurate investiga- tions of Gay-Lussac, Magendie 4 instituted a series of experiments in order to appreciate its action on the animal organism. It was injected into the veins without any apparent effect. Several dogs were made to swallow it ; they vomited, but it exerted no farther influence. He himself swallowed a coffee-spoon ful of the tincture, and perceived no other result than a disagreeable taste, which continued for several hours, but gradually disappeared. In larger doses, however, the effects were markedly injurious. Orfila, 5 likewise instituted several experiments on dogs, from which he concludes: — that, introduced into the stomach in moderate quan- tity, it acts as a gentle stimulant, but may excite vomiting: — that in the dose of a dram, it almost always killed the animal in four or five days, when the oesophagus had been tied to prevent vomit- ing, and that in the part of the mucous membrane with which it came in contact, ulcers were gradually formed; — that when ad- ministered in the dose of from two to three drams, the oesophagus not being tied, it excited vomiting for several hours, even when a part of the poison had been evacuated by the bowels; — that it seldom caused death when given in the dose of one or two drams, the animal rejecting it by repeated vomiting; that it does not de- stroy life when applied externally, and that it must be classed 1 See, on Iodine and its Combinations, Duhamel, in Philad. Journal of Pharmacy, vi. 101. Philad. 1823-4. "- Dispensatory, p. 553. Edinb. 1842. 3 Elements of Mat. Med. and Therap. i. 235. Lond. 1842; or 2d Amer. edit., by Carson. Philad. 1846. 4 Formulaire pour la preparation, &c, de plusieurs nouveaux Medicamens. 5 Toxicologic, i. 556. 29 446 IODINUM. amongst the irritant poisons. Dr. Cogswell, 1 — in repeating one of Orfila's experiments, in which seventy-two grains of iodine were introduced into a wound on the back of a dog without much effect on the health of the animal, — did not attain exactly the same results. He introduced a scruple of iodine into the areolar tissue of the thigh of an adult rabbit, through a small opening made in the skin. The animal manifested no symptom of pain, and was able to make use of the limb as freely as before the ope- ration, but, in the course of a fortnight, it gradually lost flesh,, exhibiting an emaciated look, and the hair dropped off from many parts of the head. At the end of this time, thick, adhesive pus was found distending the cavity of the wound, from which the iodine had entirely disappeared. Dr. Cogswell properly suggests, however, the possibility, that the irritation of a large abscess might have been the sole origin of the animal's unhealthy appear- ance. To discover the effects which it induces on man, Orfila took two grains fasting. An extremely disagreeable taste, with some nausea, was the only consequence. On the next day, early, he took four grains, when he immediately experienced a sense of constriction and heat in the throat, which continued for a quarter of an hour, and soon afterwards he vomited a liquid yellowish matter, in which iodine was easily perceptible. Except a slight degree of oppression felt during the day, he observed no change in any of the functions. On the second day thereafter, he took six grains fasting, after which he soon experienced a sense of heat, constriction of the throat, nausea, eructation, increased flow of saliva, and pain at the pit of the stomach: ten minutes after- wards he was attacked with copious bilious vomiting, and slight colic pains, which continued for an hour, and were removed by two emollient glysters. The pulse, which, prior to the experi- ments, beat sixty times in the minute, became more frequent, beating from eighty three to ninety, and was much stronger. The breathing was tolerably free; but from time to time, there appeared to be a great obstacle to the dilatation of the chest on inspiration. The urine was higher coloured. All the symptoms were removed by the copious use of gum water as drink, and of emollient glysters. Dr. Gully, on the other hand, says, that he has given as much as three drams of the tincture daily, and did not observe any effect. Dr. Kennedy, 2 of Glasgow, exhibited, within eighty days, nine hundred and fifty-three grains of iodine in the form of tincture, the doses having been so proportioned^ that, towards the last, the patient — a girl — did not seem to be in any way particularly af- 1 Experimental Essay on Iodine and its Compounds, page 21. Edinb. 1837. 3 Lond. Med. Repository for 1822. IODINUM. 447 fected; and Dr. Buchanan 1 gave half an ounce of iodide of po- tassium within twelve hours, without any unpleasant result, dilu- ents being largely taken at the same time. See Potassii Iodidum It has been conceived that, when iodine proves mischievous, it is owing to its being in a free state, and that it then operates as a corrosive poison. The tincture and the ioduretted iodides are esteemed objectionable on this account. 2 It does not appear, that the vapours of iodine exert any injurious effect on the workmen concerned in its preparation. 3 From experiments, instituted by Jorg 4 on himself and on other healthy individuals, it seemed to him, that iodine, first of all, acts as a stimulant on the intestinal canal; soon afterwards it excites, also, the different glands in the cavity of the mouth and stomach, the pancreas, the liver, and the urinary and genital organs. An afflux of blood to the respiratory organs likewise ensues, which extends even as far as the Schneiderian membrane. There is no doubt whatever, that it enters into the blood, and, in this way, doubtless produces its modifications on the system of nutrition. Two drams of iodide of starch, according to Dr. Bu- chanan, 5 were given to a young man labouring under gonorrhoea, and, as soon as the medicine made its appearance in the urine, blood was drawn from the arm. On examining it, both the serum and the crassamentura were found deeply impregnated with iodine. The same dose was given to a boy affected with dropsy of the knee-joint. About five hours after the dose had been taken, a very small puncture was made in the joint, and upwards of twelve ounces of synovia were drawn off by a cupping-glass. The syno- via contained iodine in abundance. To an old man, who had a very large hydrocele, two drams of iodide of potassium were given over night, and the same quantity the following morning; on tap- ping him some hours after he had taken the last dose, more than thirty ounces of serum were drawn off, containing a large quantity of iodine. 6 Dr. Gairdner 7 observed the action of iodine on the human body when administered in particular doses, and pointed out the disad- vantages attendant upon its improvident use. The most striking inconveniences were induced in the digestive organs: it excited diarrhoea, and, at times, obstinate constipation; gastrodynia and violent vomiting, especially when food was received into the stomach. The emaciation occasioned by it is, according to so*ne, 1 Lond. Med. Gazette, July, 1836. See, also, Fuster,in Bullet. General de Therap. Fev. 1837, and Sept. 1837. a Brande's Dictionary of the Materia Medica, p. 323. Lond. 1839. 3 A. Chevallier, Annales d'Hygiene Puhliq. &c., Avril, 1H42. * Materialen zu einer kiinft. Ht ilmittellehre, u. s. w. i. 473. 1824. 8 Op. cit. 6 Brande, op. eitat. p. 321. Lond. 1839. See, also, Cantu, in Journal de Cbimie Medicale, ii. 291 and 394; and Bennerscheidt r ibid. iv. 383. 1 Essay on the Effects of Iodine, &c. Lond. 1824. 448 IODINUM. a striking phenomenon, and may attain an incredible extent ; yet it is proper to remark, that Lugol 1 in his frequent employment of it in scrofula, never observed this result : he affirms, indeed, that emaciated patients became stronger under its use ; that the stout did not grow leaner, and that they who held the medium position in these respects acquired strength under its employment, — results which have been confirmed by others, 2 and which would, there- fore, seem to show that this, as well as some of the other unplea- sant effects ascribed to iodine, may have been owing to an in- cautious use of the article. In addition to the above phenomena, Dr. Gairdner noticed anxi- ety, depression of spirits, and other symptoms similar to those of hypochondriasis; obscurity of vision; hardness of hearing; palpi- tations; and tremors of the limbs, particularly of the hands, which last symptom indicated the full effect of iodine on the constitution He found, however, that the remedy was extremely variable in its effects; and that it might frequently be given in large doses ? for a long time, without disadvantage; whilst, at other times, the unpleasant symptoms supervened rapidly, indicating that much must depend upon the peculiar impressibility of the individual, Coindet, 3 who, as already remarked, first used iodine as a thera- peutical agent, speaks of many of the above-mentioned phenomena as resulting from it's administration: these he considers evidences of the saturation of the organism, as the effect on the mouth is an index of the same thing in the case of mercury. It appears, how- ever, to be never necessary, in the administration of iodine, to induce saturation of the organism, in order that the full sanative influence of the remedy shall be elicited. On the contrary, it seems to be advisable to avoid such saturation : and, accordingly, whenever there are the slightest indications of it, the dose should be diminished, or it should be discontinued for a time; after which — according to the results of numerous cases — its curative agency, when it is resumed, is exerted afresh, and more decidedly. Several physicians, indeed, advise that frequent intermissions should be made in the use of the agent, in order that its action may be more certain. According to the observations of Coindet and Formey, 4 iodine, administered internally, occasions increase of appetite ; but no in- fluence is perceptible on the condition of the bowels and urinary organs, or on the perspiratory apparatus. On the other hand, when breathed for a few instants, the vapours of iodine caused twice in M. Chevallier 5 violent colic, which readily yielded to 1 Memoire sur l'emploi de l'iode dans les Maladies Scrofuleuses. Paris, 1829; and Observations on the Effects of Iodine, p. 17, Johnson's translation. Lond. 1824. a B. Phillips, Lond. Med. Gazette, January 10, 1840; and Scrofula, its Nature, Causes. &c, Amer. edit. Philad. 1846. * Bihliotheque Universelle, Mars, Avril, Mai, et Septembre, 1821. ' ' See, also, Ricord. op. cit. * Journ. Gener. de Med. ciii. 336, IODINUM. 449 gum water and laudanum. Raspail, however, under analogous circumstances, experienced no other inconvenience than a disagreea- ble taste in the back part of the mouth. According to Lugol, the vapour, disengaged from tincture of iodine poured into the water of a bath, is liable to induce a state of "iodic intoxication" and even of cerebral congestion. He affirms, that it exerted a pow- erful diuretic influence on all his patients, the urinary secretion being so much augmented, that many of them, contrary to their usual habit, were compelled to rise from bed several times in the night to discharge their urine. In upwards of a third, it had a cathartic effect, producing six or seven evacuations in the day, and occasionally tormina. In several, ptyalism ensued. Others, and especially females, complained of gastrodynia, which was always removed by the wine of cinchona, of which two or three ounces were taken shortly after the iodine. Iodide of potassium would seem to act more powerfully on the kidneys. A patient of M. Ricord, 1 at the Hopital des Veneriens, Paris, whilst under its in- fluence, passed daily from forty to fifty litres or quarts of urine, drinking, however, in an equivalent ratio. This enormous secre- tion always ceased whenever the use of the iodide was suspended. In its character the fluid differed little from ordinary urine, except in containing evident traces of the salt. Dr. Manson, 2 who used the tincture of iodine, found it occa- sionally produce sickness of the stomach, and M. Delisser affirms, that, in two months, he gave one thousand and nineteen grains of the iodide to a female affected with cancer of the mamma, — the doses, at certain periods, amounting to thirty grains in the twenty- four hours. The consequences were anorexia, quick pulse, ulcera- tion of the mouth, and fostor of the breath — of a different kind, however, from that which arises from mercury. M. Ricord 3 affirms, that of all the tissues of the body, the skin is decidedly the most susceptible of the action of iodine, and that there is scarcely a variety of cutaneous disease, which, in different idiosyncrasies, may not be excited by iodide of potassium, although they may mostly be made to disappear under the discontinuance of the medicine. The author has not often observed such results from it. It would appear that the effects of the remedy vary according to the form in which it is administered, and it is proper to observe, in viewing the different results obtained by Lugol and Coindet, that the latter commonly gave the tincture, whilst the former pre- scribed the solution in water, with a little chloride of sodium. Lugol observes, that the appetite of his patients was very much increased by it. Eager, who likewise administered the watery solution, rarely observed diarrhoea and emaciation; in general, in- 1 Bulletin de The rap. Sept. 1 842 : cited at length in Provincial Med. Journ. March 18, 1843. 2 Medical Researches on the Effects of Iodine. Lond. 1825. 3 Op. cit. 450 IODINUM. deed, the appetite and nutrition improved under it. At times, ulceration took place in the mouth, whereby the breath assumed a mercurial foetor; and salivation has been observed from it, ac- cording to Manson, 1 Winslow, 2 Ely, 3 Mackall, 4 Sir F. W. Smith, 5 and others; but Riecke 6 suggests, that this, perhaps, only occurred in those who, along with the use of iodine internally, had employed iodide of mercury externally. Ricord, however, 7 affirms that salivation is a common effect; and that, at times, the quantity of saliva secreted is equal to that in the highest degree of mercurial ptyalism ; but it would appear to be of a different character. He says it resembles greatly the ptyalism of pregnant women. The saliva is not viscous, and it seems not only to emanate directly from the mouth, but to be regurgitated. The mucous membrane of the mouth may be a little oedematous and irritable; but no in- flammation or ulceration is perceptible as in mercurial ptyalism; neither, according to hirn, is the breath tainted, nor are the salivary glands the seat of an) r tumefaction. On the genital organs, Eager found iodine act as an excitant; it augmented the activity of the uterus, and rendered the catamenia more abundant; it is asserted, too, to have increased the sexual appetite, but this is questionable: during its use, indeed, the testes in men, and the mamma? in women, have been observed to disap- pear: 8 but this, as will be seen hereafter, is certainly not a common occurrence. 9 It has been imagined, also, to cause sterility. Two cases are detailed by Dr. Robert H. Rivers, 10 in which barrenness succeeded its administration. Magendie, on giving it as an em- menagogue to a young lady of unsuspected virtue, brought on abortion. 11 Krimer several times observed, even when the tincture was given in small doses, considerable metrorrhagia, epistaxis, haemoptysis, obstinate diarrhoea, leucorrhcea, &c, supervene under its use. Dr. J. B. Biddle 12 exhibited five grains of the iodide of potassium, four times a day, to a female patient, aged 35. After thirty-five grains had been taken, he was suddenly called, and found her suffering from intense cephalalgia, considerable nervous disturbance, nausea, and remarkable tumefaction of the whole face. Jahn 13 found, in the bodies of two persons who had long made use 1 Op. citat p. 61. 2 Lond. Med. Gaz. for 1836, p. 401. 3 Ibid. p. 480. * Medico-Chirurg. Rev. Jan. 1836. * Dublin Journal of Med. Science, July, 1840, and Jan. 1841. 6 Die neuern A rzneimittel, u. s. w. S. 282. ' Op. cit. s Christison, Treatise on Poisons, p. 180; Cogswell on Iodine, p. 47. Edinb. 1837. 9 Pereira, in Lond. Med. Gaz. vol. xvii.; or Diet, de Mat. Med. par Merat and De Lens, art. lode. w American Journal of the Medical Sciences, Aug. 1831, p. 540. u Formulary, Gully's edit. p. 105. 12 Philad. Med. Examiner, Jan. 29, 1842, p. 65. See, also, R. Coates, Ibid.; J. C. L. Carson, New York Med. Gaz. Dec. 1, 1841, p. 333, and the Report of a Conversation on the Occasional Injurious Effects of Iodine, at the London University College Med. Society, in Med. Examiner, Jan. 15, 1842, p. 48. 13 Archiv. fur Medicin. Erfahrung, i. 342, 1829; and Journal Complement, du Diet des Sciences Medicales, xxxv. 36 4 2. IODINUM. 451 of it, wasting of the fat; softness and laxity of all the organs and tissues; diminution and disappearance of the glands, and glan- diform bodies, — the mesenteric glands, suprarenal capsules, &c. — and the areolar tissue appeared to exist in smaller quantity. In the case of a female, who died from the excessive use of the tinc- ture, Zinck 1 found the bowels inflated with gas; in some parts, highly inflamed; in others, exhibiting an approach to sphacelation, both within and without: the inner membrane of the stomach dis- played redness, growing deeper from the cardiac towards the py- loric orifice, where the organ looked as if it had undergone corro- sion ; the liver was large and reddened ; and there was ecchymosis of the spleen. Dr. Christison 2 is of opinion, that iodine is capa- ble of inflaming the latter organ. Professor J. K. Mitchell 3 affirms, that he has not unfrequently witnessed very distressing effects not only from an extravagant quantity, but from the too prolonged use of even moderate por- tions of iodine. As regards iodide of potassium — he properly re- marks—large doses have been given so often and so long as to show, that while there is hazard and injury, the danger has been greatly overrated. The author has administered iodine very freely, but he has sel- dom seen unpleasant phenomena ensue, which he was disposed to refer to it; w r ith the exception of such as so nauseous an article was likely to cause in the stomach; yet, from the testimony of many observers it can scarcely be doubted that iodine disease, iodosis, iodinia or iodism, as it has been termed, may become dangerous to life: generally, it is not really so much so as it ap- pears — and is considered — to be, and the evil consequences may be readily avoided by proper foresight. Cases, however, are related in which its use seemed to have been followed by fatal results ; 4 hence the necessity of circumspection in the employment of so energetic a therapeutical agent. The author has never witnessed the vascular injection and tumefaction of the conjunctiva, with oedema and infiltration of the adjacent subcutaneous areolar tissue, described by M. Ricord. 5 In this inflammation, he says, there is little or no tendency to suppuration, and it is a phenomenon which most usually appears only at the commencement of a course of iodide of potassium, and rarely recurs ; but it is important to avoid mistaking it for a venereal or gonorrheal ophthalmia, to which it appears to bear some analogy. A somewhat similar af- fection, under the use of the iodine, he observes, sometimes ex- tends to the mucous membrane of the nose, producing coryza, but unattended with sneezing, and without any disposition to pass into a suppurative stage. 1 Journ. Complem. du Diet, des Sciences Medicales, xviii. 231. 2 Treatise on Poisons. 3 Medical Examiner, Aug. 1846, p. 460. * Sir B. Brodie, Lancet, March 30, 1839, 8 Op. cit. 452 IODINUM. Under the idea, that the unpleasant symptoms which the iodides of potassium and iron " are sometimes said to produce," are owing to the presence of free iodine in them, Dr. C. J. B. Williams 1 re- commends that the patient should eat a piece of bread or biscuit after each dose : " the starch of this, combining with the free iodine, removes its injurious property." To avoid evil consequences, Wutzer advises that iodine should be immediately discontinued, whenever a feeling of increased heat in the pharynx and stomach is experienced immediately after it is swallowed; but as this evidence cannot be available in small chil- dren, attention should be paid to observe, whether, after the medicine has been taken, the temperature of the skin becomes more elevated ; the pulse quicker, and whether there is any evi- dence of pain when pressure is made on the epigastric region. He, moreover, advises, that it should not be given internally to children at the breast. It has been affirmed, that if iodine be combined with small doses of opium, all the disadvantages, immediate and remote, may be avoided ; and it is generally considered more advisable to give it in small doses for a longer, than in large doses for a shorter period. At times, it will happen, that in chronic affections— in which it is chiefly used — its beneficial agency may not be decidedly manifested until after the lapse of four or five months; and it is important to bear this in mind, as both practitioner and patient are apt to be- come dissatisfied, unless the remedy exhibits its action more speedily. When it acts beneficially, the appetite is augmented, or is not deteriorated ; digestion improves, so that the patient is able to take more food, and experiences less inconvenience there- from: the secretion of the bile is ir creased, and the evacuations are more copious and of a yellower hue; the peristaltic action goes on more energetically, and the patient gains strength. Such, at least, are the signs that are considered by many to indicate that iodine agrees; but the absence of all disagreeable consequences is a sufficient index. To remove the symptoms of iodine disease, general or local, blood-letting has been employed ; with warm bathing ; the use of milk; emulsions of gum Arabic, and the like; rigid diet and rest. The preparations of hydrocyanic acid have also been given w : ith advantage in the palpitation, tremors, and other nervous symptoms that sometimes follow its use. Precaution is requisite in the case of impressible, and also, — it has been conceived — of robust persons, 2 to avoid the supervention of hypersemia. It is advisable, too, during its administration, to let the diet be sparing, and devoid of all heating qualities. Kol- 1 The Library of Practical Medicine, arranged and edited by Alexander Tweedie. — Practical Medicine, vol. iii. p. 124, art. Pleurisy, by Williams. Lond. Ib40. 5 Riecke, op. cit S. 284. IODINUM. 453 ley 1 remarks, that it occasionally exerts a most unfavourable in- fluence on the nervous system, so that, in those who are easily excitable, unusual pains may be brought on by the use of even three or four drops of the tincture ; these pains, at times, ending in violent spasms. Such persons exhibit the impressibility, even under very minute doses, by fidgetiness or restlessness of the limbs, so that they can scarcely be kept quiet: after a time, numbness and heaviness in all the limbs; heaviness of the head, and a species of inebriation 2 succeed, with violent cephalalgia, spasms, tremors of the limbs, paralysis, 3 prostration, spasms, depravation of vision, and disposition to lamentation and distress. Some of these nervous symptoms the author has occasionally noticed, when the dose of iodine has been rapidly augmented. Where the person is liable to gastric uneasiness, caution is requisite in the use of the remedy, as it not unfrequently occasions dyspepsia and violent gastrodynia. All febrile and purely inflammatory diseases, according to Kolley, forbid its use. Dr. Andrew Buchanan 4 affirms, that he has never witnessed any of the unpleasant symptoms that have been ascribed to iodine. He asserts, that he has never seen its use " followed by wasting of the testicles or mammae, by palpitations, faintness, excessive debility, hurried, anxious breathing, dinginess of the surface, copious clammy sweats, increased menstrual discharge, or an oily appearance of the urine, which are enumerated amongst the symptoms character- izing the supposed affection, termed iodism." As regards the wasting of the mammae and testicles, Dr. Pereira suspects it to be very rare. He has seen iodine administered, he remarks, in some hundreds of cases, and never met with one in which atrophy of either organ occurred. Magendie, also, states, that he has never witnessed these effects, although they are said to be frequent in Switzerland. 5 The author's own experience accords with that of those gentlemen. He has prescribed, and seen it prescribed, largely, both in public and in private; yet no such results have ever supervened. In the Philadelphia Hospital, great attention was paid to the condition of the testes, in several cases in w T hich it was administered, yet no case of atrophy occurred. 6 M. Cul- 1 Journal Complementaire, xvii. 307. 3 Giddiness was observed by Manson, (Researches on the Effects of Iodine, p. 61. Lond. 1825;) Ashwell, (Guy's Hospital Reports, i. 136;) and Lugol, (Essays on the Effects of Iodine in Scrofulous Diseases, O'Shaughnessy's translation, p. 73. Lond. 183!.) J F 3 Sir B. Brodie, Lancet, 1832; Manson, op. citat; and Sir A. Cooper, Lancet, ii. 147. 4 Lond. Med. Gaz. July 2, 1836. 5 Pereira, Elements of Mat. Med. and Therapeutics, i. 238. Lond. 1842; or 2d Amer. edit. Philad. 1846. 6 A. M. Vedder, in American Medical Intelligencer, for Sept. 1, 1838. See, also, J. Davies, Practical Remarks on the Use of Iodine locally applied in various Surgical Diseases and External Injuries, &c, Lond., 1839. Reprinted in American Med. Library, 1839-40. 454 IODINUM. lerier, 1 however, who has had much experience with iodine and its various preparations, lays down the proposition, that it seems to exert a more direct action on the mammae and testes when it is given to an individual in health, than when the constitution is deteriorated. Dr. J. Adair Lawrie, 2 of Glasgow, has advanced the opinion, that the iodides of potassium and starch exert a poisonous influ- ence on the mucous membrane of the air passages, not as direct irritants, but indirectly through the circulation, in the form of acute inflammation. He admits, however, that he has never seen them act as irritants to the gastro-intestinal mucous membrane, nor has he ever known them induce emaciation, atrophy of the mammae and testes, hectic and the other symptoms described under the term iodosis. EFFECTS ON THE ECONOMY IN DISEASE. Iodine exhibits itself as a most efficacious remedy in a variety of diseases, in which it is desirable to modify the condition of the function of nutrition. It doubtless has often had effects ascribed to it to which it was in no way entitled ; and not the least singular has been recorded lately. M. Delfraysse, 3 at a recent sitting of the Academie des Sciences of Paris, reported cases, both in ani- mals and in the human female, in which " ioduretted preparations, administered in the latter period of gestation, arrested the develop- ment of the foetus," and hence, that they must be valuable agents when narrowness of the pelvis would render the expulsion of a foetus of the ordinary size dangerous or impracticable! In referring to the use of iodine in the following diseases, the remarks apply not only to pure iodine, but to the iodides of the metals of the alkalies, especially the iodide and ioduretted iodide of potassium; the medical properties of which accord with those of iodine. Bronchocele. — The very first experiments made with iodine were on goitre. Coindet recommended it strongly in that affec- tion, and Formey 4 first introduced it into Germany. Coindet, gave, in the first instance, the tincture internally; and he remarked, that about a week after the commencement of its use, the skin over the goitre generally became less tense, the substance of the tumour felt softer, without the tumefaction having abated ; the par- ticular portions of the gland became more distinct, separated from each other, and less and less hard, until gradually a diminution was perceptible. Frequently, the goitre disappeared completely, 1 Memoires de la Societe de Chirurgie de Paris, Tom. i. Fascic. 1 and 2, Paris, 1847; cited in British and Foreign Medico-Chirurgical Review, Jan. 1848, p. 129. * London Medical Gazette, July 3, 1840, p. 590. 3 Archives Generates de Medecine. Juin, 1850, p. 232. * Bemerk. uber den Kropf, u. s. w. Berlin, 1820; and Hufeland's Journal, B. li. St. 4, S. 91. IODINUM. 455 in the space of from six to ten weeks, under the continued use of the remedy. At an after period, he employed iodine externally, in which form of administration the evil consequences sometimes induced by it are less to be apprehended; and often combined its internal and external administration. The efficacy of iodine in bronchocele has received the most ample confirmation.. Cases have been published by Hufeland, Grafe, Baup, Helling, Ziegler, Vollmer, Reiss, Paulitsky, Hirsch, Ulrich, Jager, Barcbewitz, Meissner, Vogel, Wutzer, Seiler, Fici- nus, Nieustadt, Hoffman, De Carro, J. Reid, Manson, Elliotson, Lugol, Bardsley, 1 Copland, 2 and numerous others. 3 Mr. Bram- ley, whilst in Nepal, amongst the Himalaya mountains, and under unfavourable circumstances, cured 57 out of 116 cases, and brought 34 more into a fair way towards ultimate recovery. 4 The author has administered it in a great many cases of soft goitre, and in every one the disease was removed. In two it recurred, but the hypertrophy was again dispersed under the use of the remedy. 5 It has been recommended by some, that its exhibition should be preceded by bleeding ; and as the abstraction of blood facilitates absorption, bleeding may be advisable; and more especially where but little, if any, effect seems to be induced by it, after it has been administered for some time. Reid advises, that we should com- mence with its external administration; and, at a later period, conjoin this with the internal. Although cases have been published, in which iodine has not answered the purpose of the prescriber, there can be no question that it is the most efficacious agent in goitre in the lists of the Materia Medica ; but when the tumour has acquired a cartilaginous hardness, although it may be diminished under the use of the re- medy, it can rarely, or never, be wholly removed. Under such circumstances, however, every other remedy would be found equally fruitless. It is worthy of recollection, that burnt sponge, which contains iodine, was long celebrated for its powers over goitre, before iodine was discovered; and the same was the fact in regard to certain brine springs, as that of Salzhausen, which also contain iodine. Glandular affections. — Besides the affections of the thyroid gland, there are others of different glandular bodies, in which iodine exhibits itself efficacious. Jahn used friction with it with advantage, in induration of the liver. Wutzer gave it in two cases of induration of the spleen, but no precise deductions could 1 Hospital Facts and Observations, p. 121. Lond. 1830. - Diet, of Pract. Medicine. 3 Richter's Specielle Therapie. Berlin, 1828, S. 214; Dictionnaire de Matiere Me- dicate, . S. Mil. >ndon M' -tlica] Gazette. May, 1841. s Med. Examiner, June 29, 1844, p. 145: and June, 1S45, p. 3*23. IODINUM. 463 and the suppurative stage is just beginning. " This stage is easily recognised by a sudden depression of the vital powers, by a soft but irritable pulse, and by the bronchial respiration being accom- panied by a harsh mucous rhonchus." Lastly, In cases grafted upon long continued intermittents, " which have left the blood in a degree impoverished." The iodide was given in the dose of a scruple in the twenty-four hours. In spasmodic asthma, it has also been found very beneficial by Dr. W. S. Oke, 1 Dr. Casey, 2 and others. Dr. Casey gave it in upwards of five and twenty cases, and in no instance, where a fair trial was made, did it fail "to afford unequivocal and decided relief." The dose varies from two to five grains three times a day. Dr. W. A. M'Murry 3 has used iodide of potassium, with great advantage, in hooping-cough. He employs, however, a compound formula. R. Potass, iodid. gr. vj. • Mucilag. acac. ^vij. Syrup. Senegse, jij.j Tinct. lobeJ. ^j. M, Dose. — For a child two years old, a tea-spoonful four times a day. In chronic engorgements of the larynx, iodine was used in two cases by Trousseau and Belloq ; 4 once without success, but the second time with marked advantage; and in tubercles of the liver it has been regarded worthy of special consideration. 5 Dropsy. — Owing to its powerful eutrophic agency, many trials have been made with iodine in cases of dropsy. 6 Drs. Bradfield and Bardsley exhibited it frequently with success in hydrothorax and ascites; and Dr. Kissam, in a case of dropsy, dependent pro- bably upon induration of the liver. Dr. Coster 7 says he has re- moved many dropsies by giving internally from six to fifteen drops for a dose of a mixture composed of iodin. gr. iii., potass, iodid. gr. vi., aquce f §j. ; aided by an ointment composed of fifteen grains of iodine, with double the quantity of iodide of potassium, to an ounce of lard. This is to be placed inside the thighs after removing the cuticle by a blister. The arm-pits and soles of the feet were also rubbed with the ointment. The same plan is re- commended by Dr. Osborne. 8 Jahn, also, regards iodine as an extremely valuable antihydropic. 9 He first used it in a case of hydrocele, in which it was doubtful whether degeneration of the 1 Provincial Med. Journ. April and May, 1844. a Boston Med. and Surg. Journal, 1845. 8 Saint Louis Medical and Surgical Journal, March and April, 1843. 4 Traite Pratique de la 1'hthisie Laryngee, p. 37 1. Paris, 1837; and translation by Warder, Amer. Med. Library edit. p. 145. Philad. 1839. s Riecke, op. cit. S, 290. 6 Wm. Stokes, in Amer. Journal of Medical Sciences, May, 1834, p. 543, cited fr6m Lond. Med. and Surg. Journal. ' Journal de Pharmacie, 1834. 8 On the Nalure and Treatment of Dropsical Diseases, 2d edit. p. 48. Lond. 1837: or Amer. Med. Library edit. Philad. 1838. 9 Elliotson, in Lancet, 1830-31. See, also, P. Spalding, in Boston Med. and Sirrg. Journal, Dec. 25, 1839, p. 314, 464 IODINUM. testicle had not been a precursor. The effect of the ointment of iodide of potassium left nothing to be desired; and, accordingly, he afterwards employed it in all cases of hydrocele of the tunica vaginalis, which he met with, — even in the new-born, — united with mercury or extract of conium ; and in every case which was not of too chronic a character, it exhibited its sanative powers. The only unfavourable effects induced by it were a temporary dis- appearance of the testicle, in some cases ; and a humid cutaneous eruption of the scrotum. He also found iodine extremely useful in hydrothorax and ascites; and especially in cases of dropsy that succeeded to exanthematous diseases, — and it acted more speedily and powerfully when combined with some diuretic. He found, farther, that it was followed by the most beneficial results in the hydrocephalus of children — as well chronic as acute — especially when the latter form had attained its full development, — that is, when the inflammatory stage was over, and the accumulation of fluid was the prominent condition. In these cases, he commonly used iodine in the form of iodide of potassium made into an oint- ment, and rubbed on the head. Frequently, however, he gave iodine also internally, in combination with calomel and digitalis ; but it may be objected to this combination, that iodine with calomel forms corrosive chloride, iodide and red iodide of mercury; so that, in very small doses, it might affect the stomach too violently. 1 Dr. Roser, 2 of Wurtemberg, likewise advocates the use of iodide of potassium, in large doses, in cases of acute hydrocephalus or tubercular meningitis, where the ordinary remedies have failed, paralysis has occurred, and death appears to be impending ; and three successful cases have been recorded by Mr. C. Fluder. 3 The ordinary means had been employed in vain, when he sug- gested a trial of iodide of potassium in half grain doses, every two or three hours. In all the cases, there was speedy diuresis, and dribbling of the saliva. A similar successful case has been re- corded by Dr. John Christie. 4 The child was eight years old, and before Dr. Christie saw him had been ill a week. He had experienced an attack of convulsions the evening before. He lay with the eyes half closed, moaning frequently, and now and then uttering a loud scream ; the pupils were fixed ; the urine was passed involuntarily; there were frequent automatic movements of the left arm and leg, and the pulse w T as rapid and weak. Dr. Christie determined to make a trial of iodine in a mode men- tioned by Drs. Evanson and Maunsell, 5 and prescribed a mix- 1 Riecke, op. cit. S. 291. 2 Hufeland's Journal, for April, 1 841 , S. 84 ; cited in Lond. and Edinb. Monthly Journ. of Med. Science. See, also, Dr. Fluder, in Lond. Med. Gaz. Sept. 30, 1842, and K. G. Zimmermann, Zeitschrift fur die gesamrate Medicin., Aug. 1842, S. 41 8. 3 Lond. Med. Gaz. Sept. 30, 1842. 4 Lond. and Edinb. Monthly Journal, March, 1843. 6 On Diseases of Children. IODINUM. 465 ture consisting of iodide of potassium, sixteen grains; iodine, four grains; and water, one ounce; of which a teaspoonful was or- dered every four hours. The head was also directed to be rubbed with a weak ointment of red iodide of mercury. Good effects, in a similar case, resulted from the internal use of iodide of potassium in the practice of Dr. Barbour, of St. Louis ; x and Dr. Malin 2 prescribed a combination of iodine and calomel in oedema menin- gum and hydrocephalus acutus with advantage. M. Ricord 3 employed iodine with success in five cases of hy- drocele; — the tincture being diluted with distilled water, and ap- plied by means of compresses wetted with it, in which the scro- tum was enveloped. He used it of four different strengths — 3j., 3ij., £iij.j and gvj. of the tincture, to f giij. of water. In hygroma or dropsy of the bursas mucosas of the joints, an ointment of iodide of potassium (3ij-, ad adipis §j.) has been suc- cessfully used by M. Reynaud. 4 The limb is kept at rest, and morning and evening, or three times a day, friction is made with this quantity of ointment; after which the knee — the joint com- monly affected — is covered with a large flaxseed poultice. From some trials made with iodide of lead, there was reason to believe it more efficacious than iodide of potassium. The treatment was generally successful in about a fortnight. Intermittent Fever. In obstinate intermittents, which had resisted quinia and other antiperiodics, M. Seguin 5 found the tincture of iodine a very valuable and effective remedy. He prescribed it in doses of thirty drops in a little sweetened wa- ter, gradually increasing the quantity to forty, fifty, and even sixty drops. Three doses were given in the apyrexia. He did not find it equally effectual in recent cases. Typhus and Typhoid Fever. Dr. Morrison 6 states, that there is a condition in typhus fever, which is materially benefited by iodide of potassium. It is marked by a dry, parched, brown or black tongue ; by dark sordes on the teeth and gums ; by a dis- position to dark fetid discharges from the bowels; by a weak and compressible pulse; and by the ordinary signs of depraved secre- tions, vitiated fluids, and debility. The dose which he is in the habit of administering is three grains every four or five hours, dissolved in water, or mixed with wine, &c. A case of typhoid fever is reported by Dr. C. B. Voigt, 7 in which iodide of potassium was apparently beneficial. 1 Boston Medical and Surgical Journal, Jan. 1846. 2 Schmidt's Jahrbucher, u. s. w. No. 2, S. 164. Jahrgang 1849. 8 Journ. des Connaissances Med. Chirurg., Janvier, 1833. 4 Cabissol, in Bulletin General de Therapeutique, Fev. 1838. s Journal des Connaissances Medicales Pratiques, Dec. 1846, cited in Amer. Journ. of the Medical Sciences, July, 1847, p. 223. 6 Dublin Medical Press, Oct. 21, 1840. 1 Medical Examiner, Dec. 1845, p. 715. 466 IODINUM. Variola. Iodine has been successfully employed in variola to prevent pitting. Dr. Crawford, 1 of Montreal, tried the compa- rative merits of tincture of iodine and nitrate of silver, and gives the preference to the former. He found the application "very manageable and very bearable." Dr. Jackson, 2 formerly of North- umberland, Pa., now of Philadelphia, informs the author, that he was led to make an experiment of aborting small-pox by the tinc- ture of iodine, from having contemplated its wonderful influence over erysipelas. He applied it in April, 1845, to one arm of a child eleven months old, in confluent small- pox, on the third day of the eruption, and to the arm which appeared the worst, rubbing it freely on with a sponge three times that day and twice the next. On the 11th day, when the pocks over the whole body were at their height, elevated, with hard bases, those on the arm to which the iodine had been applied were entirely flat, with thin purulent matter under the dead cuticle without any swelling of the part. The abortion at the time was considered to be complete. There were, however, some very slight pits to be seen afterwards, but they were very inconsiderable compared with those on the other arm. Dr. Sargent stated to Dr. Jackson, that he had sub- sequently used iodine on one side of the face in 25 cases : the swell- ing, soreness and tenderness were very much less than on the side not covered: each pock remained flattened, but he could not say that pitting was prevented. Dr. Goddard tried it in five cases ; " not one of the patients showed the least pit or mark ; none of them had been vaccinated, and the disease w r as confluent in most of them." Dr. Jackson considers, that no fair trial of its ectrotic powers in variola can be had without applying it on the first day of the eruption, and continuing it for several days, — say five or six. More recently, Dr. Sargent 3 instituted other expe- riments with it. It was painted over one half the face only, in order that the appearance of the surface, thus protected, might be fairly compared with that of the other side. Having been tested in this manner in a great many cases, of which thirty were care- fully noted, the effects were found to be as follows: — The side of the face which was covered w T ith the tincture was comparatively little swollen; the eruption was flattened, so as to be scarcely higher than the surface, w 7 hilst on the other side the vesicles first, and subsequently the pustules, were full and swollen ; there was much less heat and soreness in the protected side than in the other, and much less tenderness when this side was -touched. When pits were left on the unprotected side of the face after the disengage- ment of the scabs, and the healing of the little ulcers thus exposed, those on the protected side were found to be less numerous and perhaps less deep; but in no instance could Dr. Sargent certainly 1 Montreal Medical Gazette, April 1, 1844. 2 Medical Examiner, August, 1846, p. 464. 3 American Journal of the Medical Sciences, April, 1849, p. 373. IODINUM. 467 affirm that pitting was entirely prevented by the iodine, in cases in which there were pits on the opposite surface. Dr. Schreiber 1 states, that he has found the administration of iodine useful in preventing the family of a person labouring under variola from being infected. [?] The formula employed by him was as follows : R. Potass, iodid. gr. viij. Tinct. iodin. g«> xvi. Aquse f ^ij. M. A teaspoonful of this was given night and morning. Dr. Schrei- ber invites practitioners to a farther investigation of the anti* vari- olous power of iodine. Measles and Scarlatina. It has been already remarked, that M. Ricord considers that iodine determines diseased action to the skin ; and it has been affirmed 2 that in cases of suppressed measles and scarlatina, it will frequently induce a healthy reaction under the most desperate circumstances. One or two grains of iodide of potassium — according to the age of the patient — when under twelve, maybe dissolved in sugared water, and be administered repeatedly as an ordinary drink, the whole quantity being taken in the 24 hours for three or four days. In measles, a small plaster to the chest is said to assist the peculiar action of the iodine. In scarlatina, the compound tincture of iodine, diluted with three or four parts of water, may be frequently applied, by means of a camel's hair brush, to the front and sides of the throat and neck. Nervous Diseases. — As to the efficacy of iodine in these diseases, testimony is somewhat discordant. Drs. Manson 3 and Elliotson 4 found it useful in paralysis, but Dr. Bardsley failed with it. Chorea was removed by Gibney, 5 Bardsley, Manson, Oke, 6 and Muller; 7 and Franklin, 8 by very large doses, relieved a case of epilepsy. Dr. Bennett 9 found the iodide of potassium of great use in cases of nervous headache, when the circulation was not affected; and the local use of the tincture of iodine has been beneficial in neuralgia. 10 In a patient, whose life had been imbittered for five years with 7ieuropathic maladies, and who suffered at the time from a very painful affection of the head and neck, with occasional and frequent pain of the arms and legs, Prof. J. K. Mitchell 11 gave seven grains of iodide of potassium three times a day, which speedily relieved, and within six weeks completely cured the patient, after arsenic, I Northern Journ.of Med., July 184 4, cited in Braithwaite's Retrospect, x. 187. New York, 1845. a London Lancet, Jan. 21, 1843, p. 632. 3 Op. cit. * Lancet, 1830-31. s Ibid. 1827-8, p. 54. 6 Provincial Med. and Surg. Journal, April and May, 1844. * Gazette Med. de Paris, No. 19, cited by Gorup-Besanez, in Oanstatt und Eisen- mann's J ahresbericht uber die Fortschritte in der Heilkunde im Jahre 1848, S. 135. 8 Lancet, 1836, and Cogswell, op. cit. p. 24. See, also, Scott, Provincial Med. and Surg. Journ., April 3, 1844, p. 9. 9 London Lancet. Dec. 21, ld3U. 10 Crawford, Montreal Med. Gaz. April 1, 1844. II Medical Examiner, Aug. 1846, p. 460. 468 IODINUM. mercury, and most of the narcotics had been prescribed in vain. An equally beneficial and speedy effect was produced in a case of protracted erratic pains. Recently, like many other agents, iodide of potassium has been proposed as a prophylactic in cholera. *In this relation, it has been recommended by M. Marchandier. M. Bouchardat, 1 how- ever, knew a case of cholera supervene in a person who was at the time under its use. The intimate affinity between iodine and the urinary organs has given occasion to its employment in Incontinence of Urine, of which Corter cured two cases by the tincture. Chronic Diseases. — Cases of dry, scaly tetter were treated by Tiinnermann with an ointment of iodide of potassium, ap- plied to the affected parts three or four times a day. For the most part, an increase of the evil was at first a pretty sure harbinger of a radical cure; when this attained a certain degree, a change in the organic actions of the skin succeeded ; the remedy was then pretermitted, and the parts were washed a few times with soap, when the eruption faded and gradually disappeared. In moist tetter, Tiinnermann applies only a very weak salve, with which the parts are touched daily, two or three times: in the intervals, he envelops them in a dry linen rag. The pain, which is always induced by the application, soon passes away. Magen- die, Gimelle, and Jeffray 2 have likewise applied it successfully in tetter. In chronic cutaneous diseases in general, the various preparations of iodine are valuable remedies. They enter, as we have seen, the mass of blood, modify the condition of that fluid, and, in this manner, exert a new impression upon the morbid tissues. The author has often employed them in these cases with success; and like testimony has been afforded by MM. Biett, Gimelle, Kolley, Locher-Balber, Kennedy, 3 and others. Brehme succeeded^ in removing, rapidly and completely, a case of invete- rate porrigo favosa, and ophthalmia thereon dependent, by an ointment of iodine. Dr. G. Billingslea, of Alabama, asserts, 4 that for twelve years he had used the tincture with the happiest effect, as a local application in the troublesome cases of herpes circinatus or ring-worm that are so common in the southern part of this country. He adds, that he does not recollect a case in which it had been employed, which was not radically cured; and in porrigo of the scalp it is highly extolled by Drs. Graves, and J. J. Ross. 5 Dr. Graves advises that it should be strongly rubbed into each spot by means of a small piece of sponge covered with fine linen, 1 Annuaire de Therapeutique, pour 1850. p. 196. 9 Cogswell, op. cit. p. 80. 3 London Med. Gazette, May 8, 1840, p. 260. 4 American Medical Intelligencer, May, 1839, p. 34. s London and Edinb. Monthly Journ. of Med. Science, Sept. 1842, p. 292. IODINUM. 469 and tied to the end of a quill or slender stick. When effectually done the application must not be repeated oftener than once a week; and immediately after the application the scald must be covered with a spermaceti dressing, which must be renewed at least four times daily, so as to keep the head constantly moistened with it. fhe head is not washed for three days after the appli- cation of the tincture, when it may be well to wash it gently with yellow soap and water twice a day, taking care to cover it as before with spermaceti dressing after each washing. Dr. Barosch 1 cured an inveterate dartrous eruption, affecting the perinaeum and scrotum, by a lotion consisting of fifteen grains of iodine, and two scruples of iodide of potassium dissolved in five fluidounces of distilled water, and one fluidounce of alcohol. In lupus, the tincture applied locally has proved highly beneficial. Under its use, the process of ulceration has stopped, and cicatrization taken place. It is recommended to be applied not only to the ulcerated portion, but to the parts around. 2 Some inveterate cases yielded to the use of iodide of potassium, given in large doses, by M. Maisonneuve. 3 A case of elephantiasis, or enormous enlargement of the leg, has been recorded by M. Cazenave, 4 which was cured by iodine, associated with other remedies. The patient — a woman — was ordered a strong decoction of guaiac and mezereon ; the leg was carefully bandaged from the toes, and every other day the ban- dages were removed, and an ointment of iodide of potassium rubbed on. She was put on generous diet and wine, and kept in bed. This treatment was continued for a little more than three months, by which time the leg was reduced to its former dimen- sions. M . Cazenave states, that he has met with several similar cases, which have been all more or less benefited, and some even cured by this plan of treatment. M. Ogier Ward 5 cures itch by a simple lotion of iodide of potassium, a single washing with which, in some instances, com- pletely eradicated the disease. To ensure complete success he ap- plies sulphur ointment at night, and the lotion during the day. It usually effects a cure in seven days. The lotion consists of one dram of the iodide to eight or sixteen fluidounces of fluid, according to the delicacy of the cutaneous surface. Jlmenorrhcea. — According to Coindet, iodine is a powerful emmenagogue, and the possession of this property has likewise 1 CEsterreich, Medicinisch.Wochensch. cited in Provincial Med. and Surg. Journal, Aprils*!), 1843, p. 99. 2 Pereira, Elements of Mat. Med. and Therap. i. 246. Lond. 1842, or 2d Amer. edit. Philad. 1846. 3 Bulletin de Therapeutique, Jan. 1849; cited in Canstatt und Eisenmann's Jahres- bericht, u. s. w. im Jahre 1849, V. 159. Erlangen, 1850. * L'Experience, Oct. 19, 1843, cited in Edinb. Med. and Surg. Journal. April, 1844. * Lond. Med. Gazette, April 3, 1846, p. 608. 470 IODINCJM. been ascribed to it by Brera 1 who frequently administered it suc- cessfully in amenorrhoea; and Formey, Nieustadt, and Ashwell 2 confirm their observations. Sablairoles cured three cases by fric- tions with iodine ointment on the breast, conjoined with the inter- nal use of iodine. It was necessary, however, to give it in large doses, and for a long time. Dr. Aldridge, 3 of Dublin, states, that benefit may be expected from its use, when the absence of the catamenia is dependent upon uterine irritation, whether from ex- posure to cold, mental emotion or other causes, and accompanied by pain in the loins, headache, palpitation, &c Locher-Balber 4 and Golis found iodine of value, at times, in those troublesome cases which occasionally precede the establishment of menstrua- tion; the latter was, however, often deterred from its use, in such cases, by the evil consequences it produced on the respiratory organs, — such as dry cough, or cough accompanied by bloody sputa. Degeneration of the Ovaries. — Rochling observed a marked effect from the use of iodine in induration of the ovary. Jahn cured, by an ointment of iodine and mercury, an enormous dege- neration of the ovaries, which gave rise to two tumours, each the size of the head; and Messrs. Thetford, 5 Klaproth, 6 Jewel, 7 and Ashwell 8 were equally successful. Baron employed it beneficially in a case of dropsy of the ovarium. In hypertrophy of the ventricles of the heart, Magendie recom- mended it long ago. In scirrhus of the uterus, mammce, &c, it has been advised by Heun, Klaproth, Hennemann, Von dem Busch, 9 Ullmann, Hill, Benaben, Magendie, Hammer, Elwert, Wagner, 10 Copland, 11 Zim- mermann ; 12 and from their recorded observations, it would seem, that great efficacy ought to be ascribed to it, both when internally and externally administered. A case is published by Dr. Thet- ford 13 in which the uterus was of bony hardness, and so large as nearly to fill the pelvis ; yet it gave way in six weeks to the use of iodine. Seven cases of hard tumours of the uterus are like- wise reported by Dr. Ashwell, 14 which were removed by it, with occasional depletion, and regulated diet. It was given internally, and at the same time applied externally in the form of ointment, (lodin. gr. xv., Potass, iodid. Bij., Ung. cetacei ^ss.,) of which a piece of the size of a nutmeg was introduced' into the vagina 1 Sagsio Clinico suit' Iodic * Guy's Hospital Reports, No. 1. Loud. 1836, and Cogswell, op. cit., p. 43. 3 Dublin Hospital Gazette, Oct. 1, 1845. 4 Hecker's Litter. Annal. i. 275: and Cogswell on Iodine, p. 77. 5 Transactions of the Dublin College of Physicians, v. 510. Dublin, 1828. 6 Revue Medicale, Mars, 1824. 7 Op cit. - Guy's Hospital Reports, vol. i. 9 Hufeland's Jour. B. lx. St. 2, S. 81. 10 Revue Medicale, Juin, 1833. " Diet, of Pract. Med., art. Cancer. " Journal de Pharmacie, Juin. 1842, p. 598. 13 Trans, of the King and Queen's College of Physicians of Ireland, vol. v. ,4 Op. cit IODINUM. 471 and rubbed into the cervix uteri for ten or twelve minutes every night. The average time required for the removal of these tumours was from eight to sixteen weeks. In congestion, erosion or ulceration of the cervix uteri, Dr. Churchill 1 found iodine, used according to the formula given hereafter, the best application of all that he has tried. He usually commences with a single appli- cation of nitric acid, or the acid nitrate of mercury, and then, after a few days, paints the entire cervix with iodine, which he repeats once or twice a week. The application occasions no pain unless the orifice of the vagina should be touched. Jahn extols it much in incipient scirrhus of the stomach, when combined with the application of leeches. Riecke asserts, that his father found an ointment of iodine extraordinarily useful in a case of induration of the pancreas ; and, also, in one of scirrhus of the pylorus, Magendie extols it in cancer of the tongue; and Benaben and Triistedt employed it successfully in stricture of the urethra, supervening on badly managed gonorrhoea. In a case of scirrhous tumour, of large size, seated in the neck, and protruding into the isthmus faucium, which was attended by a prolonged ceaseless pain of an aching and depressing character, Professor J. K. Mitchell 2 found the most marked relief follow the administration of eight grain doses of iodide of potassium. " After the second dose the pain ceased for some days, although the tumour continued to enlarge. The pain returned at irregular intervals, but was alwaj^s, as speedily as at first, relieved by iodide of potassium." Leucorrhcea and gonorrhoea. — A Parisian physician made the observation, that during the employment of iodine in goitre, obsti- nate and protracted leucorrhcea disappeared : this induced him to try the remedy in the latter disease, and he found it efficacious. Goden and Broglio, likewise, observed it useful in malignant fluor albus; and Benaben, Richond, 3 De Salle, Caswall, 4 and Broglio, in gonorrhoea. The last two individuals gave it especially in those cases, in which, without any marked inflammation, a deeply rooted gonorrhoea existed, with ulcers in the urethra and prepuce, not apparently of a syphilitic character. In chronic fluor albus, it was used by Muller 5 with marked success. A young female had long suffered under this affection, which had reduced her strength, and did not yield to any of the means that had been employed, when the ointment of iodide of potassium was rubbed — morning and evening — on the inner surface of the thighs. After this plan had been continued for four weeks, the disease entirely ceased. MM. Gimelle and Jewell are also advocates for it. 6 M. 1 Medical Times, May 19, 1849. a Medical Examiner, Aug. 1846, p. 462, 3 Archives Generates de Medecine, vol. iv. 4 Lond. Med. Gazette, for 1834. 5 Wo.chenschrift. f ur die gesammte Heilkunde, No. 40, S. 633, Oct. 1836. 6 Revue Medicale, vii. 249; and Practical Observations on Leucorrhcea, &c,,by Geo. Jewell, p. 80. Lond. 1830. See, also, Solon, in Nou'v. Diet, de Med. et Chirurg., art. lode. 472 IODINUM. Ricord, 1 however — who considers that the genito-urinary organs are amongst those that are most susceptible of the action of iodide of potassium — says, that he has been able to trace the fresh access of blennorrhceas ineffectually got rid of previously, or the exaspe- ration of those actually existing, so frequently to its use, that he regards the existence or recent presence of a blennorrhea as its temporary contra-indication. " Perhaps, however," he adds, (on the principle similia similibus probably,) " advantage may be derived from the iodide of potassium in some cases of blennorrhea." A dilute tincture of iodine has been used by M. Steenkiste with great success in cases of obstinate chronic leucorrhcea. He dis- solves a dram of iodine in twelve fluidounces of alcohol; and adds about forty fluidounces of water. About a fluidounce of this is thrown into the vagina as an injection; which is repeated every day, or every other day, according to the excitement it occasions. In discharges from the nose, iodine, in the form of iodide of potassium, has been used with advantage by Dr. Elliotson 2 and by Mr. George Fayrer, 3 — given internally, as well as employed in the form of injection Oj. ad aquce f 3iv.) In secondary syphilis, iodine has been recommended by Tyrrel, Saville, De Salle, Schlesier, 4 Dietrich, 5 A. Cade, 6 Acton, 7 and numerous others; — especially when the disease is complicated with scrofula, and the effects of mercurials. Wallace 3 has like- wise communicated some fortunate results from the administration of iodide of potassium in secondary syphilis, and Ebers, 9 Ricord, 10 Von Haselberg, 11 Cullerier and others have confirmed his observa- tions. Benecke 12 has employed iodide of potassium, with the best effects, in every form of syphilis — primary, secondary and tertiary. Mr. Bullock 13 has reported the particulars of eleven cases of secondary syphilitic diseases, of a formidable character, relieved by iodide of potassium given internally, in doses of eight grains three times a day, in camphor mixture. The symptoms were: — destruction of the vulva and soft palate; or nodes, with nocturnal I L'Experience, cited in Lancet, Jan. 28, 1843. 3 Lancet, Feb. 1 0, 1838, p. 725. 3 Ibid. Feb. 24, p. 786. 4 Casper's Wochenschrift. Feb. 4, 1837, S. 78. * Joum. des Chirurg. und Augenheilkunde, von Grafe und Walther, cited in Ency- clog. des Sciences Med. Jan. 1841, p. 165. 6 Bull. Gen. de Therap. Mai, 1841, and Encycl. des Sciences Med. Aout, 1841, p. 319. * London Lancet, Jan. 31, 1846. 8 Treatise on the Venereal Disease. Lond. 1833. 9 Medicinische Zeitung, Oct. 5, 1836, S. 201 and 207. 10 J. J. L. Rattier, La Lancette Franqaise, No. 34, 19 Mars, 1839. Gazette des Ho- pitaux, Mars, 1839, and Langston Parker's Modern Treatment of Syphilitic Diseases, &c, &c. Amer. Med. Library edit. p. 77. Philad. 1840. II Medicinische Zeitung, No. 48 and 49. Berlin, 1837. ,a Cited in Schmidt's JahrbUcher der in-und-auslandischen gesammten Medicin, Jahr- gang 1848, No. 8, S. 185. " Edinb. Med. and Surg. Journal, Jan. 2, 1837. See, also, Cogswell on Iodine, p. 80; Lay cock, Lond. Med. Gaz. March 2, 1839, p. 821; and Lisfranc, cited in Med. Times, Jan. 11, 1845. IODINUM. 473 pains in the tibia, ulna, frontal and malar bones, and affection of the bones of the nose, or rupia, and other tubercular eruptions. k The period of cure was from one to two months. Mr. Mayo 1 has described it as efficacious in certain disorders, which are the consequences of syphilis, as emaciation, with ulcers of the skin; ulcerated throat, affections of the bones, &c, occurring in those to whom mercury had been given ; and M. Michel 2 gave it with great advantage for the removal of tertiary symptoms, in the dose of four grains in the day, dissolved in an ounce of tar water. Iodide of potassium has been used with much success by M. Ricord, 3 in deep-seated syphilitic tubercles. Before the tubercles have become inflamed or softened, whilst they are still indurated, he has constantly succeeded in dispersing them by iodide of potas- sium, with small doses of iodide of mercury. Very commonly, however, he employs iodide of potassium alone; and when the tubercles have become ulcerated, he still relies upon it as his prin- cipal remedy. M. Ricord 4 considers its results to be most happy in the tertiary forms of syphilis, in which he regards it as the great remedy. He employs it in gradually increasing doses, com- mencing with ten grains dissolved in three fluidounces of distilled water, given at intervals during the day in any convenient vehi- cle. When the remedy agrees, w 7 hich it most commonly does, if the stomach be healthy, the dose is increased ten grains every two or three days, till it is carried to a dram, a dram and a half, or even more, in the course of the day. In the great number of patients who have been treated by M. Ricord, the beneficial effects of the iodide were constantly exhibited, but not always with the same degree of rapidity. By the same plan Jagerschmits 5 treated successfully two cases of constitutional syphilis, after the mercurial treatment had failed. In one of the cases, the iodide of potassium was given with the iodide of quicksilver; in the other, the iodide of potassium alone. From an examination into the comparative value of the differ- ent preparations of mercury and iodine, and the best modes of administering them, Dr. Hocken 6 concludes, that iodine is inert in almost all the symptoms of primary syphilis, w T ith the exception of some forms of phagedena, attended with great debility and derangement of the health ; — that in constitutional syphilis it is * Lond. Med. Gaz., xi. 249. See, also, a Treatise on Syphilis, by Herbert Mayo, F.R.S. Lond. 1840. 2 Bouchardat, Annuaire de Therapeutique pour 1848, p. 193. .Paris, 1848. * Langston Parker, op. cit. p. 77. 4 Trait e Pratique des Maladies Veneriennes, &c. Paris, 1838; also, Acton, Com- plete Treatise on Venereal Diseases, &c. Lond. 1841; or Amer. edit., New York, l84(i •, M. Lafargue, Encycl. des Sciences Med. Fevrier, 1841, p. 359, and M. Seguin, Bull. Gen. de Therap. Dec. 1841. 1 Bulletin de Therapeutique, Janv. 1849; cited in Canstatt und Eisenmans Jahres- berieht u. s. w. im Jahre 1849, v. 159. Erlangen, 1850. 6 Edinb. Med. and Surg. Journal, April, 1844, p. 325. 474 IODINUM. a less valuable remedy, in the majority of secondary symptoms, than mercury, with the exception of some severe cases of pustular eruptions, phagedenic sore throat, rupia, and secondary ulcerations of a bad character, all of them marked by a cachectic and debilitated constitution; whilst in tertiary symptoms iodine is far more valu- able than mercury, and its effects more certain and decided than in any other set of symptoms; — that mercury and iodine are most advantageously combined, in cases presenting both secondary and tertiary symptoms ; and that the only form of iodine, safely appli- cable to the treatment of syphilis, is the iodide of potassium, which should never be carried beyond moderate doses ; and hence, that however valuable the iodide of potassium may be in some forms of syphilis, it cannot be substituted with advantage for mercury in the great majority. Nocturnal pains in the bones, and diseases of the bones and periosteum have likewise been particularly benefited by the iodide : l the latter, when localized for a longer or shorter period, have yielded sooner when blisters have been applied over the affected parts. Mr. A. Ure 2 reports a case of periostitis of the left ulna, of two months' standing, which, after leeching, blistering, &c, had been employed, was cured by two grains of iodide of potassium given twice a day in a compound infusion of gentian, with a grain of opium at bed-time for a fortnight; — bran poultices being ap- plied to the arm. An iodine suppository appeared to Mr. Keate 3 to be beneficial in enlarged prostate; and iodide of potassium was administered successfully in the same disease by Dr. Casey. 4 In enlargements of the third lobe of the prostate, Mr. R. A. Stafford, 5 has recom- mended it to be applied, by charging a bougie at its point with iodine, or iodide of potassium, and then dipping it into melted tallow, so that a coating may be formed upon it. The bougie having been passed so as to reach the desired spot, its point is allowed to rest upon the diseased part, when the tallow gradually melts, and brings the iodine or iodide of potassium into contact with it, and, by drawing the bougie gently backwards and for- wards, the necessary friction is produced. He has found it ad- visable to be very cautious as to.the strength of the application, as the prostate will not bear a strong preparation either of iodine or iodide of potassium at first. He has found it necessary to 1 Wm. B. Casey, in New York Journal of Medicine and Surgery, October, 1840, p. 3-20; and J. M. Ferrail, Lond. Med. Gazette, April 18, 1840, W. S. Oke, Provincial Med. and Surg. Journ. April 24, 1844; and Henry Hartshorne, Amer. Journ. of tLf Medical Sciences, Jan. 1849, p. 47. * London Medical Gazette, March 21, 1845, p. 785. 3 Lancet, for 1832-3, p. 672. 4 xNew York Journal of Medicine, Oct. 1840, p. 324. ' Brit, and For. Med. Rev. Oct 1840, p. 529, being a notice of Mr. Stafford's Essay on the Prostate Gland. IODINUM. 475 employ belladonna, opium, hyoscyamus, &c, to quiet irritation and pain. When these have subsided, he begins carefully by in- troducing iodide of potassium in the proportion of one grain to a dram of unguentum cetacei, and increasing it as the patient can bear it. He then goes on with two, three, four, five, and even as far as ten grains or a scruple to the dram, according as the case requires it. After this, he adds iodine to it; — half a grain, one, two, three, four, or even more grains in the same manner. In different forms of rheumatism, iodine has been given with success by Dr. Clendinning, 1 in the Mary-le-bone Hospital, and a series of cases in which it was employed has been published by him. Sir B. Brodie 2 twice relieved rheumatism by the tincture, although, in one of the cases, only temporarily. Cases of acute rheumatism, treated successfully by iodide of potassium, used in- ternally and externally, have been published by Dr. Mackey, 3 Mr. Wardleworth 4 and M. Bouyer. 5 Dr. Cowan 6 gave the iodide of potassium in fifty-two cases, in average doses of five grains three times a day. In no instance was either bleeding or leeching prescribed. Its action in rheumatism he considers to be, on the whole, satisfactory : in many cases it may be regarded as heroic, while in others, not a priori distinguishable, almost negative. In chronic rheumatism its success appears to have been equally decided ; given alone in full doses — six grains, for example, three times a day — or associated with sarsaparilla. This combination has been highly extolled by Dr. Graves in sciatica and lumbago; 7 and by Dr. Heygate 8 in chronic rheumatism, secondary syphilis: &c. 9 When rheumatism assumes the chronic form, or if there should exist a strumous or syphilitic taint, no remedy, according to Dr. George L. Upshur, 10 will be found equal to the iodide of potassium, of which he usually prescribes five grains four times h day in hop tea, the bowels, in the mean time, being opened every day by the black draught or other cathartic. He has rarely seen the most obstinate cases resist this treatment. In gout, too, it has been prescribed. Jahn found it extremely effective in dispersing gouty tophi. Yalentin observed, that when iodine was given in a case of goitre complicated with gout, the tumefaction of the joints and the depositions gradually disappeared. Adopting the 1 London Med. Gazette, May, 1835. a Lancet, for 1832-3. 3 Ibid. March 2, 1839, p. 830. 4 Ibid. March 30, 1839. s Gazette Med. de Paris. No. 32. 1840; see, also, Davies, op. cit. p. 317, and Craw- ford, Montreal Medical Gazette, April 1, 1844. 6 Provincial Med. and Surg. Journ. May 27, 1843. 7 Dublin Journal of Med. Science, Nov. 1840, and M. Ebrard, Journ. de Med. et Chi- rurgie Pratiques, Nov. 1845, cited in Amer. Journ. of the Medical Sciences, July, 1846. p. 225. 8 London Lancet, Mar. 0, 1841; see, also, E. D. Connor, American Medical Infci'l- gencer, Dec. 1, 1840, p. 257. 9 See, also, W. S. Oke, Provincial Med. and Surg. Journ. May 1, 1844, p. 54. i0 Medical Examiner, Oct, 1850, p. 581. 476 IODINUM. hint, he gave it in several cases of gout, with the effect of always mitigating the disease, and, at times, of completely curing it. Gendrin used iodine not only in chronic gouty swellings with suc- cess, but also in acute cases. Ebers likewise confirms the efficacy of iodine in gout. In coxalgia, Buchanan recommends the tincture of iodine to be applied by means of a small brush, as well as in cases of false joint, of which he has detailed a successful instance. A similar case has also been given by Treusen. Painting the af- fected surface with it, even in acute rheumatism, has been found useful. 1 In various rheumatic affections of the joints, especially of the chronic kind, Dr. R. B. Todd 2 has employed "with un- questionable benefit," the local application of iodine to the affected joints, — both in the form of the tincture, and of a stronger com- pound, used at the King's College Hospital, London, under the name of "Iodine Paint;" the formula for which is given hereafter, (see Potassii Iodidum.) The mode of application is to paint the part freely by means of a camel's hair pencil. More or less smart- ing is produced, and frequently vesication, or an herpetic eruption may ensue. The painting may be repeated as often as circum- stances demand. Dr. Todd considers it to be extremely useful, when an effusion has taken place into synovial membranes or sheaths; yet Dr. Gros, of Wesserling, 3 affirms, that before he recently recommended the tincture of iodine, it had never been employed in chronic rheumatic affections of the joints ! In adi- posis, Von Grafe 4 prescribed it, and not without advantage. The case was accompanied by great voracity and sense of suffocation. Bleeding and cathartics were premised. In stomacace or a scor- butic state of the gums, the use of iodine has been recommended by Friedrich ; as well as in mercurial salivation, by Kluge, Knod, 5 Klose, 6 Graves, 7 Asmus, 8 and others; yet its efficacy appears to be somewhat doubtful in the last affection. Heyfelder found it of no value in three cases. Dr. H. D. Holt 9 found, that every case of nurses' sore mouth, which he treated with five grain doses of iodide of potassium three times a day, yielded within forty-eight hours. In a case of stricture of the oesophagus, it was given with much benefit by Dr. Cumming, of New York. 10 A bougie had been previously used, but without advantage. An adventitious 1 Cowan, Provincial Med. and Surg. Journal, May 27, 1843. 3 Lond. and Edinb. Monthly Journal of Med. Science, Dec. 1843, p. 1084; and Craw- ford, Montreal Med. Gazette, April 1, 1844. 3 These de Strasbourg, cited in Archives Generates de Medecine, Fevr. 1850, p. 214. 4 Walther und Gr'afe's Journal fur Chirurgie, B. ix. St. 3, S. 367. 5 Gazette des Hopitaux, July, 1837. • Medicinische Zeitung, No. 34, 1836. See, also, Amer. Journal Med. Sciences, Feb. 1834, p, 533. T Dublin Journ. Med. Science, Jan. 1834. 8 Casper's Wochenschrift. fur die gesammte Heilkunde, No. 45, 1838, and Encyclo- graphie des Sciences Medicales. Juillet, 1839. 9 New York Journal of Medicine, May, 1848. xo New York Journal of Medicine and Surgery, No. 2, Oct. 1839, p. 451. IODINUM. 477 membrane was brought up in scales soon after commencing the iodine. For two or three weeks, the medicine was laid aside, but it was necessary to resume it. In affections of the mucous mem- brane of the middle ear, it has been used by Dr. Manson, and also by Mr. T. Wharton Jones ; 1 by the former with advantage ; by the latter without any marked effect. Dr. Manson likewise suc- ceeded in curing chronic dacryocystitis by it. In cases of hydrocele, Velpeau 3 prefers a solution of iodine to wine as an injection. He employs the tincture in the proportion of from one to two, and even four, drams to an ounce of water. 3 Mr. J. R. Martin, 4 of India, appears, however, to have anticipated him in this application of the remedy. Up to the time of the pre- sentation of his paper to the Medical and Physical Society of Cal- cutta, (January, 1835,) he had used it successfully in upwards of ninety cases, and subsequently, he communicated to the Medical and Physical Society of Calcutta the results of his after expe- rience. The number treated since March, 1832, at the Native Hospital, was seven hundred and seventy-seven : of these, seven hundred and sixty-six had a solution of tincture of iodine injected. In order to ascertain whether it was by mere stimulation that the cure by the tincture was obtained, Mr. Martin treated ten cases with a common urethra-syringeful of undiluted port wine, and one with diluted tinctura lyttaB, in the same proportion as that of iodine, — 3ij. to water ^vj. Of this, two drams were injected and retained ; the pain during twenty-four hours was excessive, and the inflammation, although not proportionate to the pain, was much longer in subsiding than when the tincture of iodine solution was used : this was also remarkably apparent in the cases treated with undiluted port wine. Of seven hundred and sixty-six cases it does not appear that more than four failed. 5 For hydroceles containing from six to thirty ounces of fluid, two drams of the solution of tincture of iodine are sufficient; for those containing from thirty to sixty ounces, three drams ; and for those of a larger size, four to five drams. When the hydrocele contains Jess than three ounces, a dram of the injection is sufficient. 6 The cure is effected much sooner by iodine ; and if any infiltration takes place it is readily absorbed. Highly favourable results have also been obtained by MM. Oppenheim 7 and Fricke, 8 and by Mr. 1 Lond. Med. Gaz. Aug. 17, 1839, p. 754, and Amer. Med. Intel. Nov. 1, 1839, p. 233. 3 Archives Generates de Medecine, Jan. 1 837; La Presse Medicale, Mai, 1837. See, also, Amer. Med. Intelligencer, July 15, 1837, p. 138; and Oct. 16, p. 263. * Bouchardat, Annuaire de Therapeutique pour 1844, p. 338. Paris, 1844. 4 Amer. Journal of the Medical Sciences, Nov. 1837, p. 238. 5 Quarterly Journal of the Calcutta Med. and Physical Society, for Jan. 1837; cited in American Journal of the Medical Sciences, for Feb. 1839, p. 485. 8 Dujat, in Gazette Medicale de Paris, Sept. 1 838. 1 Zeitschrift fur die gesammte Medicin. Aug. 1838, S. 389. 8 Ibid. S. 405. 31 478 IODINUM. Bransby Cooper, 1 and the method has been largely employed in this country with equal advantage. 2 Two successful cases are reported by Dr. Stewart. 3 Encouraged by the success which attended the use of iodine in- jections in hydrocele, M. Velpeau 4 has adopted a similar mode of treatment for various kinds of serous cysts, enlarged bursa, &c, about the knee, in the axilla, breast, neck and other parts. He punctures the cyst with a trocar proportioned to its size; emptying it in this manner, and then injects through the cannula a mixture of one part of tincture of iodine and two parts of water. In a few seconds this is drawn off. In a day or two, the cyst inflames, though never greatly, and it ultimately shrivels and disappears. Since then he has used the injection successfully in five cases of goitre, which is often formed of cysts filled with a thin serous or a blackish fluid. In hydrarthrosis, the operation appeared to him to be more formidable. He practised it in two cases; one reco- vered ; the other did not. 5 The plan has been employed by M. Bonnet, 6 of Lyons, in one case of hydrarthrosis. He prefers for the injection a watery solution, consisting of one part of iodine, two parts of iodide of potassium, and eight of water, in order to avoid the possible coagulation of the effused fluid by the alcohol of the tincture. He only withdraws through the trocar a portion of the fluid ; and the quantity of injection thrown in is nearly the same as that of the fluid which has been withdrawn. In all M. Bon- net's cases, the acute arthritis which supervened subsided within a few days, and was never followed by suppuration. Recently, M. Velpeau 7 has expressed himself more decidedly in regard to the beneficial effects of this plan; and he states that at least fifty cases treated by different surgeons, are now on record, in none of which were any alarming symptoms developed. Dangerous and fatal con- sequences had resulted, according to him, in M. Boyer's cases, from the joint having been laid widely open, and irritating fluids several times thrown in, whilst in the modern operation the smallest possi- ble trocar is employed, and in the majority of cases a single injec- tion is sufficient. He is now of opinion, that there is not more danger in injecting a joint than the tunica vaginalis. M. Velpeau likewise tried the effect of iodine injections into the 1 Medico Chi rurg. Rev. A pi. 1841, p. 541. 9 A. C. Post, New York Journal of Medicine, April, 1840, p. 369, and G. W. N orris, Amer. Journ. of the Med. Sciences, Feb. 1839, p. 299. 8 India Journal of Medicine, May, 1636. 4 Bulletin General de Therapeutique, Nov. 1841. ■ Recherches sur les Cavites closes, &c, pp. 112 — 165, and Bourchardat, Annuaire de Therapeutique pour 1843, p. 256. Pari?, 1843. 6 Braithwaite's Retrospect, v ii. 231 ; cited from Medico-Chirurgical Review, Apl. 1843 ; also, Traite des Maladies des Articulations. HL£ ACETA3. periments of Magendie, 1 were found to promote the coagulation of the blood. This salt of morphia has been highly recommended in arthritis and nervous affections, by M. V. Cristin, 2 of the Hospital St. John, Turin, according to a form given below. When the pains are relieved, or sleep is about to commence, the intervals between the doses are increased, or it is suspended altogether. Its good effects in neuralgia have been extolled by many others; — the effect of the remedy being kept up for days and weeks, if necessary. Mr.Braithwaite 3 remarks, that Dr. Cristin prescribes it in the dose of one-tenth of a grain every hour, but that he has generally found it necessary to give much larger doses without any other bad effect than severe sickness, which was easily abated by creasote or excitants— as the spiritus ammonia aromaticus. He pre- scribes one-fourth or one-sixth of a grain every hour or two, in severe cases, until the system is completely under its influence, and then keeps up its effects by smaller, and less frequently repeated, doses. It is questionable, however, whether the ace- tate be superior to opium. M. Gerard, of Avignon, has found it so highly useful in Asiatic cholera, that he prefers it to all other remedies. Of ninety-nine patients, treated thereby, eighty- one were cured. He found, when given early, that it especially checked the vomiting, and moderated the subsequent reaction, after which the other symptoms gradually ceased. When, how- ever, the resources of art had been long postponed, the effects of the remedy w T ere less marked; the vomiting and the other symp- toms persisted longer; the supervening reaction was much more tardy, and frequently ended in a state of collapse, which, under the most trifling imprudence, produced an unfortunate result. Gerard administered the acetate at first in the dose of one-fourth of a grain every half hour, until the serious symptoms were re- moved, and he omitted it as soon as the spasms and the diarrhoea and vomiting had ceased, or as soon as reaction ensued. In the treatment of chronic gastralgia, M. Valleix 4 derived the greatest benefit from the employment of small doses of the acetate. Its use in that disease is not new, but he modifies the usual mode of its administration. Instead of giving it before a meal, he pre- scribes it after, and in this way has relieved cases that had resisted all other treatment. He orders a grain of the acetate to be dis- solved in thirty drams of distilled water and nine drams of syrup, and directs a teaspoonful to be taken immediately after each meal. 1 Leeons sur Ie Sang, &c and translation in London Lancet, Jan. 26, 1839, p. 636. 2 Repcrtorio Medico-chirurgico del Piemonte, cited in British and Foreign Medical Review, Jan. 1840, p. 252. 3 Retrospect of Practical Medicine and Surgery, vol. i. Jan. to Jul)-, 1840, 3d edit, p. 15. London, 1S42. * Revue Medico-Chirurgicale, ii. 100, cited in Brit, and For. Med. Chir. Review, Jan. 1848, p. 275. MORPHIA ACETAS. 525 Under the use of these small doses, the bowels, instead of being very constipated, are better regulated. Acetate of morphia has been much used endermically , in the diseases mentioned under the head of Morphia. A quarter or half a grain or more is placed in some part of the skin whence the cuticle has been removed ; and it may be repeated, as the case may require. In the severer neuralgic and neurotic cases, the quantity applied in this way has been sometimes very large. In a case of hydrophobia, reported by Dr. Burne, 1 of London, ten grains at a time were sprinkled on a blistered surface, with excellent tran- quillizing effects. At times, when applied to a blistered surface for several days in succession, a papular eruption has been ob- served, which quickly becomes vesicular, proceeding from the edges of the blister, and gradually spreading over the entire sur- face. 2 A case of traumatic tetanus has been published, which was cured by the internal and endermic use of the acetate. 3 MODE OF ADMINISTRATION. The dose of acetate of morphia is from a quarter of a grain and less to a grain or more. Its strength does not vary materially from that of pure morphia. Liquor morphia acetatis. Solution of acetate of morphia, R. Morphias acetat. gr. xvj. Acido acetic, f gij. Aquas destillat. f sjvj. M. This formula was proposed by the author 4 as a substitute for the " gouttes calmantes " of Magendie, 5 which permit the depo- sition of the morphia when kept for a short time. The dose is from six to twenty-four drops. R. Morphias acetat. gr. xvj. Acid, acetic, gtt. iij. vel iv. Alcohol, f 5J. Aquas destillat. fgj. Fiat solutio. Magendie. Mistura morphise acetatis. Mixture of acetate of morphia. R. Morphias acetat. gr.i. Syrup, acacias f ^i. Aquae destillat. f %iv. M. Dose. — A spoonful every hour in arthritis and nervous affec- tions , until the pains are removed. Cristin. 1 London Medical Gazette, April 14, 1838. 9 A. T. Thomson, in London Lancet, for Jan. 19, 1839, p. 632. 3 L. Piquot, Journ. den Connais. Med. Chirurg. Dec. 1840. 4 Formulary, &c, translated from Magendie, by C. T. Haden, 2d edition, by Robley Dunglison, p. 14. Lend. 1824. Amer. edit., Philad. 1825. 6 Formulary, &c. 34 526 MORPHLE ACETAS. Syrupus morphise acetatis- Syrup of acetate of morphia. R. Morphiae acetatis gr. iv. Syrupi siraplic. Oi. Dissolve the salt in half a dram of -water acidulated with a few drops of acetic acid; filter, and add it to the syrup. This syrup is recommended and used in Paris, in place of the syrupus papaveris. It has the advantage of being always of uniform strength. Magendie. It has been suggested, 1 that the syrup of the acetate or sulphate of morphia should always be made of the strength of one grain to the ounce; and it is certainly desirable that uniformity should prevail in this respect. If this exist, it matters but little what the proportion is, within certain limits. The acetate may, also, be applied in the form of ointment; and it is frequently added to glysters, in chronic diarrhoea. Hildenbrand recommends the following ointment to be rubbed on the pubes in cancer of the uterus : — Unguentum morphiae acetatis. Ointment of acetate of morphia. R. Morphiae acetat. gr. iv. Ung. hydrarg. ciner. simpl. aa. ^ij. M. A piece, the size of a pea, to be rubbed on twice daily. A solution of acetate of morphia, which he terms liquor opii, has been proposed by Mr. Houlton. 2 He prepares it as follows; — Take two ounces and a half of the best Turkey opium; thirty- two fluidounces of Beaufoy's acid, of the strength of pickling vinegar: macerate with a gentle heat for six days, frequently shaking the vessel; then filter, and evaporate the fluid to the con- sistence of the extracts of the pharmacopoeia, finishing the evapo- ration by the spontaneous method. This Mr. Houlton employs under the name extr actum opii aceticum. To the above extract he adds, alcohol, five fluidounces; distilled water , thirty-five fluid- ounces; macerating for eight days, and filtering. This liquor opii is about the strength of the tinctura opii in sedative property, and Mr. Houlton affirms, from his observations, that it is in no respect inferior to Battley's liquor opii sedativus, — a secret preparation which has been much used. 1 Duhamel, Amer. Journ. of Pharmacy, for Oct. 1840, p. 187. a Lond. Medical Gazette, Aug. 12, 1837. See, also, Buchner, pere, in Journal de Pharniacie, Fevrier, 1842, p. 48. MORPHIiE MURIAS. 527 CXXIII. MORPHIA HYDRI'ODAS. Synontmes. Hydriodate or Iodhydrate of Morphia — called by some Iodide or Ioduret of Morphia. French. Iodhydrate ou Hydriodate de Morphine. German. Iodwasserstoffsaures Morphin. An Ioduret or Iodide of Iodhydrate of Morphia, has been introduced of late years. It is prepared by mixing a solution of acid sulphate of morphia, with a solution of ioduretted iodide of potassium, keeping the liquors for an hour at a temperature of 140°: the liquid is then poured off; and the residuum washed, col- lected on a filter, and dried. The iodide of hydriodate of morphia is in small brilliant spangles, (paillettes,) of a beautiful deep purple colour. It is insoluble in water, very soluble in alcohol, and very little so in ether. It ap- peared from the few trials made of it by M. Bouchardat, 1 to possess the narcotic properties of morphia, without diminishing the appetite. It requires to be given in double the dose of the other preparations of morphia. CXXIV. MOR'PHLE MURIAS. Synonymes. Morphinae Murias seu Hydrochloras, Morphias Hydrochloras, Morphium Muriaticum, Murias seu Chlorhydras Morphicus, Hydro- chloras Morphicus, Murias. Morphii, Muriate of Morphia, Hydrochlo- rate of Morphia or Morphine. French. Hydrochlorate ou Muriate de Morphine. German. Salzsaures Morphium, Hy drochlorsaure s Mor- phium. METHOD OF PREPARING. According to the last Pharmacopoeia of the United States, mu- riate of morphia is prepared as follows: — Take of morphia in powder, ^i.; distilled iv at er Oss.; muriatic acid, a sufficient quan- tity. Mix the morphia with the water; then carefully drop in the acid, constantly stirring till the morphia is saturated and dissolved. Evaporate the solution by means of a water bath, so that it may crystallize on cooling. Dry the crystals on bibulous paper. In the London and Edinburgh Pharmacopoeias, morphia is first separated from opium in the form of the muriate. 2 Muriate of 1 morphia is in snow-white feathery crystals, which are wholly soluble in water. 1 Nouveau Formulaire Magistral, p. 70. Paris, 1845. 3 For Wm. Gregory's mode of preparing the muriate, see Edinb. Med. and Surg. Journal, for April, 1831; or Philad. Journal of Pharmacy, iii. 124. See, also, M. Ro- bertson, in Edinb. Med. and Surg. Journal, for April, 1832 ; and A. T.Thomson, Lond. Pharmaceut. Joum. and Transact., or Amer. Journal of Pharmacy, July, 1842, p. 154. •528 MORPHIA MURIAS. MODE OF ADMINISTRATION. \ It may be given in the same cases and doses as the other salts of morphia. The following preparations are directed in the Edinburgh Phar- macopoeia. Trochisci morphiae, Morphia lozenges. R. Morphias rauriat. ^i. Tinct. tolut. f gss. Sacchar. ^xxv. Dissolve the muriate of morphia in a little hot water ; mix it and the tincture of tolu with the sugar: and with a sufficiency of mucilage form a proper mass for making lozenges; each of which should weigh about 15 grains. 1 Each lozenge contains about one- fourth of a grain of muriate of morphia. Dr. Pereira 2 states,, that the morphia lozenges of the shops usually contain one-twenty- fourth of a grain of the muriate. It is a good mode of employing morphia with the view of allaying cough. Trochisci morphiae et ipecacuanha . Morphia and ipecacuanha lozenges. R. Morphiae muriat. ^i. Ipecac, in pulv. subtil, ^i. Tinct. tolut. f gss. Sacchar. ^xxv. Proceed as for Trochisci Morphiae. Each lozenge contains about one-fourth of a grain of muriate of morphia, and one-thirteenth of a grain of ipecacuanha. They are used in the same cases as the last. CXXV. MORTHI^E SULPHAS. Synonymes. Morphinge Sulphas, Morphium Snlphuricum, Sulphas Mor- phii seu Morphicus, Sulphate of Morphia or Morphine. French. Sulfate de Morphine. German. Schwefelsaures Morphium, Morphiumsulphat. METHOD OF PREPARING. Morphia is dissolved in dilute sulphuric acid. The solution is then evaporated by heat, and suffered to crystallize, which it does in silken tufts, or snow-white feathery crystals that are wholly soluble in water. EFFECTS ON THE ECONOMY. The general effects of sulphate of morphia on the economy in 1 Christison, Dispensatory, p. 643. Edinb. 1842. 2 Elements of Mat. Med. and Therap. ii. 1782. Lond. 1842; or 2d American edi- tion, by Carson. Philad. 1846. MORPHLE SULPHAS. 529 health and disease resemble those of the acetate, to which it is perhaps to be preferred on account of its greater uniformity. There is an advantage, however, in retaining both preparations in the Materia Medica, as when the system becomes accustomed to the one, the other may be substituted. In his experiments on the blood, Magendie 1 found that the sul- phate of morphia — unlike the acetate and the muriate — opposed the coagulation of that fluid. A syrupus morphia sulphatis, a liquor morphia sulphatis, and an unguentum morphia sulphatis may be formed in the same man- ner as with acetate of morphia. The common form for the solu- tion of sulphate of morphia is the following: it is that of the Phar- macopoeia of the United States ; and it is to be regretted, that the strength is not the same as that of the Liquor Morphias Jlce- tatis. Liquor morphise sulphatis. Solution of sulphate of morphia. R. Morphias sulph. gr. viii. Aquae destillat. Oss. Fiat solutio. Dose. — A tea-spoonful (which is considered to be equivalent to about twelve or fourteen drops of laudanum,) to be repeated as oc- casion may require. Lotio morphise sulphatis et sodse boratis, Lotion of sulphate of morphia and borate of soda. R. Morphise sulphat. gr. vj. SodaB borat. ^ss. Aquse rosse f ^viij. M. To be applied thrice a day to the affected parts by means of a piece of sponge, or a piece of linen, in pruritus vulvas, taking the precaution first to wash the surface with tepid water and soap, and to dry them before applying the lotion. Meigs. 2 Citrate of Morphia is occasionally used ; but it possesses no advantage over the preparations described above. Many years ago, Dr. Porter, of Bristol, recommended a liquor morphias ci- tratis to be prepared in the following manner: — Beat four ounces of the best crude opium in a mortar, with two ounces of crys- tallized citric acid ; mix well with a pint of boiling water; and filter after twenty-four hours' maceration. Dr. Paris speaks well of this preparation. 3 Magendie recommends the substitution of the following process : 1 Legons sur le Sang, &c; or translation in London Lancet, January 26, 1 839. ? A Treatise on the Diseases and Special Hygiene of Females, by Colombat de l'lsere, translated by C. D. Meigs, p. 272. Philad. 1845. 3 Pharmacologic 4th American from the 7th London edit. By J. B. Beck, p. 439. New York, 1831. 530 MORPHIiE SULPHAS. R. Morphias pur. gr. xvj. Acid, citric, crystalliz. gr. viij. Aquae destillat. f ]§j. Tinct. cocci, q. s. Fiat solulio. Dose. — Six to twenty-four drops in the twenty-four hours. A Tartrate of Morphia was suggested by Mr. Haden 1 as a substitute for the liquor opii sedativus of Battley. Mr. Haden made it by macerating the dregs, remaining after making the tinc- ture of opium, in a solution of tartaric acid. Forty drops acted in all respects like twenty of the liquor opii sedativus. It neither stimulated nor induced costiveness. The bimeconate of morphia has been brought before the no- tice of the profession by Mr. Squire. 2 It may be prepared by adding freshly precipitated morphia , to meconic acid in solution. It occurs in minute crystals of a white colour, soluble in water, — the solution giving the reaction due to meconic acid and mor- phia. It is an acid salt: for meconic acid is tribasic; and in the bimeconate of morphia, there are two equivalents of morphia, and one equivalent of water to each equivalent of acid. 3 Impressed with the idea, that the combination of the active principle of opium, as prepared by nature, would prove more be- neficial as a therapeutical agent than the artificial salts, Mr. Squire instituted a number of experiments, with the view of procuring the bimeconate as free from the other ingredients of opium as possible; and he asserts, that at length he obtained a tolerably pure salt, which, from the trials that have been made with it, has fully an- swered his expectations as to its superior medicinal power over the other preparations of opium. The salt is given in solution made nearly of the same strength as laudanum. The dose of the bimeconate is gr. J and upwards. Dr. Macleod, who made trial of it, asserts, that it appeared to him to be a very mild and efficient preparation, rarely producing headach or other discomfort ; and that it repeatedly answered, in the most satisfactory manner, where opium had disagreed, and suc- ceeded in some cases where other salts of morphia — the acetate and the muriate — had failed to give relief. Equally strong testi- mony in its favour is afforded by Dr. A. T. Thomson, who de- tails three cases — one of neuralgic pain of the left side of the face; another of wakefulness, without any apparent cause, and a third of anomalous pain of the hip and thigh, all benefited strikingly by its use. A preparation termed M l Munn > s Elixir of Opium has been 1 Translation of Magendie's Formulary, 2d edit. By Robley Dunglison, p. 19. Lond. 1824. 3 Lond. Med. Gaz., Mar. 9, 1839. 3 Ballard and Garrod, Elements of Mat. Med. and Therap. p. 406. Lond. 1845. MOXA. 531 introduced into American practice with many testimonials in its favour; but the formula for its preparation is kept secret; and therefore, it merits no farther notice here. M. Bouchardat 1 speaks of a double muriate of morphia and codeia; French, Chlorhydrate double de morphine et de co- deine ou Sel de Gregory, which is obtained directly in the pre- paration of morphia by the process of Dr. Gregory. It is not used in France, but, he says, it is much employed in England, [?] where it is considered to enjoy decidedly sedative properties. It is given in the same cases as the salts of morphia, from which it differs but little. CXXVI. MOXA. Synonyme. Moxiburium. By the term moxa, the Chinese and Japanese designate a cot- tony substance, which they prepare by beating the dried leaves of Artemisia Chinensis, a kind of Mugwort. Dr. Lindley, however, states, that it is made from A. Moxa. 2 With this down they form a cone, which is placed upon the part intended to be cauterized, and is set fire to at the top. This mode of exciting counter-irri- tation has been long practised by the Chinese and Japanese, and by the ruder nations of the old world ; but it was not much em- ployed in Great Britain and France until about the commencement of the seventeenth century, when it was introduced through the agency of a Dutch physician 3 who had resided in India. It fell again, however, into disuse, until attention was redirected to it, during the last century, by Pouteau 4 and Dujardin, and, at the commencement of this century, by Percy and Laurent, 5 and others. 6 METHOD OF PREPARING. Various agents have been used by different people, in " moxi- bustion," — for so the mode of cauterization has been termed, which consists in placing some combustible substance on a part of the body, and suffering it to burn down. From the earliest ages, the Nomades employed the fat wool of their flocks, as well as certain spongy substances growing upon oaks, 7 or springing 1 Nouveau Formulaire Magistral, p. 70. Paris, 1845. 3 Flor. Med. 463. 3 Ten Rhyne, Medit. de Veteri Medicin.; Dissert, de Arthritide, Lugd. Bat. 1672 ; and Kaempfer's History of Japan, translated by Scheuchzer, vol. if. append, sect. iv. Lond. 1728. * Melanges de Chirurgie, p. 49. * Dictionnaire des Sciences Medicales, art. Moxibustion. 6 See, for a history of the Moxa, the author's translation of Baron Larrey's Memoir on the Use of the Moxa. Lond. 1822. 1 Hippoc. lib. de Affect, cap. xxx. 532 moxa. from the hazel: 1 the Indian, the pith of the reed, 2 and flax or hemp impregnated with some combustible material ; 3 the Persian, the dung of the goat ; the Armenian, the agaric of the oak; the Chinese and Japanese, the down of the artemisia ; the Thessalian, dried moss ; 4 the Egyptians, the Arracanese, and several oriental nations, cotton ; 5 the Ostiaks 3 and the Laplanders, 7 the agaric of the birch ; and the aborigines of this continent, rotten and dried wood. Hippocrates s was in the habit of employing fungi and flax for the same purpose. In modern times, also, various substances have been used for the fabrication of moxas. Whatever article is selected, it ought to be a spongy, light, vegetable matter ; readily combustible, and so prepared as to burn down slowly. In Germany, they use the tinder — amadou — which is known to be an agaric prepared for the purpose; and it is not uncommonly employed in our hospitals, — a small disc or cylinder being placed on the part, and set fire to. It has been generally used in the French hospitals. 9 The match used by artillerists was recommended by Percy, 10 after Bontius: 11 it is composed of hemp steeped in a solution of nitre. He likewise proposed the pith of the sun-flower — helianthus an- num — recommending that the stalk should be cut into cylinders of the desired length, the bark being lefj; on ; so that, when ignited, it may burn in the centre and be held with the hand. 12 This he called moxa de voleurs. 13 These moxas, called Percy's moxas, prepared by Robinet, are found in the London shops. They con- sist of pith, rolled in cotton and enveloped in muslin. 14 The moxa, used by Larrey, and very generally employed by many practitioners, is made by taking a quantity of cotton wool, pressing it somewhat closely together, and rolling over it a piece of fine linen, which is fastened at the side by a few stitches. Lar- rey advises, that it should have the shape of a truncated cone — the form usually adopted — and be about an inch long. Commonly, the cylinder is shorter than this ; six or eight lines — as, when above six lines high, the combustion is not felt — and about four or five lines broad. The moxas employed by Dr. Sadler, 15 of St. 1 Paulus iEginet. lib. vi. cap. 49. 3 Ksempfer, vol. ii. app. sect. iv. p. 36. 3 Bontius, De Medicina Indorurn, p. 32. 4 Percy in Pyrotechnie Chirurgicale Pratique, p. 12. 5 Prosper. Alpin. de Medicina iEgyptiorum, lib. iii. cap. 12. 6 Voyages de M. Pallas, iv. 68. * Acerbi's Travels through Sweden, Finland, and Lapland, ii. 291; and Linnseus, in Lachesis Lapponica, translated by Sir James Smith, i. 274. 8 De Affect, cap. viii. p Bulletin General de Therapeutique, Juillet, 1840. 10 Op. cit. p. 77. Paris, 181 1. ll Op. cit. p. 32. Paris, 1645. 13 Art. Moxibustion, in Diet des Sciences Medicales. 13 Merat and De Lens, Diet, de Mat. Med. art. Moxa. 14 Pereira, Elements of Mat. Med. 2d edit. p. 1352. Lond. 1842; or 2d Amer. edit by Carson. Fhilad. 184 b. 14 Zeitschrift fur die gesammte Medicin.'B. iii. H.ii. & iii., cited in British and For. Med. Review, July, 1837, p. 217. moxa. 533 Petersburg, are about half an inch in diameter; and three-quarters of an inch in height. They are composed of a nucleus formed of the pith of the sun-flower wrapped in layers of cotton of various thickness, and surrounded with an external envelope of thin mus- lin ; both of the latter being previously steeped in a solution of nitre. They are held, while burning, by means of two long- hair-pins, the legs of which are slightly bent, in order to accom- modate them to the shape of the moxa ; and when the latter is burned down to the place where it is held by the first hair-pin, it can be held with the other, and retained in its proper position. With this last view, Larrey 1 has a special porle-moxa, consist- ing of a ring to receive the cylinder, with a handle attached to it, and three small supports or knobs of ebony, placed beneath the ring, to prevent the heated metal from acting upon the surface. Mr. Leney 2 soaks a piece of lint in a strong solution of nitrate of potassa, dries it, and cuts off pieces of the size of the thumb nail, which he fastens with thin adhesive plaster over the seat of pain; sets fire to the opposite extremity, and then applies the blow-pipe. The pain during the process is very severe, but he affirms, that the Irish prefer it greatly to the application of a blister. Pro- fessor Grafe 3 employs moxas made of wafers, dipped in a mixture of three parts of oil of turpentine, and one part of sulphuric ether. Before applying this inflammable matter to the skin, it is neces- sary to remove carefully the superfluous liquid. These moxas are said to ignite readily, burn promptly and uniformly, and not to crepitate. A plan for raising vesication on the surface has been adopted, which, as Dr. Granville remarks, must be regarded as a kind of moxa. 4 This he admits to be equally successful w T ith the one he proposes, and which has been already described (p. 24S 9 ) in form- ing a rapid vesication : "but it is, at the same time, so complicated, and attended by such intense pain," that, in practice, he says, it will not bear comparison with the preparations which he recom- mends. A piece of linen or paper, being cut of the requisite size, is immersed in spirit of wine, or brandy. It is then laid on the part to be blistered, care being taken, that the moisture from the paper or linen does not wet the surrounding surface. The flame of a lighted taper is applied quickly over the surface, so as to pro- duce a general ignition, which is exceedingly rapid. At the con- clusion of this operation, the cuticle is found detached from the true skin beneath. In cases of convulsions, the region of the spine has been treated in this manner, and with good effects. 5 1 The author's translation of his Essay on the Moxa, p. 5. J Lond. Med. Gaz., July 15, 1842. ' 3 La Lancette Frangaise, 26 Jan., 1839. 4 Counter-irritation, its Principles and Practice, Amer. Med. Library edit., p. 21 and p. 42. Philad. 1838. 5 C. J. Edwards, in Provincial Med. and Surg. Journal, Jan. 1842. 534 moxa. Dr. Osborne, of Dublin, 1 avails himself of the high temperature produced by lime in the act of slaking, for the purpose of a moxa. Some quicklime in powder is placed to the depth of about half an inch within a strip of card, bent and tied so as to form a cir- cle. Water is then dropped on the lime, and mixed with it. In about two minutes, it swells, and becomes dry; and, at the same time, a degree of heat is produced, which — according to some ex- periments — may amount to 500° Fah. He considers this moxa superior to all others; — first, from the intensity of the heat, and secondly, from its convenience, — not requiring the assistance of any heated substance, and being unaccompanied by the emission of sparks or smoke, which frightens the patient. When the quan- tity of lime used is smaller than that mentioned above, or if it be not kept on long, an appearance results, resembling that produced by acetic acid; and a thick crust is formed, which separates as the new skin is perfected beneath. But if the quantity of lime be large, and it be kept on as long as the heat continues, a complete destruction of the skin ensues; and in this manner issues may be made of greater depth, and in a much shorter time, than by the usual cauterants. Dr. Osborne gives a case of apparent ulceration of the upper part of the rectum and sigmoid flexure of the colon; in which all the symptoms of internal ulceration disappeared after the application of a lime moxa, of about the size of a crown, over the region of the sigmoid flexure. In a case of incipient soften- ing of tubercles ; and in another apparently of purulent infil- tration after pneumonia, its effect in arresting the ulcerative process was most decided. In a case of hip- joint disease, in which there was great pain, and consequent loss of sleep, the pa- tient slept well on the following night, and, in a few days, had gained much power over the limb ; and in another case of the same disease, which had proceeded to destruction of the joint, and extensive enlargement of the parts around it, great relief was ob- tained. The size of the ulcer formed by it is always much larger than that of the lime applied. When the lime is prepared from calcareous spar, the heat, produced on the addition of water, is sudden and intense, and the pain is proportionably urgent. For ordinary purposes, however, well selected pieces of lime from a lime-kiln answer well if fresh, but not otherwise. In the application of the various moxas, or of most of them, their agency can be so graduated as to produce either simple ru- befaction, vesication or the formation of an eschar. Where it is desirable to produce the first result only, the cylinder of cotton may be removed w T hen the pain becomes somewhat severe; or the burning material may be held close to the surface, and be moved gradually along it. In this manner, a counter-irritant effect may 1 Dublin Journal of Medical Science, Jan. 1842. NARCOTINA. 535 be exerted along the spine or any extensive surface. Any burn- ing substance — a lighted coal, for example — will answer for this purpose. When vesication is needed, it must be kept on longer; and if it be desirable to produce an eschar, the moxa may have to remain on until it is wholly consumed. Larrey, 1 indeed, advises, that the blowpipe should be occasionally employed to hasten the combustion. When the integument has once become disorganized, the slough will be thrown off in due time, leaving an ulcer. Lar- rey says the sloughing can be prevented by the application of liquid ammonia 2 to the burnt surface, after the moxa has been removed. This will do when the disorganization is partial; but we know, from experience, that it often fails. EFFECTS ON THE ECONOMY IN DISEASE. Moxa — in its different forms— is doubtless a most valuable agent, when rapid counter-irritation is indicated. It resembles, indeed, in its action, the ammoniated counter-irritants of which we have already treated, and is applicable to the same diseases ; — the only difference between them — when cauterization is effected — being, that the agent in the case of the ammoniated lotion is a po- tential, in that of moxa an actual, cauterant. The moxa must be regarded as one of our most valuable re- vellents. CXXVII. NARCOTINA. Stnonymks. Narcotinum, Narcotin, Narcotine, Opiane, Matter or Salt of Derosne. French. Matiere ou Sel de Derosne, Sel Essentiel d'Opium. German. Narkotin, Opian ; Deros ne'sches Opiumsa Iz. In regard to the precise properties of this substance, which is one of the immediate principles of opium, and has attracted the attention of many chemists and therapeutists, much uncertainty exists. It seems, that it has not hitherto been found except in opium. METHOD OF PREPARING. It is commonly obtained, either from crude extract of opium, by means of ether, which only dissolves the narcotina, and con- sequently requires but to be evaporated to obtain it; or from crude opium, which has been exhausted by cold water : it may hence be obtained from the residue after the preparation of the aqueous extract of opium of the shops. With this view, the opium or re- sidue is twice treated with boiling acetic acid at 2° or 3°; it is pre- cipitated by ammonia, and the washed precipitate is purified by treating it with hot alcohol at 40°, and a little animal charcoal; 1 Op. citat. p. 5. 2 Ibid. p. 9. 536 NARCOTINA, the liquid is then filtered, and the pure narcotina is precipitated on cooling. It crystallizes in very white needles; is devoid of taste and smell; fusible in the manner of resins, and very slightly soluble in water; soluble with the aid of heat in alcohol, and in the volatile and fixed oils; very soluble in ether, which distinguishes it from morphia ; very soluble also in cold acetic acid, whence it is pre- cipitated on heating the solution — another mode of separating it from morphia — and soluble in dilute acids. It is coloured of a vivid red by nitric acid; and is analogous, in some respects, to the crystallizable resins or sub-resins of M. Bonastre. 1 Narcotina is generally reckoned amongst the vegetable alkaloids ; but by some it is considered to be neuter. 2 Dr. Christison 3 states, that " opium contains no fewer than seven crystalline principles ; — morphia, codeia, and paramorphia, narcotin, narcein, porphy- roxin and meconin, of which the first three are alkaline and the others neutral." Dr. O'Shaughnessy 4 prepares muriate of narcotina by taking of Bengal opium., two pounds ; Alcohol, 20 pounds. These are rubbed together in a large mortar, adding the spirit by degrees, until the opium is exhausted of its soluble parts. The solution is then de- canted, and the insoluble portion pressed. To the alcoholic solution as much ammonia is added as renders the liquid slightly turbid. Fifteen pounds of the alcohol are then distilled from a common alembic; and the fluid in the still is drawn off, and set aside to cool. On cooling, a mass of coloured crystals is deposited, com- posed of narcotina, meconate of ammonia, and resin. This is washed with water, which dissolves the meconate of ammonia, and afterwards with a quart of water and a dram of muriatic acid, which dissolves the narcotina and leaves the resin. The solution is then filtered, and evaporated to dryness. Muriate of narcotina, thus prepared, is a transparent resinous mass, of rosy colour, and brittle vitreous texture. It is very soluble in distilled water and spirit; and its salts are intensely bitter. EFFECTS ON THE ECONOMY IN HEALTH. These have been so contradictory, that it has been conceived the same preparations cannot have been used by different obser- vers. 5 According to Magendie, 6 morphia is the anodyne prin- ciple of opium, and narcotina the exciting. When a grain of nar- cotina dissolved in oil was given to a dog, it produced a state of stupor, which superficial observers might readily confound with 1 Merat and De Lens, Diet, de Mat. Med. art. Narcotine. 3 Christison, Dispensatory, Amer. edit p. 702. Philad. 1S4S. 3 Ibid. p. 701. • Calcutta Quarterly Journal, and Lond. Lancet, July 20, 1839. p. 606. 5 Ibid, and Diet, des Sciences Medicates, xxxiv. 298. 6 Formulaire pour la Preparation, &c, de plusieurs nouveaux Medicamens. NARCOTINA. 037 sleep; but it differed evidently from sleep; the animal's eyes were open ; the respiration was not deep, as in sleep, and it was impossible to arouse it from its sluggish condition. Death generally took place in twenty-four hours. When combined with acetic acid, it produced quite different effects. Animals could bear a dose of even twenty-four grains without dying, and, whilst under its influence, they were agitated by convulsions like those which camphor induces — exhibiting the same signs of fright, the same backward motions, foaming at the mouth, convulsions of the jaws, &c. When morphia and narcotina were both given at the same time, the different effects of each occurred together. A grain of morphia, for example, and a grain of narcotina, dissolved in acetic acid, were placed in the pleura of a dog. The animal soon became drowsy, and fell asleep under the influence of the morphia ; but a singular and remarkable strife appeared to go on for an hour and a half, between the stimulating effects of the narcotina and the anodyne effects of the morphia. At length, however, the ani- mal slept soundly, being probably, Magendie suggests, under the influence of the morphia alone. His opinion is, that narcotina is injurious when not united with an acid, and very exciting when so united. M. Orfila — the celebrated toxicologist — has enter- tained, it appears, various views upon the action of narcotina; at one time considering it inert, at another to possess the same action as morphia ; and at another, to concur, when combined with morphia, in the properties of opium, but to a slight degree — since opium, deprived of narcotina, is not less deleterious — and to possess a different modus operandi from opium, without, however, our being able to regard it as the exciting principle. 1 Owing to all these uncertainties connected with it, narcotina is little if at all employed in medicine. It would seem, however, that the exciting properties of opium do not appertain exclusively to it; for, as has been elsewhere remarked, there are many persons who are as disagreeably affected by morphia alone as they are by opium, which contains both morphia and narcotina. The salts of narcotina — the muriate and the sulphate — have been employed successfully as antiperiodics, especially in intermit- tents? and Dr. O'Shaughnessy 3 has laid before the Medical Society of Calcutta the results of his experience with them. Sixty cases were treated, of which all but two were successful. He remarks farther, that, besides the sixty cases recorded, more than one hun- dred ague patients had been treated by his pupils and acquaintances with perfect success by the remedy. 1 Merat and De Lens, op. cit., and Orfila, Toxicologic Generate, ii. 69. 9 Roots, London Lancet, Sept. 1832. and T. W. Jeston, ibid. Oct. 6, 1832, p. 41. 2 India Journal of Medical Science, Sept. and Nov. 1838, cited in British and Foreign Medical Review, No. xv. for July, 1839, p. 263. •538 NUX VOMICA. CXXVIII. NUX VOMICA. Synonymes. Vomic Nut, Poison Nut. Bachelor's Buttons. French. Noix Vomique. German. Krahenaugen, Brechnuss. EXTRACTUM NUCIS VOMICAE ALCOHOLICUM. Synonymes. Extractura Nucis Vomicae Resinosum seu Nucis Vomicae Spirituosum, Spirituous, Resinous or Alcoholic Extract of Nux Vomica. French. Extrait Alcoolique de Noix Vomique. German. Geistiges Extrakt der Krahenaugen. In the year 1809, Magendie discovered that one entire class of vegetables — the bitter strycbnos — has the power of exciting the spinal marrow without implicating, except indirectly, the functions of the brain. 1 Since then, many have confirmed the observations of Magendie, and have attended especially to its agency in various diseases. The preparation of the strychnos most used, if we ex- cept the active principle — has been the alcoholic extract of the nux vomica. METHOD OF PREPARING. Take any quantity of rasped nux vomica; exhaust it by repeated macerations in alcohol of 40° (.817,) and evaporate it slowly to the consistence of an extract. Alcohol of less strength may be used, but, according to Magendie, the product will be proportionably less active. A dried alcoholic extract is made by dissolving in water the alcoholic extract made by means of alcohol at 36° (.837 ;) filtering and evaporating in appropriate dishes, as in making the dry extract of bark. The Extractum Nucis Vomicje of the Pharmacopoeia of the United States is directed to be prepared as follows: — Take of Nux vomica, a pound; Alcohol, a sufficient quantity. Expose the nux vomica to steam till it is softened, then, having sliced and dried it, grind into powder. Introduce it into an apparatus for displace- ment, and pour alcohol upon it gradually until the liquid passes without bitterness. Distil off the greater part of the alcohol from the filtered liquor, and evaporate the residue to the proper con- sistence. 2 EFFECTS ON THE ECONOMY. According to Magendie, a grain of this extract, absorbed from any part of the body, or mixed with food, promptly destroys a dog of considerable size, by inducing paroxysms of tetanus, which, by their continuance, arrest respiration sufficiently long to induce complete asphyxia. When the dose is much stronger the animal 1 Exarnen de Taction de quelques vegetaux sur la moel'.e cpiniere. Paris, 1809; and Formulaire, &c. * Pharmacopoeia of the United States, p. 352. Fhilad. 1842. NUX VOMICA. 539 appears to die entirely from the action of the nux vomica on the nervous system. 1 If an animal be touched whilst under the action of the substance, it experiences a commotion similar to that of a strong electric shock, and this takes place each time the contact is renewed. On dissection, no morbid appearances exist which can account for death. When introduced into the frog's stomach, Dr. Lombard, 2 of Geneva, found, that it produced tetanic convulsions, which, in a few hours, caused death. The contractions of the heart were sometimes strong and complete, sometimes irregular, tumul- tuous and intermitting; always diminished in frequency. Ap- plied to the heart itself, it slightly stimulated it, rendering the pul- sations more energetic and frequent, whence Dr. Lombard con- cludes, that nux vomica cannot be used with advantage in any diseases of the heart; for, although it diminishes the frequency of the pulsations, it renders them irregular. The action of the extract on healthy man is the same as that described by Magendie, and if the dose be sufficiently large, death speedily follows with the same symptoms. 3 In those that are af- fected with paralysis, the effect is also the same ; but, what is sin- gular, it is particularly manifested in the paralyzed parts by tetanic convulsions, and a feeling of creeping, which indicate the operation of the remedy; and a local perspiration is also often observed to break out on some parts of the body. When administered in cases of hemiplegia, the contrast between the tw T o sides of the body is ren- dered striking: whilst the sound side remains at rest, the other may be violently agitated ; tetanic shocks may supervene, and a copious perspiration break out. In a female, Magendie saw the affected side covered by a peculiar eruption, whilst the other side afforded no trace of it. There is a difference even between the two sides of the tongue, a decidedly bitter taste being occasionally per- ceived on the one, whilst the other exhibits nothing similar. If a much larger dose be given, both sides of the body participate, but unequally, in the tetanic spasms, so that the patient is sometimes thrown out of bed by the violence of the contractions. When given in very small doses, it has no perceptible effects immediately, and some days elapse before its advantageous or noxious properties can be appreciated. According to Magendie, 4 the extract may be given in all dis- eases that are attended with debility, general or local, and in paralysis of all kinds, general or partial. He himself observed excellent effects from it in debility of the genital organs, inconti- nence of urine, &c. He also used it with advantage in several 1 S^galas, in Journal de Physiologie, par Magendie, Oct. 1822. 2 Gazette Medicale de Paris, 18 Oct, 1835. 8 See the details of two cases of poisoning by nux vomica, in Lond. Med. Rep. xix. 448 and 456; Christison on Poisons, and Brande, Diet, of Mat. Med. p. 375. Lond. 1839. See also, A. S. Taylor on Poisons, Arner. edit., by R. E. Griffith, p. 620. Philad. 1848. 4 Formulaire pour la Preparation, &c, de plusieurs nouveaux Medicamens, &c. 540 NUX VOMICA. cases of partial atrophy of the upper and lower extremities. As regards its administration in cases of paralysis succeeding to apoplexy, he remarks, that it should not be given until some time after the coup de sang in the brain, which occasioned the palsy ; and that even then beneficial results can be expected only when no marked organic mischief exists: indeed, in the latter case, he considers the disease irremediable, and that bad effects might result from pushing the remedy. The efficacy of the alcoholic extract of nux vomica in various forms of paralysis has been con- firmed by many observers. Even before Magendie had employed it, Fouquier 1 had given it in several cases, with the most satisfac- tory results. Since then, we have the testimony of Chauffart, 2 Gendron, 3 Perrussel, Recamier, Mauricet, Baxter, 4 Galli, Hauff, Wenneis, Burkard, Petrequin, 5 Gellie, 6 Debreyne, 7 and numerous others in its favour. The author's own experience with it in cases of hemiplegia has not been limited ; yet although he has succeeded in inducing tetanic movements in the limb, he has not been satis- fied that much advantage was derived from it; 8 and in some cases, it appeared to induce serious encephalic excitement. After effu- sion has occurred into the encephalon, time is required for its absorption, and but little beneficial agency can be expected from any remedy. Nor are the results of the experiments and obser- vations of Jahn by any means in accordance with those of the practitioners above mentioned. He tried it in numerous cases of paralysis, but affirms that he did not see any good effect from it; and, with the exception of two cases, did not notice the slightest action, although the extract was carefully prepared according to the formula given by Magendie. Yet, he remarks, he was by no means sparing in the dose. In the two cases in which a change seemed to be induced, there was an evident increase of the paralysis. This discrepancy, as well as other evidences of the same contrariety of experience, may doubtless have been partly owing to difference in the strength and quality of the preparation; and hence, according to some, the great value of strychnia — its active principle — which is not liable to so much uncertainty. 9 Dr. Christison, 10 however, affirms, that " there seems no particular reason why the powder and extract should have been displaced by the principle strychnia; for their effects are precisely the same; and the principle is not 1 Bulletin de la Faculte de Medecine, &c., vol. v. 1818. 2 Journ. Gener. de Med, Oct. 1824. 3 Ibid. Nov. 1829. 4 New York Medical Repos. vol. viii. » Gazette Me'dicale de Paris, 27 Oct and 3 Nov., 1838, and Bulletin General de Therapeutique, Mars, 1840. 6 La Lancette Francaise, 29 Aoiit, 1837. 1 Braithwaite's Retrospect, Amer. edit. x. 26. New York, 1845; cited from Med. Chir. Review, Oct. 1844, p. 384-396. 8 See the author's Practice of Medicine, 3d edit., ii, 167. Philad. 1848. Also. Chauffart. in op. cit. 9 Richter's Specielle Therapie, u. s. w. B. x. S. 352. Berlin, 1828. 10 Dispensatory, p. 658. Edinh. 1842. NUX VOMICA. 541 only troublesome to prepare, but likewise, being seldom pure, is liable to the objection of irregular strength, which is brought against the Galenical preparations of the drug. In cases of partial paralysis, as in colica pictonum, amaurosis? palsy of the rectum, &c, both the alcoholic extract of nux vomica and its active principle have been used with good effect. (See Strychnia.) M. Barez 3 affirms, that he has succeeded in readily- removing prolapsus ani in the young, after diarrhoea, &c, by means of an aqueous solution of nux vomica. Four scruples of salep are boiled for twenty minutes in three ounces and a half of water, and after straining, three-fourths of a grain of the aqueous extract of nux vomica are added. A spoonful of this mixture is given at intervals, so that the whole is taken in twenty-four hours. It need hardly be said that in the case of young children, this potent article should be used with great caution. It has been given with good results by M. Duclos, 3 in impo- tence and spermatorrhoea. He divides seventy-five grains of the alcoholic extract into one hundred pills. During five days, he gives one every night; then, for five days more, one, morning and night; for five days more, two, night and morning; and for five days more, two at morning, and three at night, until four are taken night and morning. The liniment, for which a formula is given hereafter, rubbed on the loins, and on the inside of the thighs, is a useful auxiliary. Dr. Cerchiari 4 treated two cases of incontinence of urine suc- cessfully with the extract. The first was that of a girl nineteen years of age — who, from her infancy, had passed her urine in- voluntarily every night in her sleep. She was ordered the third of a grain of the extract in pill, three times a day; and in eight days the cure was complete. The second case was that of a young married female, whose urine flowed involuntarily, day and night, after her first delivery. As there was no fistulous opening to account for the involuntary discharge, and it appeared to arise from weakness of the neck of the bladder, in consequence of con- tusion by the head of the child, the extract was administered in the same doses as in the preceding case, and in fifteen days the cure was complete. Mondiere, in cases of incontinence of urine, dependent upon atony, prescribed it advantageously in association with black oxide of iron ; 5 and M. Petrequin 6 found, that local ' Petrequin and Miquel, in Bulletin General de Therapeutique, Juillet, 1838, De- freyne, op. cit. 3 Journ. de Medecine, July, 1845, cited in Edinb. Med. and Surg. Journ. July, 1846, p. 256. 3 Bulletin de Therapeutique, xxxvi. 529-33 ; cited in Brit, and For. Med. Chir., Oct. 1849, p. 5G4, and in Bouchardat, Annuaire de Therapeutique pour 1850, p, 24. 4 Gazette Medicale, 14 Avril, 1838. s Bouchardat, Annuaire de Therapeutique pour 1841, p. 8. Paris, 1841. 6 Bulletin General de Therapeutique, Mars, 1840. 35 542 NUX VOMICA. ancesthesia or loss of sensibility in a part yielded, in numerous instances, to embrocations of the tincture referred to hereafter. Cazenave gave the extract successfully in a case of St. Vitus' *s dance, which had resisted every other remedy ; and Professor Trousseau relates several cases of cure, from the employment of the alcoholic extract in the dose of about three-quarters of a grain; or of strychnia, in the dose of one-sixth of a grain. Sir Charles Scudamore, M. Roclants, 1 and Mr. Pidduck, 2 found it useful in neuralgia, the former in neuralgia faciei especially. Vogt gave it — not without advantage — in cardialgia; Hildenbrand, in epi- lepsy: by the Russian and Polish physicians it was administered advantageously in cholera diarrhoea, and by many it has been strongly advised in chronic diarrhoea and dysentery, 3 as well as in dyspepsia, in the varieties termed pyrosis and gastrodynia, especially when they appeared to proceed from morbid irrita- bility of the nerves of the stomach* as in the vomiting of the pregnant female. 5 The addition of a small portion of the ex- tract has been suggested by M. Boult as a remarkably powerful adjuvant to cathartics. He generally prescribes it in pill, accord- ing to the formula given hereafter; and Dr. Ranking 6 affirms, that he has been in the habit of combining strychnia with an aperient extract, with considerable advantage, in habitual constipation. Two cases of obstinate constipation are recorded by M. Ossieurs, 7 which, after having resisted other means, yielded at once to nux vomica. Recently, Mr. C. F. Gream 3 employed it, at the sug- gestion of Mr. Hammerston, of St. George's Hospital, London, in the cure of hay fever — summer bronchitis, with the best effects. He gave the tinctura nucis vomicae of the Dublin Phar- macopoeia in doses of ten drops, gradually increased to twenty, three times a clay ; at the same time applying to the lining mem- brane of the nostrils, as high up as possible, an ointment composed of a dram and a half of Goulard's extract, two ounces of spermaceti cerate, and a few drops of oilofbergamot. (See the article Strychnia.) 1 Med -Chir. Review, from Edinb. Med. and Surg. Journal, Oct. 1843. a London Med. Gazette, Aug. 7, 1840. 3 Most's Encyclopadie, 2te A ullage, art. Dysenteria, i. 573. Leipz. 1836. Geddings, N. American Archives, No. 2, Nov. 1834 s Roots, in St. Thomas's Hospital Reports, No. iii. for April, 1836; Hufeland, in Bally, Bulletin General de Therapeutique. Fev. 1S3S; and Nevins, Lond. Med. Gaz., Dec. 15, 1848. 4 Mellor, in Med. Gaz., March 4, 1837, p. 850. H. S. Melcombe, ibid. March 25, 1837, p. 964; cited in Amer. Med. Intel. July 1, 1837, p. 124; and M. Huss, in Zeit- schrift fur die gesammte Medicin. May, 1837, p. 393, cited in Amer. Med. Intelligencer, Aug. l,p- 162. 5 Kroyher, cited in Annuaire de Therapeutique, pour 1S42, par Bouchardat, p. 39. Paris, 1842. 6 Half-Yearly Abstract, &c, from July to December, 1848. p. 215. 'Med. Times, May 26, 1849. 8 Lancet, June 8, 18C0, NUX VOMICA. 543 MODE OF ADMINISTRATION. The best form for exhibiting the alcoholic extract of nux vo- mica, according to Magendie, is in pill, when we are desirous of inducing the tetanic convulsions. Each pill may contain a grain. One or two pills may be given at first, and the dose be daily aug- mented until the required effect is induced. It may then be dis- continued, to avoid accidents. It is better, he thinks, to give the pills in the evening, as night is the most favourable time for ob- serving the phenomena w T e are desirous of inducing. It is some- times necessary to increase the dose to twenty or thirty grains, before the tetanic effects supervene, but commonly from four to six grains are sufficient. Esquirol saw two cases, in one of which death took place after eighteen grains; in the other, after five: the stomach and bowels were found inflamed. Dr. Elliotson began with half a grain of a well prepared extract, and increased the dose every day, or every other day, by a quarter of a grain; but none of the patients bore a greater quantity than seven grains, and few more than four. If, from any cause, the administration of the remedy has been interrupted for some days, it is necessary to recommence with the small doses, and to increase them gradu- ally as before. When it is desirable to produce only the slow effects of the remedy, a grain or half a grain daily is sufficient. M. Petrequin 1 begins with one-eighth of a grain for a dose, and gradually increases it to two, three, and even five grains in the course of the day. Magendie directs a tincture to be made from the extract — the Tinctura Nucis Vomica, T. Strychnos, T. Nucum Vomica - rum, which has been introduced into some of the pharmacopoeias. It is made by taking three grains of dried alcoholic extract of nux vomica, and dissolving it in an ounce of alcohol at 36° (.837.) It is given by drops, and in mixtures, in those cases in which the alcoholic extract itself is indicated. M. Petrequin 2 also employs a tincture of nux vomica, which he prepares with four ounces of the powder and a quart of brandy. This is used altogether ex- ternally as an embrocation to, and around, palsied parts. The tinctura nucis vomicae of the Dublin Pharmacopoeia is made of two ounces of rasped nux vomica to eight ounces of rectified, spirit, (alcohol.) Tinctura nucis vomica composita. Compound tincture of nux vomica. R. Extract, nuc. vomic. alcohol, gr. xxiv. Camphoree gj. Tinct. pyrethri f ^j. M. Dose. — Twenty drops, four times a day, with arnica tea, in cases of paralysis. Fogt. 1 Op. cit. 3 Op. citat. 544 NUX VOMICA. R. Tinct. nucis vomicae, cantharid. Naph. phosphorat. 1 ^ij. M. Dose. — Thirty drops, three or four times a day, with arnica tea, in the paralysis of torpid subjects. Vogt. Mistura nucis vomicae. Mixture ofnux vomica. R. Extract, nuc. vomic. alcohol, gr. ij. — iv. — vj. Mucilag. acac. f ^ss. Aquae melissae f §vj. M. Dose. — Two spoonfuls, every two hours, in epilepsy. Hildenbrand. A similar form is recommended by Richter* in dysentery. Two table-spoonfuls every two hours. R. Tinct. nucis vomicae gtt. ij. Aquas lauroceras. gj. M. Dose. — Ten drops every morning and evening in the vomit- ing of pregnancy. Kroyher. Pilulae nucis vomicae. Pills ofnux vomica. R. Ext. nuc. vomic. alcohol. £j. Ext. glycyrrhiz. Bvij. Misce et riant pilulae lxxx. Dose. — Two to six, two or three times a day, in paralysis. Pilulae nucis vomicae ferruginosae. Ferruginous pills ofnux vomica. R. Extract, nucis vomic. alcohol, gr. vj. Ferri oxid. nigr. gj. M. et divide in pil. xxiv. Dose.— Three, daily, in incontinence of urine dependent upon atony. Mondiere. Pilulae nucis vomicae et quiniae. Pills ofnux vomica and quinia. R. Ext. nucis vomicae gr. xij. Quiniae sulphat. Ext. hyoscyam. aa. gr. xxiv. M. et fiant pil. xxiv. Two to be taken an hour before meals, in gleet. Ch. Johnson. 1 Naphtha phosphorata, JEther sulphuricus phosphoratus, is made by dissolving twenty-eight grains of phosphorus in four ounces of rectified ether. 2 Die Specielle Therapie, ii. 133. Berl. 1821. See, also, Joy, in Tweedie's Library of Medicine, v. 296. Lond. 1840; or 2d Amer. edit, Pbilad. 1842. OLEUM JECORIS ASELLI. 545 Pilulee nucis vomicae et aloes. Pills of nux vomica and aloes. R. Nucis vomicae gr. ss. Aloes Ext. rhei aa. gr. f . M. et f. pilnla. Dose. — One at bed time, as a cathartic. To increase its chola- gogue power, a grain of calomel may be added. Boult. Pnlveres nucis vomicae. Powders of nux vomica. R. Ext. nucis vomicae alcohol. Bismuth, sub-nitrat. aa. gr. ss. Magnes. carbonat. gr. iij. Sacch. gr. xv. 01. menth. pip. gtt. ij. Misce, et fiat pulvis. Dose. — One every three hours, in cramp of the stomach. 1 VogL R. Nucis vomic. pulv. gr. iij. Acacise, Sacchar. aa. gr. xij. M. et fiat pulvis. Dose. — One of these powders to be repeated according to cir- cumstances during the twenty-four hours, in diarrhoea and dysen- tery. Huf eland, Linimentum nucis vomicae compositum. Compound liniment of nux vomica. R. Tinct. nucis vomicae arnicas seu melisssB aa. partes Ix. lyttse part. xv. M. To be rubbed on the loins and inside of the thighs in impotence and spermatorrhoea. Duclos. Embrocatio nucis vomicae. Embrocation of nux vomica. R. Tinct. nucis vomicse f gj. Liquor, ammon. f gij. M. To be rubbed on the paralyzed limbs, and on the surface, in cholera. See Strychnia, and its preparations. CXXIX. O'LEUM JECORIS ASEL'LI. Svnonymes. Oleum Morrhuse seu Jecinoris Aselii, Codliver Oil, Cod Oil. French. Huile de Morue, Huile de Foie de Morue. German. Stockfischleberthranj Bergerthran, Giehtthran, Leberthran, Kabl iau thr an. The animal fat, which appears under this name in commerce, is obtained from several of the fishes belonging to the genus Gadus, 546 OLEUM JECORIS ASELLI. order Malacopterygii thoraclcl, but especially from the codfish, {Gadus morrhua;) the Trosk, (Gadus callarias ;) the Coalfish, (Gadus Carbonarlus,) and the Burbot, (Gadus lota.) At Ant- werp, it is said by M. Gouzee 1 to be prepared from the liver of a species of Ray — the Raja Pastinaca — and of the Skate. Skate- liver oil is by some preferred to cod-liver oil as a therapeutic agent. The disagreeable odour and taste of cod-liver oil led to the substitution of the oil obtained from the liver of the skate — Rata clavata and R. Rails; German, Rochenleberthran. In Holland and Belgium this oil is preferred to that of the cod, both as being less disagreeable to the taste, and also more effica- cious in its therapeutic effects. 2 Several varieties of the oil are met with in commerce, which, differ from each other by their brighter or darker hue, and by their greater or less transparency. The clearest sort is admitted, into the shops of continental Europe especially, under the name Oleum jecoris aselli album seu depuratum : as a remedial agent it is more used than the darker variety, although several physi- cians affirm, that they have found the latter more efficacious. 3 METHOD OF PREPARING. According to Riecke, 4 the oil is obtained by exposing to the sun the livers of the fishes above mentioned, cut in slices, and col- lecting the fixed oil that runs out. That which is first obtained resembles fine olive or poppy oil, and is called " yellow cod-liver oi) " — Oleum jecoris aselli flavum, (German, Hellblanker Leberthran.) If the livers are running gradually to putre- faction, the oil becomes of a chestnut-brown colour — Oleum jecoris aselli sub f us co jiavum — (German, Braunkblanker Thran:) and, again, after the oil has been obtained by the above methods, some can still be procured by boiling the livers, which constitutes the Oleum jecoris aselli fuscum; 5 but between the finest pale- yellow or almost colourless oil, and the dark-brown cod-oil used by curriers, there is an almost infinite variety of shades, so that no absolute difference can be founded on colour only. 6 At New- haven, near Edinburgh, the fishermen simply boil the livers in an 1 Bullet. Med. Beige, Janvier, 183S. 2 Edinb. Med. and Surg. Journal, Oct. 1842, p. 504, and Gobley, Archiv. General, de Med., Mai, 1842, p. 111. 3 See Taufflied, in Gazette Medicale de Paris, 12 Aout, 1837. 4 Die neuern Arzneimittel, u. s. vv. S. 351, and 2te Auflage, S. 538. Stuttgart, 1840. 5 For the Analysis of the yellow and brown varieties, by Marder, see Riecke, op. cit. 2te Auflage, S. 541. Stuttgart, 1840; or Pereira, op. eft. p. 1805; and of the three varieties, see De Jongh, The Three Kinds of Cod-liver Oil, by E. Carey, Amer. edition, p. 79. Philad. 1849. 8 Pereira, Pharmaceutical Journal, Feb. 1849. See, also, a full account of the dif- ferent kinds offish oils in Dierbach. Die neuesten Entdeckungen in der Materia Medica. 3er Band. 2te Abth. S. 1292. Heidelb. und Leipz. 1847. OLEUM JECORIS ASELLI. 547 iron pot, and then filter the oil through a towel containing a little sand. 1 Mr. Donovan 3 recommends the following process. Take any quantity of livers of cod; throw them into a very clean iron pot; and place it on a slow fire; stir them continually until they break down into a kind of pulp: water and oil will have separated. When a thermometer plunged in the pulp shall have risen to 192°, the pot should be taken from the fire, its contents transferred to a canvass bag, and a vessel placed underneath. Oil and some water will run through: after twenty-four hours, separate the former by decantation, and filter through paper. The properties of cod-liver oil are said to be different in the dif- ferent varieties met with in commerce. The colour varies from a bright yellow to a reddish-brown; and the oil is sometimes clear, but, at others, more or less turbid. The bright has the consistence of poppy oil; the brown is thicker. The smell is weaker in the former; in the latter, it resembles that of old salt herrings. The taste of the brown is an empyreumatic bitter; and resembles train oil; is somewhat acrid, and remains for a time on the tongue; that of the clearer oil is much less disagreeable. Litmus paper is feebly reddened by the clear, considerably so by the brown variety. Both sorts are soluble in alcohol and ether. A good deal of the difference in the appearance, and other sensible properties of the different varieties would appear, from the observations of Mr. Donovan, 3 to be owing to the comparative freshness, or the con- trary, of the oil, or of the livers from which it has been prepared. To test its purity, Mr. Hockin* mixes, on a porcelain slab, four parts of the oil and one of strong sulphuric acid. If it be genuine, a rich violet hue is produced, which in a few minutes passes gra- dually to a dirty brown. This characteristic, he says, is not pos- sessed by any other oil, either animal or vegetable. From the researches, however, of Dr. Pereira, 5 it w T ould appear, that al- though sulphuric acid is a test for liver oils, probably owing to the presence in them of one of the constituents of bile, it does not distinguish one liver oil from another, neither does it distin- guish good cod-liver oil from bad; for it produces its characteristic reaction both with common brown cod-oil and with the finest and palest qualities ; but it serves to distinguish oil procured from the liver from oil obtained from other parts of the animal. In com- merce it is said to be extensively adulterated with other fish oils; 1 J. H. Bennet, cited by Pereira, Elements of Mat. Med. and Therap. ii. 1866; or 2d Amer, edit, by Carson. Philad. 1846. 2 Dublin Journal of Medical Science, July, 1840, p. 363. See, also, for a full account of the article, Mr. Donovan, ibid. Sept. 1845. s Op. cit. Sept. 1845. * Pharmaceutical Journal, Sept. 16, 1848; cited in Kanking's Half- Yearly Abstract, July to December, 1848, Amer. edit. p. 213. 1 Pharmaceutical Journal, 1848. 548 OLEUM JECORIS ASELLI. scarcely a tenth — it is believed — of what is sold under that name is genuine, being either refined whale or sea elephant oil. 1 According to Messrs. Gouzee and Gmelin, the brightest oil ought to be employed internally; but MM. Trousseau and Pidoux 2 think that the limpid oil has no medical virtue. They prefer either the second, or that which is obtained by ebullition, and has a disagreeable acrid taste. Such, too, appears to be the opinion of Richter, 3 Delcour 4 and others. On the other hand, Dr. J. C. B. Williams 5 prefers the pale oil, as free from taste and smell as it can be procured. To obtain this he advises, that the livers of the fish should be obtained as fresh as possible, the pale plump livers being preferred. These should be beaten into a pulp, mixed with water at 120°, and filtered. After standing, the oil must be de- canted, cooled to 50°, and again filtered. The process is to be performed quickly and in close vessels. The oil, prepared by Mr. Donovan's process, is of a pale-yellow colour ; its smell is weak, and resembles that of a cod boiled for the table when in excellent condition. Its taste is bland, by no means disagreeable, and totally devoid of rancidity. It is very liquid. Its specific gravity, in Mr. Donovan's trials, was 0.934, although in all the published tables of specific gravities it is stated to be 0.923. 6 In cold weather, it deposits much stearine, which ought not to be separated. Mr. Donovan has obtained as much as a gallon of pure oil from twenty-eight pounds of liver, the produce of fifty cods ; and he concludes, that in preparing the oil for medical purposes, three great points are to be attended to, — 1. The livers must be perfectly healthy ; 2. they must be as fresh as possible, the least putrescency being injurious; and, 3. The heat at which the separation of the oil is effected must not exceed 192°. This pale oil is the only kind that Mr. Donovan 7 has sup- plied so abundantly tp the profession for the last three years ; and its efficacy, he says, has been in many cases most surprising. Much of the oil used in this country is prepared in Boston. 8 EFFECTS ON THE ECONOMY. Cod-liver oil has long been used as a popular remedy in north- ern Germany, especially in Westphalia — as well as in Holland and England ; it fell, however, into disuse in the British isles, but in Germany it has maintained its character to the present day. In England, it appears to have been first recommended by Perci- 1 Report of the Committee on adulterated drugs, Dr. Huston chairman, in Transac- tions of the Amer. Med. Association, vol. iii. Philad. 1850. 3 Traite de Therapeutique, &c, 2d partie, p. HI. 8 Medicinisch. Zeitung, No. 26, July, 1835. 4 Bulletin Medical Beige, Juin, 1841, p. 249. 8 London Journal of Medicine, Jan. 1849. 6 Donovan, op. cit. " * Op. cit. 8 Dispensatory of the United States, 8th edition, p. 1209. Philad. 1S49. OLEUM JECORIS ASELLI. 549 val, 1 and in Germany by Schenck. 2 In Percival's time, it was so largely employed in Manchester, in the hospital of that town, that nearly a hogshead of it was consumed annually. When administered internally, it excites a disagreeable taste in the mouth, and nausea. Yet patients soon become accustomed to it ; and children frequently take it without repugnance. When the nausea is once overcome, the oil does not oppress the stomach, except when the organ is embarrassed, or the digestive powers are greatly enfeebled. Nor does it seem to destroy the appetite by continued use. Yet many persons, especially adults — less so children — reject it immediately. It is necessary for the digestive powers to be energetic when it has to be given for any length of time. To those whose digestive organs are very irritable, Kopp recommends that Bourdeaux wine should be taken after it. Cod-liver oil has no manifest effect on any of the secretions, ex- cept occasionally on the urinary and cutaneous depurations; and on the healthy organism it appears to excite no marked change. In strumous affections, however, its favourable influence is said to be striking, as well as in rhachitic, rheumatic, and gouty dis- orders. In such cases, it is said, by the German writers, to excite powerfully the reproductive or nutritive functions, when adminis- tered for a proper length of time. 3 The favourable effects are, in general, not rapidly exhibited ; and to produce a cure, according to Kopp, the remedy must be persisted in for at least four weeks, and commonly for some months. Kopp suggested, that owing to the similarity of the effects of this oil to those of iodine, its effi- cacy might be owing to its containing the latter ; and some che- mical investigations made by him in the year 1836 confirmed the suggestion. 4 The quantity is extremely small, but — Kopp sup- poses — like iron in chalybeate waters, as the iodine is commingled naturally with the oil, it may exert a much greater effect than if it were added artificially in the like quantity. This is the opinion also of Dr. J. H. Bennet, 5 but Delcour 5 and Panck 7 think it very problematical. Experiments by L. Gmelin 8 seemed to show, that the genuine oil contains iodine, whilst the spurious does not. Iodine has likewise been detected in it by Hausmann, Bley, Brandes, 1 Essays, Medical, Philosophical and Experimental. Warrington. 1790. Vol. ii. a Hufeland's Journal, 1822 and 1826. 3 Riecke, Die neuern Arzneimittel, S. 352, und 2te Auflage, S. 542. Stuttgart, 1840; also Klencke, cited in Brit, and For. Med. Keview, Oct. 1842, p. 443. 4 Hufeland und Osann's Journal, 1836; Annalen der Pharmacie, xxi. und xxii.; and Bulletin General de Therapeutique, No. xx. 30 Oct., 1837, 5 Treatise on the Oleum Jecoris Aselli or Cod Liver Oil, &c &c. Lond. 1841. 6 Bulletin Medical Beige, Juin, 1841, p. 254. 1 Zeitschrift fur die gesammte Medicin, July, 1842, p. 282. 3 Bulletin General de Therapeutique, Mai, 1840. 550 OLEUM JECORIS ASELLI. Springmiihl, 1 and W. Stein. 2 Herberger 3 found both iodine and bromine in it, and analyses made by De Jongh 4 showed, that the light-brown oil contained the largest quantity of iodine. Owing to skate-liver oil appearing to be more efficacious thera- peutically than cod-liver oil, MM. Girardin and Prisser were induced to analyze it carefully, when they found it to contain a per centage more of iodide of potassium. They, consequently, recommend it as a valuable substitute for the more nauseous article in use. 5 On the other hand, Mr. Donovan 6 is of opinion, that every known fact impugns the notion that the curative prin- ciple is iodine. In the first place, he says, many patients who have been cured by the oil were not in the least benefited by a previous course of iodine, — as shown by Dr. Taufflied. Secondly. Chemical analysis has discovered only minute traces of iodine in some specimens, whilst others were entirely destitute of it. One analysis, indeed, referred to by Dr. Bennett, gave 0.324 per cent., and another, 0.162: others gave still less. Thirdly. " The ten- dency of iodine is to render the person thin who uses it, while the effect of cod oil is to fatten." Lastly. None of the oil prepared by them, when agitated with alcohol, communicated any impres- sion of iodine, although the oil was eminently successful as a me- dicine, and its colour contra-indicated the presence of free iodine. Again, it has been affirmed, that equally beneficial effects have followed the use of oil that contained no iodine. The author has for many years stated to his clinical classes, that such had been the result of his observation, and that vegetable oils had appeared to him to exert a similar action ; and recently cases have been published confirming this - view of the subject. 7 Testimony has also been afforded in favour of the good effects of other animal oils. 8 M. Eretonneau 9 regards common train oil to be equally efficacious. In a recent report (1849,) of the Hospital for Consumption and Diseases of the Chest, which is highly favourable to the use of cod- liver oil, it is stated, that other animal oils, not derived from the liver, and vegetable oils, were tried; but the experiments thus far made there had not shown them to possess the same powers: they had not, however, been sufficiently often repeated to warrant decided conclusions. Dr. J. C. B. Williams 10 does not esteem it necessary to discuss the question whether the oil owes its efficacy to the iodine con- 1 Riecke, op. cit. 2te Auflage, S. 541. Stuttgart, 1840. 2 Journal fur Praktische Chemie, B. xxi., or Journal de Pharmacie, Fev. 1841, p. 94. 3 Pereira, op. cit. p. 1 866. 4 The three kinds of Cod-liver Oil, &c. by E. Carey, Amer. edit. p. 79. Philad. 1849. 6 Edinb. Med. and Surg. Journ. Oct. 1842, p. 504. 6 Op. cit Sept 1845. 1 Dr. P. M. Duncan and Mr. Nunn, London Medical Gazette, Feb. 1850. 8 See Drs. Bagot and Stapleton, in Dublin Medical Press, March 6, 1850. 9 Bulletin de Therapeutique, cited in Medical Examiner, Sept. 1847, p. 579. 10 London Journal of Medicine, Jan. 1849. OLEUM JECORIS ASELLI. 551 tained in it. " To suppose," he says, " that the minute proportion of this ingredient could be the curative agent would savour of the absurdities of homoeopathy; and besides most of the patients had taken iodine in one form or other previously to taking the oil." 1 The author has elsewhere remarked, 2 that the effect which cod- liver oil induces upon the system of nutrition, when cachexia exists, is similar to that of eutrophics in general. It doubtless furnishes a modified chyle, and of consequence a modified blood. This in- duces a new action in the tissues which it laves, — acting in these respects, like sugar, both dietetically and therapeutically ; and probably its main action, as maintained by Dr. Bennett and by M. Eouchardat, 3 is that of a fatty aliment. Dr. Williams thinks " there is much reason to believe that it proves serviceable by supplying the fat molecules, which appear to be essential to healthy nutrition in forming the nuclei of the primary cells: thus supplying a fat, which is capable of being readily absorbed and converted into a better plasma, as well as more readily conveyed by the blood to the vicinity of the tubercular deposits, the absorption of which it favours by dissolving the irregularly concreted fat of which the masses are partly composed." The following results of the use of cod-liver oil in the medical ward of the Pennsylvania Hospital, during six months, reported by Dr. Levick, one of the resident physicians, have been published by Dr. Gerhard. 4 First. The light coloured oil can be taken without difficulty by patients who have steadily rejected the brown oil. Secondly. A few of the patients took it without any thing to dis- guise its taste. Its nauseating properties are corrected by its ad- ministration with milk; but its taste is most effectually disguised by the froth of porter. Thirdly. As a general rule it was taken before meals ; but in four cases where it was not tolerated before meals, it was readily taken after them. Fourthly. Patients have increased in flesh, weight and strength under its use : the cough and expectoration have diminished, and with some hectic and rigours have wholly disappeared. Six were so much benefited as to leave the hospital, and resume their former occupations. A patient, who entered the hospital with cough, copious purulent expectoration, extreme emaciation, inability to leave his bed, and with tEe physical signs of a cavity under the left clavicle, after six months' use of the oil left the hospital weighing 140 pounds, with little or no cough, no hectic nor rigors, and with an almost entire absence of expectoration ; and the physical signs had greatly diminished. 1 See Pereira, Pharmaceutical Journal, 1848. 2 General Therapeutics and Materia Medica, 4th edit. ii. 316. Philad. 1 S."0. 3 Annuaire de Therapeutique pour 1849, p. 253. 4 The Diagnosis, Pathology, and Treatment of Diseases of the Chest, 3d edit. p. 241. Philad, 1850. See, also, Notes of Cases of Phthisis Pulmonalis, treated in the Penn- sylvania Hospital, with Remarks on Cod-liver Oil and its uses in Tubercular Disease, by Dr. Levick, in American Journal of the Medical Sciences, Jan. 1851, p. 21. 552 OLEUM JECORIS ASELLI. Fifthly. The improvement of the physical signs was not coincident with that of the general symptoms. Sixthly. That in those cases which terminated fatally, the appetite, nutrition and strength ap- peared for a time to be decidedly increased: life appeared to be temporarily protracted; but for a few weeks immediately preceding dissolution the remedy seemed to have entirely lost its value ; and lastly, To be of decided permanent benefit, its use must be steadily persevered in, even after the most striking symptoms of the disease have in a great measure disappeared. As respects the administration of cod-liver oil in disease, it has been employed — especially in Germany — as a remedy in Rheumatism, in which its reputation has been favourable. In the year 1782, it was highly recommended in chronic rheu- matism by Dr. J. Percival, 1 and in 1807 by Dr. Bardsley, 3 who states, that it was in high repute in Lancashire. In the year 1835, Brefeld wrote a monograph on it, in which, resting upon nume- rous indigenous and foreign experiments, he maintained it to be a remedy of great and specific efficacy in every form of chronic rheu- matism; and since then his testimony has been corroborated by that of Spiritus, 3 Moning, 4 Schiitle, 5 Wesener, 6 Osberghaus, 7 Giinther, 8 Volkmann, 9 Kopp, Rust, 10 Moll, 11 Panck, W. O. Chalk, 12 and Bradshaw. 13 By many, its use has likewise been advised in gouty affections; but Brefeld esteems it ineffectual in actual gout ; and Taufflied 14 affirms, that it is of no avail in gouty arthritis. Scrofula and Rickets. — In these diseases it would seem to be more efficacious than in rheumatism. Brefeld, indeed, asserts that he has found no remedy equal to it, in cases where the osseous tissue is permanently affected, — as in the different forms of rick- ets, arthrocace, spina ventosa, and caries scrophulosa: 15 and Kreebel 15 is of opinion that its efficacy is most marked in scro- fulous affections of the bones and in atrophia infantum. Next to these, it has been extolled in affections of the chyliferous ves- sels and internal glands, especially when they present themselves under the chronic form of atrophy. In affections of the external glands, its efficacy was less striking and rapid; Taufflied, indeed, states, that it is of no avail in the swellings of any lymphatic glands excepting those of the abdominal cavity. Its action is 1 Lond. Med. Journ. iii. 393. 3 Reports from Hospital Practice, p. 18. Lond. 1S07. 3 Rust's Magazin, Band. xvi. 566. * Ibid. * Horn's Archiv. 1824 (July and August.) 6 Hufeland's Journal, 1824," Heft 1. (May.) T Ibid. 1S25, Heft. iii. (September.) * Ibid. 1S24, Heft.ii, (August.) 9 Ibid. 10 Rust's Magazin. xx. 563. " Richter's Specielle Therapie, x. 46?. Berl. 1S25. 13 Lond. Med. Gaz. Dec. 29, 1843, p. 414. 13 Provincial Medical and Surgical Journal, Dec 31, 1S45, p. 753. " Gaz. Med. Nov. 9, 1839. IS Sourzac, Journ. de Med. et Chir. Prat. Mars, 1842, p. 110. ■■ Schmidt's Jahrbucker, u. s. w. No. 9, S. 287. Jahrgang 1849. OLEUM JECORIS ASELLI. 553 almost null in scrofulous affections of the skin, ophthalmia, dis- charges from the ear, &c, unless when applied externally, in which cases, as well as in external glandular swellings of a scro- fulous character, it was especially useful. The slighter forms of scrofulous eruptions disappeared, without any unpleasant sequelse, by simply smearing them with the oil ; the more obstinate forms, by the simultaneous use of appropriate internal agents, of which Brefeld prefers aBthiops antimonialis to all others. Scrofulous inflammation of the eyes disappeared frequently and rapidly by simply smearing the eyelids with the oil. 1 Where, in the case of scrofulous ophthalmia, there is inflammation of the eyelid with photophobia, Brefeld recommends, that the free edges of the eye- lid should be anointed with pure cod-liver oil. Cunier advises it in association with the extract of belladonna, one part of the latter to two of the former. Introduced between the eyelids by means of a camel's hair pencil, it acts, he says, beneficially on scrofulous ulcers of the cornea, and hastens in a remarkable man- ner the absorption of the opacities of that membrane. In the in- ter ciliary ulcerations, it is likewise very useful. In such cases, as well as in opacities of the cornea; following vascular pannus in cellular pannus, atonic ulcerations, &c, Cunier found an ointment, the formula for which is given hereafter, very useful. 2 Mr. Wilde, of Dublin, 3 states, that in cases of pannus and long con- tinued chronic ophthalmia attended with granular lids, &c, where the constitutional powers had fallen below par, as shown by dimi- nution in volume, and increased quickness of pulse, pallor of coun- tenance, coldness of the extremities, a clammy condition of skin during the day, and heat, and restlessness at night; together with loss of appetite, and " a large flabby, putty coloured tongue, which is usually attendant on such broken down strumous patients," he had found it a most useful remedy, — in fact, in all cases in which tonics and nutrients were indicated. Kopp extols it in scrofula and rickets, both when internally and externally exhibited. Numerous trials with it by other phy- sicians — as by Schenck, Schutte, Yon dem Busch, Gumpert, Fehr, Rosch, Schmidt, Knod von Helmenstreit, Heineken, Munzenthaler, Beckhaus, Spitta, Giinther, Roy, Gouzee, 4 Taufflied, 5 Jungken, 6 W. O. Chalk, 7 Daumerie, 8 and others, confirm its great efficacy in 1 Piffard, Bullet. General de Therap. Mai, 1840. a Journal fur Kinderhrankheiten, cited from Annales d'OcuIistique, Mai, 1845, and in Braithwaite's Retrospect, xii. 234, Amer. edit. New York, 184t>. 3 Donovan, Dublin Journal, &c, Sept. 1845. 4 Bulletin Medical Beige, Janvier, 1838, p. 6. 5 Gazette Medicale de Paris, 12 Aout, 1837; and 9 Nov., 1839. 6 Lond. Med. Gaz. April 20, 1839, p. 126. ' Op. eit. 8 Journ. de Brux., Fevr. et Mars, 1847, cited in Schmidt's Jahrbucher, u. s. w. No. 5. S. 161. Jahrgang 1849. 554 OLEUM JECORIS ASELLI. scrofulous and rachitic affections. 1 Schenck, 3 indeed, esteems it as certain a remedy in scrofula and rickets as cinchona is in inter- mittent fever ! In the Pennsylvania Hospital, in scrofulosis, when there was no reason to suspect the existence of pulmonary tubercles, the improvement in the patient's health was very decided. 3 The efficacy of the oil in scrofula suggested its administration in cases of — Tubercles ; — and, accordingly, it was prescribed by Hankel, whose experiments led him to advise a further trial of it. Riecke 4 refers to a case of the kind, confirming Hankel's observations, which occurred to Dr. Pagenstecher, of Elberfeld; and Richter, of Weisbaden, Professor Alexander of Utrecht, and Haser, of Jena, 5 seem to have experienced equally satisfactory results. M. Tauf- flied, 6 however, considers its action to be doubtful or null in scro- fulous phthisis when at all advanced. Both Kopp and Brefeld recommend it highly in phthisis pulmonalis of strumous origin, occurring especially in youth, and Raye 7 speaks in the highest terms of its efficacy in chronic inflammation of the lungs and stomach. Of late years, great attention has been given to it as a remedy in tuberculous cachexia; and the testimony in favour of it has been overwhelming. At the present day, there is no single article of the Materia Medica so fashionable ; and hence it has been em- ployed too indiscriminately. Of those who have recently given the strongest evidence in favour of its great efficacy in phthisis, may be mentioned, Drs. Madden, 55 Blakiston, 9 Ranking, 10 and Trumbull. 11 Dr. J. C. B. Williams 12 prescribed it in above 400 cases of tu- berculosis of the lung in its different stages, and of these he kept notes of 234. Of this number the oil disagreed and was discon- tinued in only 9. In 19 it appeared to do no good, whilst in the large proportion of 206 out of 234, its use was followed by marked and unequivocal improvement, — such improvement varying from a temporary retardation of the progress of the disease, up to a more or less complete restoration to apparent health. He found the most striking advantage from the oil in the third stage of phthisis, even when far advanced, where not only the lung w T as excavated, 1 Riecke, op. cit. S. 330, und 2te Auflage, S. 542. Stuttgart, 1840. See, also, Tauf- flied, in Gaz. Medicale de Paris, Nov. 1839. ■ Hufeland's Journal der Praktisch. Heilkunde, Mars, 1833. 3 Levick, in Gerhard, op. cit. p. 242. 4 Op. cit. S. 356. 5 Hufeland's Journal. B. lxxxvi. 1838. 6 Gazette Medicale, 9 Nov. 1839. I Annales de la Societe des Sciences, Nat. de Bruges in Encyclographie des Sciences Medicales, Mars, 1S40, p. 100; and Sept. 1840, p. 10. 8 Lond. Med. Gazette, Sep. 17, 1847. 9 Practical Observations on certain Diseases of the Chest, Lond. 1848. Amer. edit. Philad. 1848. 10 Half-yearly Abstract, &c, from July to Dec. 1843. Amer. edit. p. 213. II Lond. Journ. of Med. Feb. 1850, cited in Amer. Journ. of the Med. Sciences, July, 1850, p. 182. . ,a London Journal of Medicine, Jan. 1849, OLEUM JECORIS ASELLI. 555 but the body was rapidly wasting, with copious purulent expectora- tion, night sweats, colliquative diarrhoea, &c. Of the power of the oil in this stage of the disease he quotes several decided cases. The total number amounted to 62, in 34 of which the improve- ment was known to have continued up to a recent period. Eleven, after- temporary improvement, relapsed, and terminated fatally. From the report of the physicians of the Hospital for consumption and diseases of the chest, for 1849, it appears that 542 cases were treated with it. In about 63 per cent, the symptoms improved ; in ly per cent, the disease was arrested ; and in 19 per cent, it went on unchecked. Chronic cutaneous diseases. — In m these affections, cod-liver oil has been given with advantage by Richter; and it is suggested, that the greater success obtained by him than by BrefeJd may have been owing to his having administered the remedy in much, larger doses. Richter's trials were numerous, and were made through a period of three years ; they are, therefore, highly de- serving of attention. He says ; — that the impure, yellowish-brown, and odorous oil should be selected, as it is the most active ; — that at least six, and never more than ten spoonfuls should be adminis- tered daily to adults; — that it must be continued for a long time, as the first traces of a favourable impression are generally somewhat late in presenting themselves, — commonly four weeks, and, in very obstinate cases, later ; — so that usually from six to twelve weeks are required for a cure; and, lastly, that the diet must be regulated, and every thing difficult of digestion, flatulent, fatty, strongly salted, or acid, be carefully avoided. In this manner, he treats tetter, inveterate itch, and tendency to the formation of boils. Kopp's experiments agree wu'th those of Richter, as to the internal use of the oil in tetter; he esteems it to act by "improving the humours." He found it, also, of use in cases of dry tetter, when rubbed on the part, and in porrigo. A severe case of lupus in a young female was successfully treated by M. Gibert 1 with the oil. The face ,was eaten away by tuberculous ulceration, the fleshy parts of the nose being completely destroyed. Independ- ently of this, scrofulous abscesses existed in the neck, with caries of the malar bone, and white swelling of the wrist. Cod-liver oil was prescribed both internally and externally with success, after iodine had been used in the same manner without effect. The treat- ment was, however, continued for more than a year. But the strongest testimony in its favour in lupus is given by M. Emery. 3 In a severe case, which had resisted other remedies, "he gave it in large doses — from a pint to a pint and a half in the day. In two months a cure was effected. He subsequently employed it in a 1 Bulletin de l'Academie, Nov. 1844. 3 Revue Med. Chirurgical, Aout, 1848; cited in Ranking's Half-yearly Abstract, July to Dec. 1848, p. 77, 556 OLEUM JECORIS ASELLI. great number of cases, commencing every one with one hundred grammes — nearly 25 drams — and quickly increasing it to fifteen or twenty ounces in the day. If vomiting supervened, its use was suspended for a few days, and then re-commenced as before. Sixty four cases were treated in this manner, the majority of which re- ceived essential benefit, and twenty-four were completely cured. M. Devergie, 1 however, is of opinion, that M. Emery has over- estimated the beneficial effects of the oil in lupus, and properly re- gards it as a great error to depend upon any one agent for the cure of diseases, especially of the skin, which may be single or complicated, and yet bear the same name. In some troublesome affections of the skin, especially of the hands, conjoining the characters of impetigo, with erysipelatous redness and swelling, and inducing the most severe suffering, Dr. Marshall Hall 2 speedily succeeded in restoring the textures to a healthy condition by the external use of cod-liver oil, after all other remedies had been tried fruitlessly. For rhagades and chaps, he says, it is a preventive, and a speedy cure ; and it is productive of great benefit in eczema, and other diseases inducing excoriation and fissures of the skin. 3 Carron du Villards 4 extols cod-liver oil in opacities of the cornea, whether resulting from slight ulcerations, or from inter- lamellar effusion. It is only applicable after the inflammation has disappeared. A drop or two of the oil is then placed on the cor- nea with a camel's hair pencil. Sometimes, even the white oil is too stimulating : it is then necessary to dilute it with oil of sweet almonds: in other cases, the white oil is not sufficiently stimu- lating, and the brown must be used. In cases of tumours of the mammas in young females Kopp found the oil useful, when administered for some time, conjoined with the application of leeches to the affected part. In the Charite, at Berlin, the oil was given with advantage in coxarthrocace, in doses of four ounces every morning; — the mouth being rinsed afterwards with peppermint tea, followed by a cupful of this tea, or of coffee. Kopp also affirms, that he cured a case of chorea by it, which had supervened an attack of gout. Lastly. — Dr. Day 5 states, that he has used cod-liver oil exten- sively for several years, his attention having been first directed to it by Dr. Bennet, in 1840 ; and he can confidently bear out the statement of Mr. Donovan, that it " is a most useful addition to our Materia Medica ; that it produces effects of which no other i Bulletin de Therapeutique, xxxv. 466, cited in British and Foreign Med. Chirurg. Rev. April, 1849, p. 538. *Lond. Med. Gaz. Sept. 1832. 3 W. O. Chalk, op. cit. * Bullet Gener. de Therap. 30 Oct., 1835. 5 Report on Materia Medica, &c, in Ranking's Abstract of the Med. Sciences, pt 2. p. 340, Amer. edit New York, 1846. OLEUM JECOR1S ASELLI. 557 known remedy is capable ; and that it is well worthy of the atten- tion of the medical profession." MODE OF ADMINISTRATION. The dose of cod-liver oil for an adult is from half a spoonful to three spoonfuls, two or three times a day. To children, it is given in tea-spoonfuls. Dr. Williams begins, in adults, with a tea-spoonful, gradually increasing to a table-spoonful; and he advises it to be taken about an hour and a half after each meal. The au- thor has always been in the habit of directing it to be given midway between breakfast and dinner, and between dinner and supper ; the first dose being taken in the morning on rising ; so that three doses are taken in the day. He begins with a dessert-spoonful. Its un- pleasant taste can scarcely be corrected by admixture with other agents; for which reason, many prefer to give it in the pure state, taking afterwards some peppermint lozenges. It is also recommend- ed to be given united with coffee, or with lemon juice, or in the form of emulsion, or in thin flaxseed tea flavoured with lemon peel ; and M. Fredericq 1 states, that a simple and effectual means is to masticate a morsel of dried orange peel just before and just after swallowing the dose. Kopp prescribes it in the pure state, advising that the mouth should be rinsed with water, and that some dry bread should be eaten after it. Dr. Ure 2 has suggested the adoption of cod-livers as a diet for patients who are advised to take the oil. In order to prevent the loss of oil during the process of cooking, he recommends the livers to be immersed entire in boiling water, to which a sufficient quan- tity of salt has been added to raise the boiling point to about 220° Fahr. The sudden application of this high temperature coagulates the albumen of the liver, and prevents the escape of the oil. When the liver is cut, the oil exudes, and mashed potatoes may be used as a vehicle. Dr. Ure states that, having been advised to take cod-liver oil, he found the nauseous flavour very objectionable* until he contrived this plan, which answered extremely well. It would appear, from the observations of Dr. Stapleton, 3 that amongst the Norwegian fishermen the liver of the cod has been found peculiarly efficacious in rheumatism. Mistura olei jecoris asellk Mixture of cod- liver oih R. 01. jecor. aselli f ^ss. Liquor potassse gtt. xl. Aq. menth. pip. f ^ss. M. et fiat haustus. The draught to be washed down with a tea-spoonful of lemon juice to liberate the oil in the stomach. Percival. 1 Revue Med. Chirurg. v. 114 : cited in Brit, and For. Medico-Chirurg. Rev., July>, 1849, p. 299. a Pharmaceutical Journal, Nov. 1, 184a, p. 361. 8 Dublin Medical Press, Mar. 6, 1850, 36 558 . OLEUM JECORIS ASELLI. R. 01. jecor. asell. f §j. Liq. potass, carb. f gij. 01. calami gtt. iij. Syrup, cort. aurant. fgi. M. Dose. — One or two tea-spoonfuls, morning and evening, in eases of rickets. Fehr. R. 01. jecor. aselli, Syrup, cort. aurant. Aquae anisi, aa. f ^j. 01. calam. aromat. g lt - iij. M. Dose. — A spoonful, morning, noon, and night, in gouty swell- ings, rickets, &c. Bosch. Emulsio olei jecoris aselli. Emulsion of cod-liver oil. R. 01. jecor. asell. alb. Vin. Hungaric. (vel Malag.) aa. f §iv. Acac. %]. Fiat emulsio, cui adde Syrup, cort. aurant. f %]. Elaeosacchar, menth. pip. f ^ij. 1 Dose. — Two table-spoonfuls, two or three times a day; shaking the mixture. ' Brefeld. Sapo olei jecoris aselli. Soap of cod-liver oil. R. 01. jecoris aselli part. cxx. Sod. caust. part. xvj. Aquae part. iv. M. To be given in the form of pill ; or made into a kind of opodel- doch with an equal quantity of alcohol. Deschamps. 2 Syrupus olei jecoris aselli. Syrup of cod-liver oil. R. 01. jecor. asell. f ^viij. Acac. pulv. gv. Aquae f ^xij. Syrup, commun. f sjiv. Sacchar. ^xxiv. Make an emulsion of the first four ingredients ; dissolve the sugar at a moderate heat ; clarify, and add Aq. flor. aurant. f ^ij. Duclou? Unguentum olei jecoris aselli. Ointment of cod-liver oil. R. Olei jecoris aselli f gi. Hydrarg. oxid. rubr. gr. iv. CjratBij. M. Cunier. 1 The elxosaccharum or oleosaccharum menthae piperita is officinal in the Pharma- copoeias of Austria, Denmark, Hanover, Oldenburg, Prussia, &c. It is made by tritu- rating eight drops of the essential oil of peppermint with an ounce of sugar. ' Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 135. Erlangen, 1848. 'Journal de Phannacie, Sept. 1837. OLEUM SINAPIS. 559 Lini men turn olei jecoris aselli. Liniment of cod-liver oil. R. 01. jecor. aselli f gss. Plumbi acetat. gij. Vitell. ovor, (seu adipis,) giij. M. ( For external use in cases of ulcers, fistula, &c. Brefeld. CXXX. OLEUM SINA'PIS. Synonymes, Oleum iEthereum seu Volatile Seminum Sinapis, Oil of Mus- tard Seed, French. Huile Volatile de Moutard. German. iEtherisckes Senfol. This preparation has been recommended to the notice of practitioners in Germany, by Dr, Meyer, of Minden, especially; at whose suggestion numerous experiments were made with it at the Charite in Berlin, the favourable results of which have been published by Dr. Wolff. 1 METHOD OF PREPARING. M. Faure, in France, and M. Hesse, in Germany, found that if bruised mustard seed be placed in a still with cold water, much more essential oil is obtained than if hot water or steam had been at once employed. M. Hesse, indeed, advises, that the seed should be macerated with cold water for several hours before the distil- lation is commenced. It would seem, too, that acids, alcohol, &c, exercise the same influence in preventing the separation of the oil. EFFECTS ON THE ECONOMY IN HEALTH. Volatile oil of mustard is of a yellowish-white colour. It ex- hales so strong a smell of mustard, that the attempt to test its odour instantaneously excites a violent pungent sensation in the nose, and tears in the eyes. Its acridity is so great, that its appli- cation to the sound skin immediately occasions a sense of burning, and intense redness and vesication in the parts with which it comes in contact. EFFECTS ON THE ECONOMY IN DISEASE. Mustard seed oil may be applied either externally or internally. For the first object, Dr. Meyer advises a solution in alcohol (twenty-four drops to the ounce,) or in oil of almonds (five or six drops to the dram.) In Berlin, the former of these is used. Even this solution exhales so strongly the characteristic odour of mus- tard, that simply smelling it induces a sense of pungency in the nose, as well as tears in the eyes. Owing to the great volatility of this oil, its property and efficacy is soon lost; and the strength of the spirituous solution becomes less and less when the fluid is 1 Schmidt's Jahrbucher, 1837. 560 OLEUM SINAPIS. preserved for a long time in vessels that are not accurately closed or are frequently opened for the administration of the remedy, and afterwards not carefully attended to. It is therefore advisable in practice, that only small quantities should be prescribed at a time, and that these should be kept in well-closed vials, and in a cool place. The modes of external administration may be one of two — accord- ing to the sensibility of the skin, and the effect it may be desirable to induce. It may consist either in rubbing the liquid on a part of the surface, or in applying strips of linen wetted with it. The first method is advisable where the skin is delicate — as in the case of women and children, and in those whose healthy sensibility has not been diminished — as by paralytic affections. The fluid, when rubbed on the surface, very quickly evaporates, and excites a vivid sensation of burning, with bright redness of the surface, which disappears in the course of a few hours at the farthest. The augmented sensibility, produced by friction w T ith the solution of the oil, continues generally for a longer period; and, conse- quently, if a fresh application be needed at a short interval — say in from four to six hours — it must be made on the neighbour- ing parts, avoiding those first implicated. It is sufficient to use the remedy in this manner two or three times a day. The application of the oil by means of strips of linen is adapted for skins, such as those of men, which are thicker, and less sensi- ble, as well as for morbid cases in which the healthy sensibility has been depressed. The size and shape of the strips must be determined by circumstances. The linen, dipped in the oil, is placed upon the prescribed portion of the skin, and suffered to dry, which generally happens in about eight minutes. Burning pain immediately succeeds, and is often so insupportable, that the patients object to wait until the linen is dry, and it has, therefore, to be removed earlier. Besides the more violent pain produced by this mode of applying the oil, the redness of the skin is much greater, and in many cases vesication succeeds. If the application be made twice a day, morning and evening, this is sufficient for the treatment of chronic diseases; but friction cannot be made on the same part of the surface on the same day, on account of the severe pain and vesication which would be induced. This me- thod of applying the oil is considered to be especially proper in the case of the trunk and the extremities ; whilst the first method is generally to be preferred, where it is desirable to use it upon the face, behind the ears, or on the neck. The Oleum sinapis is indicated wherever a counter-irritant or local excitant is demanded. Riecke 1 advises it in chronic cases unaccompanied by fever, as well as in light febrile affections, 1 Die neuern Arzneimittel, S. 341; und Qte Auflage, S. 519. Stuttgart, 1840. OLEUM TIGLII. 5(J| where a gentle excitant may be needed; and in such fevers as are conjoined with a torpid state of the system, and which require the use of excitants. He regards its powerfully excitant action as constituting it a most useful article in our lists of antagonizing or derivative as well as of excitant agents. In the firlt relation, Wolff employed !t with advantage both in sub-inflam,matory dis- eases, and m nervous affections not of an inflammatory character -as m subacute rheumatism of the joints, aponeuroses and mus- wonlH I" 1 t, rh * u f a } ism of those farts, where blisters rr*l serviceable ; Md for which it may be substituted with advantage, in consequence of its not being attended with the in- oZ V n? e, T occas ; on! %. P^uced by the latter on the urinary 2 „ , He , "^P'oyed it, likewise, in rheumatic neuralgia, otalgia odontalgia, prosopalgia, and McA*w,-Mood-lettiii K being prescribed or not, according to circumstances; and, also, as a pal- gMynt WmC ml Z' la ' colic °f the hysterical kind, and W^ff a " !. X l tant , t0 ar0Use the vital activit 7 in debilitated parts, thfZnJ Tt- Sm -' 8nd , '" "«"***. which was probably the-resu t of exsudatmn into the neurilemma, &c. He gave it also internally several times with good effect, in disorders of the stomach, accompanied by too grlat a secretion of mucus, (fe s- ann tite mU T g d /' Ma S ens >) and producing complete loss of bv P the a'ifl Jf W ° T ? ere ? rmed iDt0 a mixt " re of si * °«»ce S) was given every two hours. In cases of atonic dropsy, it has been conceived that advantage m.ght ,n many cases, be derived from the internal use of this of asm the majority of those to whom it was given internallv the urinary secretion was largely augmented by ft.' Kuhn" /deed . psasztjg? benefit in "~ ° f ^ ^°-s malo^t. 0111 SinapiS LaS bee " reCeived int0 the Hambu 'g p har- CXXXI. OLEUM TIGLII. %ZT M i S '-i °I eU n- Cr ° ,0 J nis seu Seminis Crotonis, Croton Oil. French. Huile de Pignon d'Inde German. Krotonol, Crotonol, Granatillol. The seeds of Croton Tiglium or purging croton-a tree indi- rthe S Wr M S ° 1UCCa r f sIe ^ C eylon, Javf, &c, which beings in the Sexual System to Moncecia Monadelphia, and to the 562 OLEUM TIGLn. Natural Family Euphorbiacese — are characterized by their acrid drastic properties — which, indeed, belong to the whole family. These seeds were carried by the Dutch to Europe, two centuries ago, and were admitted into the old Pharmacopoeias under the names Grana Tiglii, G. Tilii, G. Molucca, &c, being pre- scribed as a drastic cathartic, but owing to their too violent ope- ration, which frequently induced unpleasant results, they fell sub- sequently into entire disuse. The oil of croton was also introduced into Europe about the same period, and was occasionally used internally. It had, however, sunk into total neglect, when atten- tion was recalled to it by Dr. Conwell, a physician in the English East India Company's service at Madras, by whom its employ- ment was reintroduced into Europe; and, in a short time, it ac- quired so much repute as an active cathartic, that it was received into various pharmacopoeias. 1 Croton oil is a thickish fluid, of a honey-yellow colour, has a disagreeable smell, and a very acrid burning taste, so that it ex- cites inflammation of the tongue and fauces. It is a fixed oil, having a very acrid matter associated with it, which appears to possess acid qualities — crotonic acid. In ether and turpentine it is wholly soluble; in alcohol, partially so. It is imported chiefly from Madras, but partly from Bombay, and is prepared like castor oil, being strained, however, instead of being boiled. It is like- wise expressed in England. 2 About fifty per cent, may be obtained in this way; and ten per cent, more may be removed by the solvent action of sulphuric ether, which is afterwards expelled by a gentle heat. 3 Being an expensive article and readily adulterated, it is often found impure and comparatively inert. The adultera- tion generally consists in mixing it with a large proportion either of olive oil, or of oil of almonds. 4 According to Dr. Pereira, 5 two kinds are found in the London market, one imported from India and Ceylon ; the other, expressed in London, which differ somewhat from each other. EFFECTS ON THE ECONOMY. Croton oil holds a distinguished place amongst cathartics, inas- much as it can be given in small doses; and in cases of great torpor of the intestines, its action is very certain. Even a drop com- monly produces eight or ten fluid evacuations; but, at times, in unusual torpor of the canal, as many as four or five drops, and 1 Recherches sur les Proprietes Medicinales et l'Emploi de l'Huile du Croton Tiglium, &c. Paris, 1824. 3 Pereira, Elements of Mat. Med. and Therap. ii. 1116. Lond. 1842; or 2d Amer. edit by Carson. Philad. 1846. 3 Christison, Dispensatory. Edinb. 1842. 4 Report of the Committee on Adulterated Drugs, Dr. Huston, Chairman, in Trans- actions of the American Medical Association, vol. hi. Philad. 1850. * Elements of Mat. Med. and Therap. 3d edit., vol. ii. p. 1279. Lond. 1850. OLEUM TIGLII. 563 even more, have been given in the course of ten or twelve hours. Like most of the drastic cathartics, it occasions tormina, but these are less distressing than the burning sensation which it commonly excites in the pharynx, and which is least felt when the oil is given in the form of pill or lozenge. Not unfrequently, also, it causes nausea, often ending in vomiting, in delicate persons, or where the dose has been large, but without interfering materially with the cathartic effect. At times, it is formed into a soap with caustic soda — Sapo olei tiglii — which is given in doses of from one to three grains. This soap is said to be less excitant, and to occasion less pain than the pure oil, and it has the advantage, that the dose can be better apportioned. As with other cathartics, the incautious employment of croton oil may occasion inflammation of the intestinal canal, and, there- fore, it need scarcely be said, its use during inflammation of the canal, is contraindicated. It does not appear to affect any other secretory organs than those of the bowels, although some physi- cians affirm, that they have remarked an increase of the urine after its use. Occasionally, when rubbed, in the quantity of four or five drops around the umbilicus, it would seem to have acted as a cathartic, and even its odour has been known to produce the same effect. Like other active cathartics, it has been employed as an anthel- mintic, especially in cases of tape-worm, by Poccinotti, and others, and with success. 1 It has been recommended in dropsy by Dr. Geo. Fife 2 as pos- sessing one very decided advantage over elaterium ; viz. : — that even when its extreme action is manifested, " it is not followed by the depression inseparable from the effective action of the latter ; but that where the greatest vis inertiee has prevailed, accompanied by absolute incapacity for exertion, a sensible amelioration in these respects has followed its continued employment." Croton oil has been used externally as a revellent or counter- irritant, and at times to induce a cathartic effect; but in this re- spect it is uncertain. 3 Rubbed on the surface in small quantity, it induces inflamma- tion of the skin, which gradually disappears of itself. When the friction is longer continued, pustules are caused, which, when they are numerous, run together or are confluent, and around the spot where the confluent eruption is seated, papulae or pimples appear over a wider extent, which are transformed into pustules, and are surrounded by a red base or areola. When the pustules are discrete, they dry up more rapidly than when they run to- 1 Richter's Specielle Therapie, B. x. S. 248. Berlin, 1828. 2 Provincial Med. and Surg. Journ. Sept. 25, 1844, p. 397. 3 See a case of ileus cured in this manner, by Dr. Susewind, in Casper's Wochen- schrift. fur die gesamrnte Heilkunde, June 24 ; 1837, S. 404, 564 OLEUM TIGLII. gether; and in the latter case they commonly form scabs. Fric- tion readily excites pustulation on the head, face, neck, chest, and on those parts of the extremities where the skin is thin. Where it is thicker, the effect is of course induced with more difficulty. Commonly, the eruption is perceptible in twelve hours after the first friction, but at times not till a later period ; very, rarely is the second friction ineffectual. In the course of from three to six days, the eruption again disappears. The pain usually commences in about an hour after the rubbing, being at first nothing more than a slight itching and burning, which gradually, but decidedly, augments; yet the eruption is never so painful as that caused by the ointment of tartarized antimony, or by the plasler of the same agent, with which it is capable of fulfilling like indications. These frictions with croton oil are adapted for all cases in which local counter-irritation is required. It is important, however, to bear in mind, that it may in this manner act on the bowels, and hence, that it may not be adapted for intestinal disorders, in which it is not desirable to produce such an effect. Frictions with it have been recommended by many physicians — as by i\.ndral, 1 Elliotson, Hutchinson, 2 Short, Landsberg, Romberg, and others, in the following affections : — in chronic inflammations, and such as have a tendency to exsudation; in chronic rheumatic, and gouty diseases, in aphonia* and chronic hoarseness, 4 ' in phthisical affections, especially in incipient phthisis; and in the neuroses — as spasmodic asthma, hooping-cough, paralysis, 5 &c. Gunther 6 advises them as almost specific in rheumatic odontalgia and in otalgia. In neuralgia faciei, the cause of which is considered by Sir Charles Bell 7 to be seated primarily in the intestinal canal, and remotely in the fifth pair of nerves, croton oil has been recom- mended as a superior purgative, and this, as well as other forms of neuralgia? would seem to have been removed by it, — doubtless by the revulsion it excites upon the intestinal nerves. But it need scarcely be said, that it possesses no specific virtue, as has been imagined by some. The same remark applies to its employment as a purgative in acute rheumatism by Dr. Geo. L. Upshur, of Norfolk, Virginia, 9 who is disposed to believe " that the efficacy of Croton oil does not depend entirely upon its cathartic properties. 1 Gazette Medicale, Jan. 1832, and Archives Generates, Aout, 1833. - London Lancet, May, 1833, and Sauer, in Medicin. Zeitung, Aug. 10, 1836. S. 158, cited in Amer. Med. Intel. Nov. 1, 1837, p. 286. 3 Romberg, in Wochenschrift. fur die gesammte Heilkunde,1835. 4 Sauer, op. cit. 5 Boileau, (Paralysis of the Facial Nerve,) Bulletin Medical du Midi. Avril, 1839. 6 Berliner Medicin. Central-Zeitung, Nov. 19, 1838. 7 Practical Essays. Edinb. 1841, p. 101. See, also, Allnati 1 on Tic Douloureux. London, 1841. 8 J. Cochrane, Lond. and Edinb. Monthly Journ. of Med. Science, July, 1841 ; J. A. Easton, London Lancet, Jan. 29, 1841; and Newbigging, Edinb, Med. and Surg. Journ. Jan. 1841, cited in Amer. Journ. Med. Science, Jan. 1841, p. 209. 9 Medical Examiner, Oct. 1850, p. 580. OLEUM TIGLII. 565 It possesses — he thinks — a power over the disease beyond these, and apparently not dependent upon them; for other cathartics, which act as powerfully and as promptly, producing similar watery stools, do not bring a like amount of relief to the patient. " I do not say," he adds, " that it is a specific, for I am not a believer in the doctrine of specifics in medicine: that doctrine has put more stumbling-blocks in the way of medical progress than all the open quackery of the past half century. I merely desire to state, that after a fair trial, in a number of cases accurately observed, where there was scarcely a possibility of falling into error, I believe that the croton oil is the best single remedy in the treatment of acute rheumatism; and I am thoroughly convinced, that it is as justly entitled to the term specific in this disease, as is quinine in mias- matic fever." Yet the cases reported by Dr. Upshur, in which other favourite anti-arthritic remedies — as colchicum and sulphate of quinia — were also prescribed, are far from impressing the au- thor as strongly as they do him. In the only case of genuine tic in which Dr. Christison tried it, no benefit whatever was de- rived. In delirium tremens it has been advised by Dr. Prankerd 1 as an efficacious remedy, in which disease it acts, he conceives, as a direct sedative to the nervous system. The testimony is, how- ever, inadequate to establish the position: and but little reliance ought therefore to be reposed in it. Croton oil has likewise been used as a direct excitant. Cam- panelli 2 gives a case of paralysis of the upper eyelid, which was promptly relieved by the application of four drops to the affected lid, and to the eyebrow. It has been employed also, as proposed by M. Lafargue, 3 by Mr. A. Ure, 4 in the way of inoculation for the removal of a ncevus or erectile tumour, at the inner angle of the right upper eyelid. Several minute punctures were made, with a cataract needle besmeared with oil, over the surface of the nsevus. These gave rise to redness and swelling, which lasted a few hours; and subsequently to small points of suppuration. The operation was repeated at the interval of a week. A rapid dimi- nution, with withering of the tumour, took place. A common lancet may be used for the purpose as in vaccinating. MODE OF ADMINISTRATION. Internally, the dose is from one-fourth or one-half a drop to two drops, given every three or two hours, or more frequently if necessary. The dose is rarely carried higher, except in desperate cases, and in mental affections, for which it is peculiarly appro- priate. It may be prescribed either in the form of emulsion or of pill. Hahnemann 5 and Hufeland recommended it as a substitute 1 Provincial Med. and Surg, Journ. April 29, 1846. 2 Annali Universali di Medicina, July, 1835. 3 Cited in Provincial Med. and Surg. Journal, Feb. 17, 1844, p. 393. 4 London Med. Gaz., March 21, 1845, p. 786. * Apotheker Lexicon, B. ii. Apth. 1, S. 203. 566 OLEUM TIGLII. for castor oil, which is expensive in Germany, — advising that a drop of croton oil should be added to an ounce of oil of poppies, and that the mixture should be called Oleum Ricini Officinale. This preparation is well adapted for emulsions. In apoplexy, or other comatose diseases, it may be given on a piece of sugar, which may be introduced into the throat, or be simply placed on the back of the tongue. When applied exter- nally to excite an eruption, from four to six drops, or even more, may be rubbed in twice a day. For women and children a single application may be sufficient ; but if the skin be thick and insensi- ble, it will be well to rub it previously with flannel, or to apply first a rubefacient, especially when it is desirable to produce the effect speedily. On the other hand, where the skin is excitable, the croton oil should be mixed with from one to four or five parts or more of olive oil, oil of turpentine, or soap liniment. 1 Pilulse olei tiglii. Pills of croton oil, R. Olei tiglii gtt. iv. Micse panis q. s. ut fiant pilulae viij. Dose. — One, or two, or more. R. Olei tiglii gtt. v. Saponis, Acacias pulv. §.§,. ^j. Misce et fiant pilulse xx. Dose. —One to three. Sundelin. R. Olei tiglii gtt. ii. Micse panis vel Saponis 9j. M. et divide in pilulas viij. Dose. — One to four. Pilulse olei tiglii composite. Compound pills of croton oil. R. Olei tiglii gtt. x. Ext. colocynth. comp. gi. 01. menthge piper, gtt. viij. M. et fiant pil, xviii. Two for a dose — to be repeated at short intervals, in cases of obstinate constipation. Haustus olei tiglii. Draught of croton oil. R. Tinct. ol. tiglii fgss. Syrup. Mucil. acacias, aa f ^ij. Aquae destill. f^ss. Fiat haustus. After swallowing a little milk, this draught must be taken very quickly, and be washed down with the same diluent. — JVimmo. 1 See the Author's Gen. Therap. and Mat Med. 4th edit. ii. 262. Philad. 1850. OLEUM TIGLII. 567 Emulsio olei tiglii. Emulsion of croton oil. R. Olei tiglii gtt. iij. Olei amygdal. f ^ss. Acac. pulv. gij. Misce sensira terendo cum Syrup, flor. aurant. f ^ j. Aq. anthemid. f ^v. M. Dose. — A spoonful every two hours until it operates — shaking the vial. Phobus. 1 R. Olei tiglii gtt. i.— ij. anthemid. gtt. ij. Terendo misce cum Mucilag. acaciae Syrup, amygdal. aa, f ^ss. M. Dose. — A tea-spoonful every two hours— -shaking the vial. Lockstadt. Mistura olei tiglii. Mixture of croton oil. R. Olei tiglii gtt. ii. Mucilag. acac. f gij. Aquae f^j. M. Dose. — A fourth part, every two hours, until the desired effect is induced. Mistura olei tiglii saponacea. Saponaceous mixture of croton oil. R. Olei tiglii gtt. viij. Potassae gr. vj. Aquae destillat. f gij. M. This is a substitute for the Sapo Olei Tiglii, which is trouble- some in the preparation. Dose. — Three to six drops. 2 R. 01. tiglii gtt. ij. Sacchar. gij. Acaciae pulv. £ss. Tinct. card, f gss. Aquae destillat. f gx. M. Dose. — Two dessert-spoonfuls, to children ; to be repeated every three or four hours, if necessary. Trochisci olei tiglii. Lozenges of croton oil. R. Olei tiglii gtt. ij. Sacchar. ^j. Mucilag. acaciae q. s. ut fiant trochisci, non torrendi No. viij. Dose. — One every two hours, until the desired effect is induced. Seiler. 3 1 Handbuch der Arzneiverordnungslehre, Th. ii. Berlin, 1836. 3 Ellis's Medical Formulary, 8th edit, by Dr. S. G. Morton, p. 58. Philad. 1846. 3 Hufeland's Journal, B.lix. St.4, S.134; und Rust's Magazin, B.xviii. St. 2, 8. 358. 568 OLEUM TIGLII. Sapo olei tiglii. Soap ofcroton oil. Sapo crotonis. R. Olei tiglii partes ij. Liquor, potassae partem j. Triturate in the cold, and when the mixture has acquired the proper consistence, run it into moulds of pasteboard, and, in the course of a few days, remove it by slices. Dose. — Two or three grains in water, or in the form of pill. Caventou. Linimentum olei tiglii, Liniment ofcroton oil. Linimentum crotonis. R. 01. tiglii p. i. — olivae p. v. M. To be rubbed on the skin night and morning, until pustulation is induced. R. Olei tiglii Liq. potassae aa. f ^ss. Mix intimately by agitation. R. Soluti hujusce ir^xxx. Aquas rosae f ^i. M. To be rubbed on the part night and morning, or even three times a day, until the peculiar eruption is induced. James Allen. 1 The Linimentum Crotonis of the Dublin Pharmacopoeia 2 con- sists of one part of croton oil to seven of oil of turpentine. Embrocatio olei tiglii cum antimonii et potassae tartrate. Embrocation ofcroton oil with tartrate of antimony and potassa. R. 01. tiglii -rn^xx. Antim. et potass, tartrat. 5j. Liq. potassae f gi. Aquae fgvij. M. Used to keep up a mild rash upon the skin. Morris. Unguentum olei tiglii. Ointment of croton oil, R. Olei tiglii ^.x. — xxx. Adipis ^ss. M. A little of this to be rubbed on the part so as to excite the peculiar eruption. Emplastrum olei tiglii. Plaster of croton oil. Sparadrap de croton. M. Bouchardat melts, over a very gentle fire, four parts of 1 Provincial Medical and Surgical Journal, Oct. 28, 1843, p. 75. a The Pharmacopoeia of the King and Queen's College of Physicians in Ireland, 1850. p. 77. Dublin, 185U, PAULLINIA, 569 diachylon plaster ; and when it is in a semi-fluid state, he mixes with it one part of croton oil. This he spreads upon linen, so as to form an adhesive and irritating plaster. M. Caventou prefers the following form, as he considers the degree of heat employed in the process of M. Bouchardat may interfere with the powers of the oil. R. Adipis p. iiss. Cerse p. ss. 01. tiglii p. i. The wax and lard must be melted, and when nearly cold the oil be incorporated. 1 A stronger plaster is also advised by M. Bouchardat. 2 He melts over a gentle fire eight parts of diachylon plaster, and when it is semi-fluid mixes it with twenty parts of croton oil. The resulting plaster must be spread thickly on muslin. It produces considerable irritation of the skin, and may be employed in all cases in which revellents are required. It does not, he says, cause such severe pain as many other counter-irritants, and may be ap- plied over an extensive surface, if desirable. Pope 3 recommends a tinctura granorum tiglii, or a tincture of the seeds, to be made of two ounces of the seeds from which the rinds have been carefully removed, to one ounce of alcohol. This is allowed to digest for six days, and is then filtered. The smallest dose for an adult is twenty drops. This preparation, he says, has the advantage of excluding the more acrid drastic mat- ter contained in the epidermis and husk, whilst the kernel affords cathartic material enough to act powerfully and certainly. CXXXII. PAULLINIA. Synonymes. Guarana, Guarana Pasta, Pasta Seminum Paullinise. French. Pate ou Extrait de Guarana ou Paullinia. German. Guaran a-Sament eig. Paullinia is an extract from the plant of the same name, a native of Brazil. It is prepared by the Indians, and seems to possess considerable excitant powers. M. Gavrelle presented a specimen of it to the Socieie de Medecine of Paris, as well as a new alkali, which had been separated from it by two chemists of Paris. Both Paullinia and the alkali are very bitter, and somewhat resemble cafein. M. Gavrelle states, that Paullinia is obtained from Paullinia sorbilis ; Guarana officinalis, Family, Sapindacese. M. * Bulletin General de The'rapeutique, Mars, 1842, or Journ. de Pharm, Avril, 1842' p. 453. 3 Annuaire de Therapeutique, &c, pour 1844, p. 210. Paris, 1844. 3 Medico -Chirurgical Transactions, vol. xiii. p. 1. 570 PAULLINIA. de Chastetus found it to be composed of a gum, starch, a resinous matter of a reddish-brown colour, a fat oil, tannic acid, and a crystallizable substance possessing the chemical properties of ca- fein. EFFECTS ON THE ECONOMY IN DISEASE. In Brazil and the neighbouring countries, it is given in the form of tisane — the powder being mixed with cocoa — in diarrhoea and dysentery; and in the same affections it has been administered, in France, by Lallemand. As a tonic, M. Gavrelle has employed it successfully in chlorosis, tedious convalescence, paralysis, the col- liquative diarrhoea of phthisis, and hemicrania. According to Von Martius, an extract is prepared in Brazil from Paullinia sorbilis, which is known there under the name of Guarana, and is administered in similar pathological cases. 1 It is probably the same substance. MODE OF ADMINISTRATION. M. Gavrelle has given formulae for Lozenges, Syrup, Pills, Powder, Tincture, and Ointment of Paullinia. 2 Trochisci paulliniae. Lozenges of paullinia. R. Paulliniae ^vss. Sacchar. (vanilla, odorizat.) Baiss. Make into lozenges each containing ten grains. Syrupus paullinise. Syrup of paullinia. R. Paullin. ^iiss. Syrup. Oij. Half a fluidounce may be given in the 24 hours. Pilulse paullinia. Pills of paullinia. R. Paullin. q. s. To be made into pills, each containing a graiu and a half. Pulveres paulliniae. Powders of paullinia. R. Paullin. in pulv. gi. Sacchar. aromatizat. ^ss. M. For a dose. 1 See art. Guarana, in Diet. Univers. de Mat. Med. par Merat et De Lens, torn. ii.,p. 365. Bruxelles, J $38 ; Journ. de Pharmacie, cited in Amer. Journ. of Pharmacy, Jan. 1841, p. 340; Dechastetus, Journ. de Pharm. Aout, 1840; J. J. Virey, ibid.; Von Schlechtendal, Encyclop'ad. Worterb. der Medicin. Wissenschaft. xxvi. 433. Berlin, 1841; and A.Richard, Elements d'Histoire Naturelle Medicale, 4eme edit iii. 51 J. Paris, 1849. 3 Journal de Chimie Med., cited in American Journal of Pharmacy, Oct. 1840, p. 208. PHLORIDZIN A. 571 Tinctura paullinia. Tincture of paullinia. R, Paullin. ^i. Alcohol. (22°) Oi. M. Unguentum paullinia, Ointment of paullinia, R. Paullin. g[ij. Adipis gij. M. CXXXIII. PHLORIDZINA. 1 Synonymes. Phloridzinum, Phloiorrhizinum, Phlorrhizinum, Phloior- rhyzinum, Phlorrhizin, Phloridzia, Phloridzine, Phlorizin, Ehloridzin. German. Phloridzin ; Phloiorrhizin. This bitter principle exists in the bark of both the trunk and the root of the apple, pear, cherry, and plum tree. METHOD OF PREPARING. The following plan is recommended by M. de Koninck, its dis- coverer (1834 or 1835.) — The fresh bark of the root of the apple tree is to be boiled for two hours with sufficient water to cover it: the decoction is to be decanted, and a second one made by the addition of more water. On uniting the two decoctions, and per- mitting them to stand for twenty-four hours, a deposition of phlo- ridzin, in granular crystals, takes place. These are to be treated with distilled water and animal charcoal to purify them. An additional quantity is obtained by evaporating the mother waters to one-fifth. At this degree of concentration, all the phloridzin is deposited. This method affords about one part in three hun- dred. Another plan yields five per cent. It consists in digesting the fresh root in weak alcohol, at a temperature of 120°, for about eight or ten hours, distilling off the greater part of the alcohol, and crystallizing the residue. 2 Phloridzin crystallizes in silky spicula of a dead-white colour when in masses, or in long slender prisms or tables when crystal- lized with care. One thousand parts of water, at a temperature from 32° to 71°, only dissolve about one part; but at from 71° to 212°, water dissolves it in all proportions. It is also very soluble in pure alcohol at ordinary temperatures, although but slightly so in ether, even when boiling. It has no action on test papers. S. g. 1.429. 3 1 From cpXoog, inner bark, and ^ita, root. 3 Journal de Pharmacie, xxii. 78, cited in Amer. Journ. of Pharmacy, vol. ii. new series, p. 240. See, also, M, Boullier, in Gazette Medicate de Paris, 17 Juin, 1837, and Marchand, Journ. de Chim. Med., Avril, 1841. 8 For some elaborate chemical researches on Phloridzine, see M. J. S. Stass, Annales de Chimie et de Physique, Dec. 1838. 572 PIPER I NA. EFFECTS ON THE ECONOMY IN DISEASE. M. de Koninck found, that from ten to fourteen grains given for a dose, with a dram of sugar, produced the most marked effect in intermittent fever, where sulphate of quinia had failed. 1 In four cases, reported by Van Mons, 2 of Bruxelles, the disease was ar- rested by the first sixteen grains: other cases required sixteen grains a few hours before the first paroxysm; twelve grains before the second ; six before the third ; and four before the fourth. Five successful cases are likewise given by M. Mathysen, 3 eleve interne at the Hospital St. Pierre, Bruxelles; and M. Lebaudy 4 affirms, that its efficacy is so decided, that we cannot hesitate to class it with the most powerful febrifuges ; and that it has this advantage over quinia, that it never induces gastralgia; yet M. Leonhard 5 is satisfied, from his various trials, that phloridzin does not possess any febrifuge virtue ! MODE OF ADMINISTRATION. It may be given in the form of pill or powder, like the sulphate of quinia. It was administered at the hospital at Bruxelles, in one case, in the way of lavement ; — twenty-four grains being given in three lavements. The paroxysm returned, but was less violent. In two days afterwards, the same quantity was administered in the same manner, and the fever did not recur. CXXXIV. PIPERI'NA. Synonymes. Piperinum, Piperium, Piperine, Piperin. French. Piperin. German. Piperin, Pf eff erstof f . This substance was discovered by M. Oerstadt, in the year 1819, in black pepper, Piper nigrum. 6 It is found, also, in Piper longum, and it has been presumed to be the same, or an analogous principle, with the cubebin of Piper cubeba. It has been affirmed, that it exists only in black, and not in white pepper; but this is an error. Dr. Christison 7 invariably obtained it from the latter in larger quantity than from the former, and more easily, because it is combined with less resin. M. Oerstadt at first regarded it as ' See, also, Prince Louis Lucien Bonaparte, cited in Bouchardat, Annuaire de The- rapeutique pour 1843, p. "203. Paris, 1843. ' Bulletin Medical Beige, Mai, 1836, 3 Ibid. Oct. 1835. 4 Journal des Connaiss. Med. Chirurg. cited in Braithwaite's Retrospect of Medicine and Surgery, No. 5. p. 12:), Lond. 1842, where it is termed erroneously P/iloridrine; and whence it is copied into the Amer. Journ. of the Medical Sciences, and the Araer. Journ. of Pharmacy, for Jan. 1843, under the name Phloridine. 5 Encyclographie des Sciences Medicales, Mai, 1838. 6 Journ. de Physique, No. 2, lc20, and Gazette de Sante, 25 Mai, 1820. " Dispensatory, p. 69& Edinb. 1842. PIPERINA. 573 a vegetable alkali, but M. Pelletier subsequently analyzed it, and proved it not to be sucb, but to bear a considerable analogy to resins. 1 METHOD OF PREPARING. Let two pounds of black pepper, bruised, be digested, at a gentle heat, in three pounds of alcohol at 36° (.837.) This mixture must afterwards be raised to ebullition, then suffered to remain at rest, and grow cold ; when it must be decanted, and the operation be repeated with fresh alcohol. The two solutions must then be mixed together, and two pounds of distilled water and three ounces of muriatic acid be added. The liquor becomes turbid, and a preci- pitate, of a deep gray colour, is thrown down, which is composed in a great measure of fatty matter. The deposit being separated, crystals may be collected on the filter and sides of the vessel. These are piperin. On adding water, until the liquor is no longer rendered turbid, a fresh quantity is obtained. The above process, which is that of Meli, is the same as one de- scribed by M. Pelletier. He has likewise procured it by the fol- lowing method: — After having exhausted pepper by alcohol, and evaporated the alcoholic tinctures, a fatty or resinous matter is ob- tained : this must be subjected to the action of boiling water, which must be added again and again, until it passes off colourless. By dissolving this fatty matter — thus purified by washing — in alcohol, by the aid of heat, and leaving the solution to itself for some days, a multitude of crystals are obtained, which may be purified by so- lution in alcohol and ether, and by repeated crystallization. The alcoholic mother waters, left to themselves, will furnish fresh crys- tals. This crystalline matter is piperin. Piperin presents itself in the form of four-sided prisms, two of which — parallel to each other — are evidently broader than the others. In the pure state, it is of a white colour, and translucent: it is frequently, however, coloured yellow by portions of resin being combined with it. It has been affirmed, that when piperin is quite pure, it is bland; 2 but Dr. Christison 3 states, that the very whitest crystals he was able to obtain were as acrid as those which are brownish, and they emitted an intensely irritating vapour when thrown on a heated iron plate. It is inodorous, and of a feeble taste of pepper ; fuses readily by heat ; is not volatile, and is scarcely soluble in cold water, but somewhat more so in hot. In respect to its solubility in alcohol, testimony is discordant. According to Magendie, it dissolves very readily therein; according to C. G. Gmelin,it is soluble only in small quantity in cold, but in tolerable proportion in hot alcohol, as well as in ether and in the volatile oils. The solutions taste acrid and peppery, and do not react on 1 Examen Chimique du Poivre, par J. Pelletier, 8vo. Paris. a Dispensatory of the United States of America, 4th edit. p. 512. Philad. 1839, 3 Op. cit. p. G97. 37 574 PIPERINA. vegetable colours; — which shows that it is not an alkaloid, as the discoverer conceived. With acids it forms no intimate chemical combinations; acetic acid, indeed, dissolves it in considerable quantity; it is, however, in great part, precipitated by water, and by evaporation the whole of the acid escapes. It is related to the resins. EFFECTS ON THE ECONOMY. Piperin has been exhibited chiefly by the Italian physicians for the cure of intermittent fever. Its employment was doubtless suggested by the use of pepper-corns as a popular remedy in that disease. According to Riecke, 1 the antiperiodic virtue of pepper is exhibited upon the healthy economy, — a few pepper-corns, taken before the expected appearance of the menses, arresting them for several days. Of this, he himself has had no experience ; but he affirms, that the females in a district of southern Germany have great confidence in their virtues. Meli, 2 w T ho treated many cases of intermittent with piperin, con- siders it the best of all febrifuges, quinia not excepted. He forms twenty grains into ten pills, and gives these at intervals during the apyrexia. He ascribes the efficacy of the oleum acre piperis in the same complaint to the piperin it contains. The febrifuge virtue of piperin has been confirmed by many other Italian physicians, — by Brandolini, Bertini, Gordini, Torelli, and others. According to Brandolini, from forty to fifty grains are generally required to effect a cure. Bertini gave it in three doses during the apyrexia, to the extent of a scruple, made into pills with a bitter extract : after two or three doses, the fever was generally arrested. Gordini affirms, that relapses occurred less frequently after the use of piperin than after that of the sulphate of quinia. On the other hand, in the hospital at Turin, Christ in was disappointed in it, and such seems to have been the result of the trials made by Chiappa. 3 In the year 1823, he administered it in ten or twelve cases, but was unable to detect any great anti- periodic property; not more than a fourth part of the sick expe- rienced benefit, whilst on the others cinchona acted like a charm. In general, a burning sensation was experienced in the stomach after taking it, as well as in the throat, with the same kind of feeling occasionally in the rectum, and in the whole abdomen ; and in two young individuals, the eyes were made red, and the eyelids, nose, and lips were swollen. Piperin has been employed by others besides the Italian physi- cians. Dr. Blom, of Utrecht, has given it in intermittents, but not with as much success as quinia. According to him, the remedy, 1 Die neuern Arzneimittel. S. 361 ; und 2te Auflage, S. 522. Stuttgart, 1840. 2 Nuove Esperienze, &c. Milan, 1823, 8vo. ; and Annali Universal! di Medicina, xxvii. 161, and xxvii i. 22. 3 Riecke, op. cit. S. 361; und 2te Auflage, S. 553. Stuttgart, 1840. PLATINI PRiEPARATA. 575 soon after it is taken, particularly in very impressible persons, oc- casions a sense of internal heat, especially in the epigastric region, and not unfrequently it causes perspiration, especially on the upper lip. BJom is, however, doubtful whether these effects be ascriba- ble to the piperin, or to a portion of the resin of the pepper re- maining united with it. He is of opinion, that both in general de- bility and in debility of the digestive apparatus, piperin merits a preference over sulphate of quinia, both because it can be better borne by the stomach, and because it acts more tonically upon it. It has been given in intermittent fever, with great success, by Dr. Hartte, 1 Port of Spain, West Indies. He prescribed it as soon as the sweating stage was established, until 18 grains had been taken, and, on the following day, when the intermission was com- plete, he directed the same quantity every three hours. It suc- ceeded, in every case, in checking the paroxysm, and as soon as this was accomplished he gave, for some days, pills composed of Piluke Hydrargyri, Piperin, and Sulphate of Quinia, the formula for which is given below. In inflammatory intermittents, as well as in those with gastric complications, piperin is to be avoided. Magendie suggests that it should be given in blennorrhcea, in place of cubebs. METHOD OF ADMINISTERING. PilnlsB piperinsB. Pills of piperin, R. Piperin. gr. xij. Extract, gentian, q. s. ut fiant pilulae xij. Dose.— One every hour, during the apyrexia of fever. Pilulse piper inae composite. Compound pills of piperin, R. Pil. hydrarg. gr. i. Piperin. gr. ij. Quinise sulphat. gr. ij. Syrup, q. s. ut fiat pilula. One to be taken morning, noon, and night. Hartte. CXXXV. PLATINI PRIEPARATA. Synonymes. Preparations of Platinum or Platina. French. Les Preparations de Platine. German. Platinpraparate. EFFECTS ON THE ECONOMY. The preparations of platinum have not been much used in medicine. Experimental researches were undertaken by M. F. s Edinb. Medical and Surgical Journal. Jan. 1841, p. 98. 576 PLATINI PREPARATA. Heifer, 1 in regard to their employment as physiological and thera- peutical agents ; and the following were the main results. Experi- ments were made on rabbits, dogs, and on himself, with the view of discovering the physiological action of the perchloride of pla- tinum or chloroplatinic acid, of the chloroplatinate of sodium or the double chloride of platinum and sodium ; of the chloro- platinate of potassium, and the chloroplatinate of ammoni- um. He found — First. That the chlorides of platinum are poi- sonous, — the perchloride in the dose of 15 grains; the chloroplati- nate of sodium in that of ^ss. Secondly. The chlorides of plati- num are less poisonous than the chloride of gold and corrosive sublimate. Thirdly. The perchloride of platinum, in concentrated solution, produces violent itching or irritation of the skin, followed by a slight eruption on the part to which the solution has been ap- plied. Taken internally, it first of all irritates the mucous mem- brane of the stomach, occasions headache, reacts on the nervous centre, and through it exerts a special alterative action on the fluids of the economy. Fourthly. The chloroplatinate of sodium produces no local irritation on the skin. Taken internally, it does not react on the nervous centres in as manifest a manner as the simple perchloride. It more especially increases the urinary secre- tion. Fifthly. The perchloride of platinum is a very efficacious remedy in the treatment of syphilitic diseases, and especially in those that have been of long duration, and are inveterate. Sixthly. The chloroplatinate of sodium is more proper for the treatment of recent syphilitic diseases. It is also very efficacious in the treatment of rheumatic affect ions. Seventhly. Platinum ought to be ranked in the class of alterative remedies, by the side of gold, iodine, and arsenic. It differs from mercury in previously inducing excitement, whilst its administration is not followed by any of .the disagreeable consequences induced by mercury. Eighthly, and lastly. Platinum is preferable, as an alterative, to mercury and gold. The preparations of platinum have been used by others in syphi- litic affections with success, but the observations of Fricke were unfavourable to them : by Cullerier, they were given in gonor- rhoea and leucorrhcea. Mr. Tuson 3 remarks, that from what he was led to believe of the effects of the chloride of platinum on scirrhous tumours, as stated to him by a medical gentleman whom he met in consulta- tion, he fully expected some most striking results from it, but that he had been disappointed on every occasion where it had been pre- scribed. Still it was his intention to watch carefully its effects on some future opportunity. From what he had seen, he had little faith in its use, either as a local application or as an internal remedy. 1 Gazette Medicate de Paris, No. 48, 1840; orJonrn.de Pharmacie, Avril, 1841, p. 213. a The Structure and Functions of the Female Breast, p, 428. Lond. 1846. PLATINI BICHLORIDUM. 577 The preparations of platinum have been prescribed by Dutten- hofer and Prevost in scirrhus of the stomach ; and by the latter in epilepsy. 1 They are, however, but little employed at the present day. CXXXVI. PLATINI BICHLORIDUM. Synonymes. Platini Perchloridum, Platina Muriatica, Platinum Bichlo- ratum, Chloridum Platinse ; Bichloride or Perchloride or Chloride of Platinum. French. Bichlorure ou Perchlorure de Platine. German. Chlorplatin, Platinchlo r id , Salzsaures Platin- o x y d . This preparation is made by dissolving platinum in aqua regia, and evaporating the solution to dryness. A very gentle heat ought to be used ; otherwise the bichloride may be decomposed ; and the protochloride, or even reduced platinum, be the result. Bichloride of platinum in concentrated solution or in the solid state is of a deep red colour. It is very deliquescent, very solu- ble in water, and soluble also in alcohol. Mistura platini perchloridi. Mixture of perchloride of platinum. {Potion platinique.) R. Platin. perchlorid. sice. gr. iss. Mucilag. acac. Aquae aa. f ^iij. To be taken by table-spoonfuls in the course of the 24 hours. Pilulae platini perchloridi. Pills of perchloride of platinum. (Pilules Platiniques.) R. Platin. perchlorid. gr. viij. Guaiac resin, gi. Glycyrrhiz. pulv. q. s. ut fiant pil. xx. Dose. — One, two, three, or four, morning and evening. Ungnentum platini perchloridi. Ointment of perchloride of platinum. (Pommade platinique.} R. Platin. perchlorid. gr. xv. Extract, belladon. ^ss. Adipis §i. To be applied to indolent ulcers. 1 Dierbach, Die neuesten Entdeckungen in der Materia Medica, 2er Band. S. 1173. Heidelberg und Leipzig, 1843 ; and Aschenbrenner, Die neueren Arzneimittel, u. s. w. a 226. Erlangen, 1848. 578 PLUMBI IODIDUM. CXXXV1I. SODII CHLOROPLAT'INAS. Synonymes. Platina Muriatica Natronata, Chloroplatinate of Sodium, Double Chloride of Platinum and Sodium. French. Chloroplatinate de Sodium, Chlorure Double de Platine et de Sodium. German. C hlorplatinn atrium, Natriumplatinchlorid. The chloroplatinate of sodium is prepared by dissolving bichlo- ride of platinum and very pure chloride of sodium in proper proportions in water, evaporating and crystallizing. It is soluble in water and in alcohol, and crystallizes in beautiful transparent prisms of an intensely yellow colour. Mistura sodii c hloroplatin atis . Mixture of chloroplatinate of sodium. {Potion de chloroplatinate de sodium.) R. Platin. perchlorid. gr. v. Sodii chlorid. pur. gr. viij. Mucilag. acac. Aquae aa. f ^iij. To be taken by spoonfuls in the 24 hours. Injectio sodii chloroplatinatis. Injection of chloroplatinate of sodium. {Injection de chloroplatinate de sodium.) R. Sodii chloroplatinat. crystalliz. gss. Decoct, papaveris Oss. The experiments of M. Hofer with the salts of platinum have not been numerous; but they confirm the assertions of Magendie, that they possess properties analogous to those of the salts of gold. CXXXVIII. PLUMBI IO'DIDUM. Synonymes. Plumbi Ioduretum seu Iodatum seu Hydriodas seu Hydro- iodas seu Iodhydras, Plumbum Iodatum seu Hydroiodicum, Iodide or Ioduret of Lead. French. Iodure de Plomb, Iodure plorabique. German. Bleiiodid, Iodblei, Bleiiodiir, Einfach Iodblei, Hydroiodsaures oder Iod wasserstoff saur es Blei. METHOD OF PREPARING. This preparation may be made by adding a solution of one hun- dred parts of iodide of potassium to a solution of seventy-five parts of acetate of lead. The London Pharmacopoeia of 1836, gives the following form: — Take of acetate of lead, nine ounces; iodide of potassium, seven ounces; distilled water, a gallon (imperial measure:) dis- solve the acetate of lead in six pints of the water, and filter: PLUMBI IODIDUM. 579 to these add the iodide of potassium, previously dissolved in two pints of the water: wash the precipitate and dry it. In the Edinburgh Pharmacopeia, it is directed to be prepared by the double decomposition of nitrate of lead and iodide of po- tassium. Dr. Christison 1 considers, that the nitrate is preferable to the acetate of lead, as being more uniform in composition, and free from any excess of oxide of lead, which interferes with the purity of the product. Iodide of lead is of a bright yellow colour. According to Sou- beiran, 2 it is soluble in 1235 parts of cold water; and is somewhat more soluble in boiling water, which, on cooling, deposits the iodide in minute, shining, yellow, crystalline scales. Riecke 3 says it is soluble in 1200 parts of cold water, and in 200 of hot. When heated it melts, and is dissipated in vapours, which are at first yellow, and afterwards violet. EFFECTS ON THE ECONOMY. Iodide of lead is not an irritant, when applied even to a denuded surface. 4 M. Paton 5 administered twelve grains of it to a cat of moderate size. In four hours the animal did not appear to expe- rience any inconvenience ; twelve more grains were then given ; in twelve hours, the animal became uneasy, and constantly refused every kind of food. It appeared to suffer in the kidneys. Sub- sequently, it was attacked with violent colic, which caused it to jump to great heights. Three days after taking the iodide, it died, suffering dreadfully. The dissection was made twelve hours afterwards, when no traces of irritation were perceptible. M. Paton examined the exterior of the stomach chemically, but was unable to detect any of the iodide, nor could any portion of it be discovered in the faeces. He then boiled the intestines and their contained matters in distilled water; the liquid was filtered and decolourized by charcoal, but no effect was induced by the tests for lead. The matter remaining on the filter was digested in di- lute nitric acid: the solution was filtered, and a precipitate obtained on pouring in a solution of chromate of potassa. The liquid was evaporated; the residue calcined along with what was left by the evaporation of the water, and the whole brought in contact with dilute nitric acid. Nitrous gas was disengaged, and the solution responded to re-agents like the solutions of the salts of lead. M. Paton infers, that iodide of lead introduced into the stomach is partly absorbed, and that it is this portion which causes death, — the remainder passing into the intestines, and admitting of detec- 1 Dispensatory, p. 711. Edinb. 1842. 3 Traite de Pharmacie, cited in Dispensatory of the United States of America, 6th edit. p. 1076. Philad. 1845. 3 Die neuern Arzneimittel, u. s. w. 2te Auflage, S. 563. Stuttgart, 1840. 4 Eager, Dublin Journal for 1834. s British Annals of Medicine, Mar. 3, 1837. 580 PLUMBI IODIDUM. tion by the method described. When given internally, in the dose of a quarter or half a grain, Velpeau thought, that it occasioned, in one instance, irritation in the alimentary canal ; but Dr. O'Shaugh- nessy thinks that this result must have been owing to idiosyncrasy, as ten-grain doses can be borne with perfect impunity. The ex- periments of Dr. Cogswell 1 show, that it is by no means an active agent, and that its physiological operations do not correspond with its therapeutical effects ; as, in continued doses, it produced tne constitutional action of lead, and not at all that of iodine. Owing to its not exciting cutaneous irritation — like iodine and iodide of potassium — iodide of lead has been applied externally. Velpeau 2 treated three cases of enlarged glands with very grati- fying success, although the patients had used frictions with other preparations of iodine ineffectually. Similar good effects were ob- served by Guersent, Roots, Cottereau, Baudelocque, Delisle, and others. 3 Dr. Pereira, 4 however, used it in two cases of enlarged cervical glands without benefit. Dr. Christison 5 has seen it re- peatedly useful to appearance in obstinate ulcers, especially when " consecutive to mercurio-syphilitic eruptions in strumous habits." The dose is three, four, or more grains. Bally has given 30 grains at a dose. Piln lac plumbi iodidi. Pills of iodide of lead. R. Plumbi iodid. gr. iv. Confect. rosae §j. M. et divide in pilulas xij. Dose. — One, night and morning, in scrofulous affections of the glands, joints, &c. The dose may be gradually increased to three or four pills, or more. Cottereau and Joy. 6 Unguent um plumbi iodidi. Ointment of iodide of lead. R. Plumbi iodid. ^j. Adipis ^viij. M. Applied to scrofulous and other indolent swellings in the form of friction. 7 Lond. Pharm. CXXXIX. PLUMBI TANNAS. Synonymes. Plumbum Tannicum seu Scytodepsicum, Tannate of Lead. French. Tannate de Plomb. German. Gerbestoffblei,Bleitannat. 1 Essay on Iodine, p. 142. Edinb. 1837. a Lugol, Essays on Iodine, &e. by O'Shaughnessy, p. 206. 3 Riecke, Nachtr'age zu ersten Auflage der neuern Arzneimittel, S. 78. Stuttgart, 1840, and Aschenbrenner, Die neueren Arzneimittel u. s. w. S. 229, Erlang. 1848. * The Elements of Mat. Med. and Therap. 3d edit. i. 744. Lond. 1849. 8 Dispensatory, p. 712. Edinb. 1843. 6 Tweedie's Library of Medicine, v. 320. Lond. 1840, or 2d American edit. vol. iii. Philad. 1842. . 1 Trousseau and Pidoux, Traite de Therapeutique &c. 3eme edit i. 142. Paris, 184^. POTASSiE CHLORAS. 581 METHOD OF PREPARING. Tannate of lead is formed by precipitating an infusion of oak bark by acetate of lead, according to the following formula : " Take of oak bark, in coarse powder, an ounce; boil in eight ounces of water, until, when strained, four ounces remain: add acetate of lead as long as any precipitate falls; filter the liquor through bibulous paper, and dry the precipitate remaining on the paper to the con- sistence of a thin ointment." EFFECTS ON THE ECONOMY. Autenrieth 1 has strongly recommended tannate of lead in cases of paratrimma ad decubitum or sores produced by lying, and its advantages have been confirmed by others; and Dr. Tott has ad- vised it in cases of decubitus gangrcenosus or sloughing sores pro- duced by lying. 2 In one case, in which it appeared to be ineffi- cacious, he took two drams of the dried precipitate, mixed it with an ounce of unguentum rosatum, and used this unguentum plum- bico-tannicum with success. M. Ossieur has spoken highly of it in the same affection. As a means of preventing chapped nipples it has been highly extolled by M. Leon. 3 EU advises every pregnant woman, who has reason to fear this painful affection, to apply the following ointment, during the month preceding delivery, over the nipple once a day, washing it previously with warm water. Should the ointment be too irritant, the oil of roses may be left out, as it is only employed to " aromatize " it. Unguentum plumbi tannatis. Ointment of Tannate of lead. R. Plumbi tannat. gj. Cerat. gj. 01. ros. gtt. ij. M. Leon. CXL. POTAS'SiE CHLORAS. Synonymes. Kali Chloricum seu Oxychloricum seu Chlorinicum seu Oxymuriaticura seu Muriaticum Hyper-oxygenatum, Chloras Kalicus Depuratus seu Potassicus, Alcali Vegetabile Salito-dephlogisticatum, ChloruretumPotassseOxidatum, HaloidumOxygenatum ; MuriasPotassse Hyper-oxygenatum seu Oxygenatum, Oxygeno-chloruretum Potassii, Potassse Euchloras, Chlorate of Potassa, Chlorate of Protoxide of Potas- sium, Oxymuriate or Hyperoxymuriate of Potassa. French. Chlorate de Potasse. German. Chlorsaures Kali 1 , Oxydirt oder Hyperoxygenirt Salzsaures Kali. METHOD OF PREPARING. In the chemical manufactories, chlorate of potassa is usually 1 British Annals of Medicine, June 2, 1837; and Journ.de Chim. Med., Mars, 1837. 2 Grafe und Walther's Journal der Chirurgie, B. xxiv. S. 676. Berlin, 1836; and Gazette Medicale, Jan. 1837. 3 Gazette Medicale, cited in Abeille Medicale, I Octobre, 1848, p. 217. 582 potassa chloras. prepared by passing- chlorine gas into a solution of carbonate of yotassa. In this way, chlorate of potassa is obtained mixed with more or less chloride of potassium. The salt prepared in the labo- ratories, before it is adapted for medical use, should be purified by recrystallization. 1 It is to be observed, that when the adequate quantity of chlorine gas is not employed in the preparation, the resulting compound is analogous to chlorinated soda and chlori- nated lime, and in action it agrees rather with those preparations than with true chlorate of potassa. This may tend to explain the discrepancy in the experience of different physicians. Chlorate of potassa crystallizes in white leaves having the splendour of mother-of-pearl, or in four or six-sided tables having a specific gravity of 1.989. It is permanent in the air, and has a cool, saline, disagreeable taste, similar to that of saltpetre. Six parts are soluble, at the ordinary temperature, in 100 parts of water. When exposed to heat, oxygen escapes, and chloride of potassium remains. When beaten forcibly in a mortar, it crackles, and emits light and sparks. Rubbed lightly with inflammable substances, or when struck, it inflames readily, and hence its well known em- ployment in the formation of matches. EFFECTS ON THE ECONOMY. These have not been completely tested, — in the opinion of some at least. 2 L. W. Sachs, who has frequently administered it, is of opinion, that in this salt the direct effect of the alkali is rendered milder by the chloric acid, whilst the alkali modifies that of the acid : in this manner, the caustic property of the alkali is destroyed; and the liquifying or resolvent (fluidisirende) property is mo- derated, but not removed. On the other hand, by the union of the chloric acid with the alkali, the powerful excitant action on the nerves, which the former exerts, is at the same time manifestly moderated, although certainly not destroyed: the mode in which it is exerted, he thinks, is probably changed. By such a union, a medicine has been supposed to be formed, which acts chiefly on the nervous system, and which is capable of mitigating and pro- bably of removing any morbid erethism therein, with hyperesthe- sia thereby induced. Such is the opinion of certain therapeutists. Others imagine, that it is capable of purifying the mass of blood in consequence of the chlorine it contains ; but a salt of chloric acid is not possessed of the same properties as chlorine ; and, accordingly, when the au- thor has found occasion to administer it, he has never witnessed any of the effects ascribed to it; nor has he seen any evidence of the modus operandi on the nervous system mentioned above, or of 1 For various forms of preparation see Pereira, Elements of Materia Medica and The- rapeutics, 3d edit. i. 490. Lond. 1849. 4 Riecke, Die neuern Arzneimittel, S. 300, und 2te Auflage, S. 451. Stuttgart, 1 840. potass^ CHLORAS. 583 its imparting oxygen to the blood as supposed by some. 1 The saline powder given below, which was considered by Dr. Stevens to be so useful in many febrile affections, is affirmed by Mr. Braith- waite 2 to have been very beneficial in typhous cases, marked by dry, parched, brown or black tongue ; dark sordes on the teeth and gums, &c, &c. In almost every case, he found the dark appearances in the mouth altered in an incredibly short time. From its excitant properties, and under the notion that it may act upon the blood, and through the blood on the function of nu- trition as an excellent alterative, chlorate of potassa has been re- commended in chronic cutaneous diseases in general, as well as in hepatic and syphilitic affections. It has also been occasion- ally administered in chronic asthenia. Kohler 3 employed it in several cases of tubercular phthisis, and notwithstanding the general results of his experiments were un- favourable, he thinks it ought to be admitted into the number of those remedies that are useful in phthisis, although its stimulating action on the circulating and pulmonary systems cannot be denied. Its use is contraindicated where the fever runs high, and where there is any sign of inflammation of the lungs, or tendency to haemoptysis. Dr. Christison 4 states, that he has tried the effects of seven-grain doses three times a day in phthisis, but could not observe any physiological or therapeutical action whatever. Sachs, in accordance with the views before mentioned in regard to its antineuropathic properties, has advised it in cases of proso- palgia. He affirms, that, in a great many instances, it afforded essential relief. Chisholm appears to have been one of the earli- est to prescribe it in neuralgia faciei ; and, after him, Herber, and subsequently, B. Schaffer, Jos. Frank, Meyer, and others, employed it both as a curative and palliative agent in that disease. It has likewise been advised in obstinate rheumatism of the ner- vous kind by Knod von Helmenstreit; and Eyr has extolled it in ulceration of the mouth after violent salivation. In cancrum oris and phagedena of the cheek, both of which Dr. Henry Hunt 5 regards as identical, varying only in the degree of severity, and proceeding from a cachectic condition of the system, he has found chlorate of potassa, freely given, followed by the best results, — the beneficial influence of ihe salt being generally appa- rent within 48 hours after its first administration : and it seldom failed to arrest the progress of the disease, and to effect a cure, if administered before the patient was much exhausted. He gave it x See Stevens on the Blood, p. 296. London, 1832; and Pereira, Elements of Mat. Med. and Therap. 2d edit. i. 514. Lond. 1842; or 2d Amer. edit by Carson, Philad. 1846. 2 Retrospect of Practical Medicine and Surgery, July to December, 1840, p. 275. 3 Rust's Magazin, B. xlvi. 4 Dispensatory, p. 739. Edinb. 1842. 5 Lond. Med. Gaz. April 7, 1843, p. 76, and Medico-Chirurgical Transactions, xxvi. 142. 584 POTASSvE CHLORAS. in the close of from ^j. to 7)ij., according to the age of the child, in twelve hours. It appears to have been employed successfully in the same affection in Romberg's Poliklinik, in Berlin. For children, some years old, eighteen grains were dissolved in three ounces of water, with half an ounce of syrup; and of this mixture a table-spoonful was given three times a day. A few days were sufficient for the cure. 1 Dr. Watson 2 affirms, that he has been in the habit of directing a solution of chlorate of potassa in water (Potass, chlor. 3j. Jiq. Oj) as a drink for patients in scarlet fever, and in the typhoid forms of continued fever ; a practice which was suggested to him by Dr. Hunt, who informed Dr. Watson that he had long employed it with advantage. Under the use of a pint or a pint and a half of the solution daily, he noticed, in many instances, a speedy improvement of the tongue, which, from being furred, or brown or dry, became cleaner and moist. Dr. Scruggs, of Ger- mantovvn, Te. 3 extols it both as an internal remedy and a collu- tory in the erysipelatous inflammation of the mouth and fauces, which occurs in the ' black tongue ' of the Western States ; and Mr. J. Allison 4 speaks highly of it as an internal remedy in cases of mercurial salivation. He cautions the practitioner, however, to watch its effects; for if its exhibition, he says, be not disconti- nued at the proper time, a state of the system may be induced characterized by the phenomena of true inflammation. MODE OF ADMINISTRATION. Sachs prescribed it in the dose of from three to six grains, three or four times a day, but some give it in much larger quan- tity. It may be administered either in the form of powder or of solution. It would appear, as Dr. Pereira 5 has properly remarked, that most of the uses of this salt have been founded on certain views of chemical pathology, some of which are now considered un- tenable. It passes through the kidneys unchanged, and conse- quently the notion that it furnishes oxygen to the system must be discarded. From the results of the author's numerous trials with it, he is disposed to accord with Dr. Christison, 6 that no evidence has yet been published of such a nature as to entitle it to admission into the pharmacopoeias: yet it is officinal in the London Pharmacopoeia. 1 Mittheilungen des badischen arzlichen Vereins. Karlsruhe, Nr. 5, Marz 13, 1850; cited in £J ordamerikanischer Monatsbericht fur Natur und Heilkunde, Dec 1. 1850, S. 216. 3 Lectures on the Principles and Practice of Physic, 2d Amer. edit. p. 1 024. Philad. 1845. '■' 3 Medical Examiner, for April, 1849. 4 London Med. Gazette, cited in Amer. Journ. of the Med. Sciences, for Jan. 1847, p. 169. 8 Op. cit 3d edit i. 493, Lond, 1849. 6 Ibid. p. 738. Edinb. 1842. POTASSII BROMIDUM. 585 Pnlvis potassae chloratis compositus* Compound powder of chlorate ofpotassa. (Stevens^s saline 'powder.') R. Potassae chlorat. gr. viij. Sodii chloric], gr. xx. Sodae bicarbonat. gr. xxx. M. One of these to be given every two or three hours in low febrile: cases. Stevens. Liquor potassae chloratis. Solution of chlorate ofpotassa. Solutio muriatis potassce oxygenati, Liquor ad ulcera atonica. R. Potassae chlorat. J5J. Aquae destillat. f gxij. M. To be applied to indolent ulcers, by means of lint, or of a camePs hair pencil, dipped in it, to excite the tissues. — Swedidur. 1 Potus potassse chloratis. Drink of chlorate ofpotassa. Potus oxygeriatus. — French : Tisane oxy genie. R. Liquor, potass, chlorat. Oij. Aquae Oiv. M. Given internally in cases of general asthenia. Dose. — One or two pints a day. Swedidur. Mistura potassa) chloratis, Mixture of chlorate ofpotassa. R. Potassae chlorat. giss. Aquae destili. f %\v. Solve. Dose. — A spoonful, every two hours. Von Helmenstreit. Eyr dissolves twenty-five grains of the chlorate in four fluid- ounces of distilled water, and administers a spoonful three times a day. R. Potass, chlorat. gj. Syrup, althaeas f |jj. Aquae destili. f ^iv. M, Dose. — A table-spoonful four times a day. Kbhler, CXLI. POTASSII BROMIDUM. Sfnonymes. Kaliura Bromatum, Bromuretum Potassicum, Brometurn Kalii, Brometurn seu Bromuretum Potassii, Bromide of Potassium. In solution, Potassae Hydrobromas, Kali Hydrobromicum, Bromhydras Potassae, Hydrobromate of Potassa. French. Bromure de Potassium. German. Bromkalium, Kaliumbromid, Kaliurnbromur, Bromwasserstoffsaures oder Hydrobromsaures Kali. 1 Pharm. Med. Pract. Bruxelles, 1817, 2d edit. 586 POTASSII BROMIDUM. METHOD OF PREPARING. According to Liebig, this preparation can be readily made by dissolving bromine in alcohol, and adding potassa until the spirit begins to change colour, then evaporating and heating to redness. In the London Pharmacopoeia, it is directed to be made by adding first an ounce of iron filings, and afterwards two ounces of bromine, to a pint and a half of distilled water. The mixture is set aside for half an hour, and frequently stirred with a spatula ; a gentle heat is then applied, and when a greenish colour is pro- duced, two ounces and a dram of carbonate of potassa, dissolved in a pint and a half of water, are poured in. What remains is filtered and washed with two pints of boiling distilled water, and again filtered. The mixed solutions are then evaporated, that crystals may form. Liebig says it crystallizes in four-sided shining tables; but ac- cording to Ballard, 1 commonly in cubes, and at times in long rectangular parallelopipedons. It has a pungent taste like that of common salt, but more acrid ; and is devoid of odour. By heat, it crepitates, and melts into a red-hot flux, without experiencing change. It is more soluble in hot than in cold water; producing, during its solution, evident cold, and becoming converted into hydrobromate of potassa. It is also soluble in alcohol, although in small quantity. The solution of bromide of potassium dissolves no more bromine than pure water. EFFECTS ON THE ECONOMY. Bromide of potassium excites the same phenomena as bromine, but with less certainty and intensity. 2 From a dram and a half to two drams is needed to kill a dog. The animal appears to suffer; is restless, and gradually falls into a state of prostration. In smaller doses, it appears to act powerfully on the human stomach. The bromide, like bromine, seems first to have been applied to therapeutical purposes by Pourche. 3 Two cases of scrofulous tumours are reported by him to have been removed by friction with an ointment composed thereof, and a cataplasm sprinkled with an aqueous solution. In a third patient, chronic otorrhea and scrofulous tumefaction of the testicle yielded to the same agency, combined with the internal use of bromine. A very large goitre was reduced two-thirds by it. Pourche prescribed it internally in the form of pill, in the dose of four to eight grains in the day. Magendie 4 employed the preparations of bromine in scrofula, in amenorrhcea, and in hypertrophy of the ventricles of the heart. 1 Annales de Chirnie. torn, xxxii. a Bouchardat, Annuaire de Thc'rapeutique pour 1847, p. 237. Paris, 1847, 3 Journ de Chimie Medicale, iv. 594; see, also, Bulletin General de Th6rapeutique, No. 14, 30 Juillet 1837. * Formulaire, ed. cit. POTASSII BROMIDUM. 587 Prieger recommended an ointment of "Kali bromicum" in inve- terate porri go favosa as well as in obstinate and malignant tetter, and with good success; and Dr. Williams 1 in cases of enlarged spleen. The last gentleman suggests, that it possesses " unusual, if not specific (?) powers in the cure of diseases of the spleen." It was owing to these results that the bromide was introduced into the London Pharmacopoeia of 1836. 2 Dr. Williams also gave it with success in a case of ascites. The low price of the bromide compared with that of the iodide of potassium induced M. Ricord to substitute it in the treatment of secondary syphilitic affections. He gave it in the same dose. The therapeutical effects were found to be identical, but induced more slowly. The results of the experience of others has, how- ever, been less satisfactory. Dr. Egan, from extensive observa- tion, has satisfied himself, first, that the iodide of potassium exerts, in the majority of instances of secondary and tertiary syphilis, an instantaneous, decided, and always beneficial action, contrasted with the bromide ; the effects of which are slow, unsatisfactory, and frequently unsuccessful. And, secondly, that the iodide seems to act favourably not only upon the disease for which it is pre- scribed, but also upon the constitution in general, increasing the appetite and improving the powers of digestion, thereby enabling the patient to gain flesh when under its influence ; whilst the bromide not unfrequently produces nausea, impairs the appetite, and deranges the digestive organs; and, lastly, that every form of secondary 'and tertiary syphilis, with the exception of iritis, is amenable to the action of the iodide, whilst that of the bromide is extremely circumscribed. Similar views to those of Dr. Egan are maintained by Drs. Stapleton and Geoghegan. 3 MODE OF ADMINISTRATION. Liquor pfrtassii bromidi. Solution of bromide of potassium. R. Potassii bromidi gr. vi. — viij. — x. Aquae lactucse f ,^iij. Syrup althaeeefgi. M. To be given in the course of twenty-four hours, in table-spoon- fuls. Magendie. Unguentum potassii bromidi. Ointment of bromide of potassium. R. Potass, bromid. gv. xxxiv. Adipis gj. M. 1 Elements of Medicine, i. 338. 2 Pereira, Elements of Mat. Med. and Therap. 2d edit. i. p. 499. Philada. 1842; or 2d Amer. edit, by Carson. Philad. 1846; and Brande's Diet, of Mat. Med. p. 126. Lond. 1839. 3 Dublin Medical Press, May 19, 1847; cited in Amer. Journal of the Med. Sciences, July, 1847, p. 206. 588 POTASSII CYANURETUM. From half a drain to a dram to be rubbed on scrofulous swell- ings. Magendie. M. Pourche employs 3j. of the bromide to the ounce of lard. Unguentum potassii broniidi coinpositum. Compound ointment of bromide of potassium. » R. Broraini gr. vi. ad xij. Potassii bromid. gr. xxiv. Axung. 5J. M. Magendie. CXLII. POTAS'SII CYANURETUM. Synonymes. Potassii Cyanidura, Kali Hydrocyanicura seu Cyanogena- tum seu Cyanatum seu Borussicura, Kalium Cyanogenatum, Cyanu- retum seu Cyanidum. Potassicum seu Kalii, Cyanidum seu Cyatietum Kalii, Hydrocyanas seu Cyanhydras Potassae seu Kalicus, Cyanide or Cyanuret of Potassium. French. Cyanure de Potassium. German. Cyankalium, Bl aus tof f kalium, Kaliumc yanur , Kaliumcyanid Hydrocyansaures Kali, Cyanwasser- stoffsaures Kali, Blausaures Kali. This preparation was proposed by MM. Robiquet and Viller- me, 1 as a substitute for hydrocyanic acid. It is, in their opinion, far more certain in its effects than that. METHOD OF PREPARING. Cyanuret of potassium is formed whenever potassa is calcined with an animal mattery as in the preparation of Prussian blue. It is commonly prepared after the process of Robiquet, by ex- posing to long continued heat the ferrocyanuret of potassium. The cyanuret of iron is completely decomposed, and that of po- tassium remains. The residuum, after this strong calcination, con- stitutes a solid, blackish mass, which consists wholly of cyanuret of potassium, soiled by the iron and the charcoal belonging to the cyanuret of iron. The mass is dissolved in water, when the iron and charcoal are deposited; the cyanuret of potassium dissolves, and is transformed into hydrocyanate of potassa. When the pro- cess has been well conducted, the solution is perfectly colourless, and retains no portion of iron. M. Chevallier 2 prepares the salt by calcining the ferrocyanuret of potassium, and then separating the cyanuret from the quadricarburet of iron by pure alcohol : on distilling this, the cyanuret is obtained very pure. Dr. Hamilton and Mr. Mackenzie, of Baltimore, 3 recommend the following pro- cess as most convenient and simple: — Expose — say — four ounces of the dried ferrocyanuret of potassium in a common Hessian cru- cible to a red heat, until nitrogen ceases to pass over; (this gene- 1 Bulletin de la Soci^'ts Medicale d'Emulation, Juillet, 1823. See, also, James Ham- ilton and Thos. (I. Mackenzie, in Maryland Med. and Surg. Journ.. April, 1840. p. 201. 3 Journ. de Chimie Medicale, and Journ. of Philad. College of Pharmacy, 1832. * Op. cit. p. 203. POTASSII CYANURETUM. 589 rally takes from one and a half to two hours;) then, breaking the crucible, powder the black mass quickly, and add — say — sixteen fluidounces of alcohol, stirring the mixture repeatedly, until it ac- quires the temperature of about 150° Fahr.; then filter, and eva- porate by a sand or water bath, regulated so as to be below the boiling point of alcohol ; for if heated above this temperature, oil of wine is formed, which is gradually decomposed during the pro- cess, and carbon is deposited, which blackens the mixture. The evaporation should be carried on so as to have as great an extent of surface exposed as possible. The ferrocyanuret will be found to have yielded six or seven drams of the cyanuret, which is dry, inodorous, and perfectly white. The following process is directed in the last edition of the Pharmacopoeia of the United States, (1842:) — Take of ferrocy- anuret of potassium, in powder, gviij.; Distilled water, f 3vj. Expose the ferrocyanuret to a moderate heat until it becomes nearly white, and is wholly deprived of its water of crystallization. Put the residue in an earthen retort, with the beak loosely stopped, and expose it to a red heat for two hours, or till gas ceases to be disengaged. Withdraw the retort from the fire, close the orifice with lute, and then let the whole remain until quite cold. Break the retort; remove the black mass, and reduce it to coarse powder, introduce it into a bottle of the capacity of twelve fluidounces, and then add the distilled w 7 ater. Agitate the mixture occasionally for half an hour, throw it on a filter, evaporate the filtered solu- tion rapidly to dryness, and keep the dry mass in a closely stopped bottle. Pure cyanuret of potassium is white and transparent: it may be fused in the fire without being decomposed, and keeps for an indefinite period, provided it be preserved dry. It is very soluble in water, but sparingly so in alcohol. All acids decompose it, even the carbonic: hence the solution, when exposed to the air, emits the smell of hydrocyanic acid; and carbonate of potassa is formed, in the place of the hydrocyanate of potassa. It has a sharp, somewhat alkaline, and bitter almond taste, and an alkaline reaction. EFFECTS ON THE ECONOMY. MM, Robiquet and Villerme performed some experiments on animals in the presence of Magendie. 1 A tenth of a grain de- stroyed a male linnet in a minute; Jess than a grain killed a gui- nea-pig in two or three minutes: a small drop of the hydrocyanate of potassa, containing only the hundredth part of a grain of the cyanuret in solution, caused a linnet to drop down dead in half a minute. Half a dram, containing five grains of the cyanuret, killed a dog of large size in a quarter of an hour; and three grains * Formukire pour la Preparation, &c, de plusieurs Nouveaux Medicamens, &c. 38 590 POTASSII CYANURETDM. proved fatal to a man in three quarters of an hour. 1 Dr. Letheby 2 states, as the result of his experiments on animals, that with the exception of hydrocyanic acid, of the strength of four per cent., cyanuret of potassium is the most virulent and active of all the compounds into which cyanogen enters. Magendie proposes, that the cyanuret of potassium should be dissolved in eight times its weight of distilled water, when it be- comes transformed into hydrocyanate of potassa. To this solution he gives the name medicinal hydrocyanate of potassa, and ad- vises that it should be given under the same circumstances, and in the same doses, as the medicinal hydrocyanic acid, (see pages 24 and 35.) He farther suggests, that to render it wholly indepen- dent of the action of the small portion of alkali contained in the cyanuret, a few drops of some vegetable acid may be added, or it may be prescribed with an acid syrup. The dose of the cyanuret is a quarter of a grain at first, gra- dually increased to a grain and more. M. Bally gave it to fifty- two individuals labouring under different diseases: it produced no effect on thirty-five; and, on the others, the result was neither constant nor salutary, so that he is not inclined to place more reliance upon the cyanuret than upon hydrocyanic acid. By M. Lombard, 3 of Geneva, it has been applied externally, with success, in some cases of facial neuralgia. He uses it by friction, in the form of watery solution, or of ointment, according to circumstances. The watery solution is in the strength of from one to four grains to the ounce of water; and the ointment is com- posed of from two to four grains of the cyanuret to an ounce of lard. The aqueous solution, however, is considered by Dr. Lom- bard to be the most prompt in its effects. He regards the cyanu- ret to be contraindicated where the nervous affection is compli- cated with inflammatory action. He has found it a useful remedy, also, in chronic rheumatism. In sciatic neuralgia, it was not successful. In white swelling, attended with acute pains, poul- tices, moistened with the solution, gave great relief. Dr. Lombard, indeed, affirms, that the soothing properties of the cyanuret are superior to those of any remedy known. Lotions of hydrocyanic acid are not to be compared with it, — the acid being decomposed with facility, and not devoid of danger. In a case of acute rheumatism attacking the articulations of a chlorotic young female, M. Malherbe, 4 after leeching, applied compresses over the joints affected, moistened with a solution of the cyanuret — ten grains to the ounce of distilled water. In forty-eight hours the pain ceased. It is probable, however, that 1 See Christison on Poisons, first Amer. edit p. 503. Philad. 1845. 9 London Medical Gazette, Jan. 9, and Feb. 4 and 17, 1H45. * Gazette des Hopitaux, and Lond. Med. Gaz., Sept. 1831. * Journal des Connaissances Medico Chirurgicales. POTASSII CYANURETUM. 591 much of the good effect was owing to the compression. MM. Trousseau and Rullier 1 also recommend the cyanuret, in the pro- portion of four grains to an ounce of water, as a local application in various forms of neuralgia. In the quantity of nine grains to eight ounces of water, it is employed by M. Cazenave, 2 as a lotion in pruritus ani et vulva. M. AndraP employed it with complete success in a case of in- tense cephalalgia, which, for ten months, had resisted the most powerful remedies, as bleeding, a seton in the neck, blisters and sinapisms. It was given in solution, in the proportion of from six to eight grains to the ounce of distilled water; and compresses, wet with the solution, were applied, for eight days, to the fore- head and temples. When nitrate of ^silver has been long used in affections of the eye, it turns the conjunctiva of a dark olive colour, and greatly disfigures the patient. Mr. Guthrie 4 states, that a solution of the cyanuret, {Potass, cyanur. gr. vj.; rfquce f §j.,) applied by drops, every other day, is an admirable remedy. It is also equally effec- tive in removing the stain made hy iodine on the skin. MODE OF ADMINISTRATION. Mistnra potassii cy a nureti. Mixture of cyanuret of potassium. Mixture of hydrocyanate of potassa. Pectoral mixture of Magendie. R. Potass, hydrocyan. med. f £i. Aquae destillat. Oj. Sacchar. ^iss. M. Dose. — About five drams (a table-spoonful,) night and morning. (Pectoral potion.) R. Potass, hydrocyan. med. gtt. xv. Infus. heder. terrestr. f §ij. Syrup, althaeas fgj. M. Dose. — Five grammes (a tea-spoonful,) every three hours. Magendie. R. Potass, cyanur. gr. -|. Syrup, althaeae f gj. Aquae lactucae f ^ij. M. Dose. — Five drams (a table-spoonful,) every two hours. Magendie. R. Tinct. castor. Moschi, Potassae nitrat. aa. gr. iv. Potassii cyanuret. gr. ij. Aquae flor. tiliae sen cinnamom. f ^viij. 1 Lond. Med. and Surg. Journ. Dec. 15, 1832; cited in Amer. Journal of the Medi- cal Sciences, May, 1833, p. 238. 3 Ranking's Half- Yearly Abstract, July to Dec. 1846, p. 198. 3 Gazette Medicale, Jan. 1832. * Cited in Amer. Journ. of the Med. Sciences, Oct. 1844, p. 517. 592 POTASSIl HYDRARGYRO-IODIDUM. To be taken in the course of the twenty-four hours, in chorea. Fouquier. Sympus potassii cyannreti. Syrup of cyanuret of potassium. R. Potass, hydrocyanat. medic, f gj. Syrupi Oi. This syrup must be added to pectoral draughts, and may be substituted for other syrups, in appropriate cases. Pilnlse potassii cyannreti. Pills of cyanuret of potassium. R. Potassii cyanur. Amyli aa. gr. iv. Syrup, q. s. ut fiat massa in pilulas viij. dividenda. Dose. — A pill, night and morning, in convulsions, dyspnoea, &c. Hospital of La Pitie. 1 lotio potassii cyannreti. Lotion of cyanuret of potassium. R. Potass, cyanuret. gr. xij. Mist, amygdal. f ^vj. M. To be used in lichen, and other chronic eruptions attended with much itching. Louis. R. Potass, cyanur. gr. vj. Solve in Aquae destillat. f gj. M. ' Compresses to be wetted with this, and applied in cases of neuralgia faciei, hemicrania, &c. Recamier, Trousseau, Blouquier. 2 Ungnentnm potassii cyannreti. Ointment of cyanuret of potassium. R. Potass, cyanur. gr. ij. — iv. Adipis |i. M. The size of a hazelnut to be rubbed in, in cases of neuralgia. Lombard. CXLIII. POTASSII HYDRARGYRO-IODIDUM. Synonymes. Potassii Iodo-Hydrargyras, Hydrargyro-iodidum Potassii ; Hydrargyrum Biiodatum cum Kalio-Iodato, Kali Iodatum Hydrargyra- tum, Kalium Hydriodatum Hydrargyratum, lodo-Hydrargyrate of Po- tassium, Iodhydrargyrate of loduret of Potassium, Hydrargyro-iodide of Potassium, Hydrargyro-biniodide of Potassium, Dihydrargyro-bin- iodide of Potassium. French. Iodhydrargyrate de Potassium. German. Quecksilberiodidkalium. 1 Ryan's Formulary, 3d edit. p. 392. Lond. 1839. a Lincke, Vollstandiges Recept-Taschenbuch, ii. 91. Leipz. 1841. POTASSII HYDRARGYRO-IODIDUM. 593 Dr. A. Channing, 1 who has highly extolled this preparation in various diseases, affirms, that this, with other new salts, was dis- covered by Bonsdorff, of the University of Finland, in 1826 ; and it is a fact well known to the chemist, that iodine, chlorine, &c, enter into combinations so as to form both acids and bases. By experiment, Dr. Channing ascertained, that a solution of eight grains of pure iodide of potassium, in ten or fifteen minims of water, would combine with a fraction less than eleven grains of red iodide of mercury, and maintain the combination in solution, when diluted with water or alcohol to any extent. If more than eleven grains of red iodide be added, although a small excess may be dissolved in the concentrated solution, on diluting with water, it is promptly precipitated. It would appear, therefore, as Dr. Channing has remarked, that in preparing this salt for administra- tion, the labour of crystallizing it, in order to obtain a solution of a definite strength, is wholly unnecessary; inasmuch as a solution, combining a fraction more than eight grains of the iodide of po- tassium with eleven grains of the iodide of mercury, may be used as containing twenty grains of the hydrargyro-iodide of potassium. If it be desirable to obtain the preparation in a crystallized form, it is important that the definite proportions of the two iodides should be observed, and particularly, that there be no excess of iodide of mercury ; for the saturated solution of eight grains of iodide of po- tassium will dissolve, and enter into combination with, more than thirteen grains of iodide of mercury, forming similar crystals soluble in alcohol, but in water precipitating more than two grains of iodide of mercury. This double salt may also be formed by dissolving one equiva- lent of bichloride or of per 'nitrate of mercury in a solution of four equivalents of iodide of potassium, evaporating to dryness, and dissolving the double iodide from the chlorohydrate or nitrate of potassa by means of alcohol. When made from the pernitrate of mercury, it is liable, however, to contain nitre, which may be de- tected by its insolubility in strong alcohol. 2 EFFECTS ON THE ECONOMY. These are similar to those of the iodides of mercury, but, ac- cording to Dr. Channing, in a less degree. The hydrargyro-iodide is not, however, much employed, experience seeming to have shown, that it possesses no essential, if, indeed, any advantages over those preparations. It has been highly extolled by Dr. Charles C. Hildreth, 3 of Zanesville, Ohio, in several diseases in which a com- bination of iodine and mercury might be expected to be beneficial. In ordinary dyspepsia, his faith in its remedial powers is so strong 1 American Journal of the Medical Sciences, Feb. 1834, p. 388. a Ambrose Smith, American Journal of Pharmacy, Jan. 1841, p. 271. * American Journal of the Medical Sciences, Aug. 1840, p. 314, 594 POTASSII HYDRARGYRO-IODIDUM. that he had prescribed but little else for the previous four or five years. He speaks highly of it, also, in enlargement of the spleen, amenorrhea, dysmenorrhea, leucorrhcea, dropsy, and glandular enlargements of a scrofulous character. In these last cases, he combines the internal use with the external, according to the form of ointment given below. Puche 1 has recommended it as not being so subject to produce salivation or pains in the tones, as the other combinations of mer- cury and iodine. MODE OF ADMINISTRATION. Mistura pot a s s ii kydrargy ro-iodidi- Mixture of hydrar gyro-iodide of potassium. R. Hydrafg. iodid. rubr. gr. iv. Potassii iodid. 9j. Aquae destillat. f gj. M. Dose. — Five drops, three times a day, Charming. R. Hydrargyri iodid. rubr. Po'tassii iodid. aa. gr. iv. Aquae f ^i. Solve. The dose of this is from two to six drops, equivalent to from about the thirteenth to the twelfth of a grain of the double salt. 2 R. Hydrarg. iodid. rubr. gr. viij. Potassii iodid. gr. viij. Aquas destillat. f 3 viij. M. Dose. — f jij. to f |ij. in twenty-four hours. Puche. Tinctura potassii hydrargyro-iodidi. Tincture of hydrar gyro-iodide of potassium. R. Potass, hydrargyro-iodid. gr. j. Alcohol, dilut.fgj. M. Dose. — Ten drops, three times a day. Charming. Pilule potassii hydrargyro-iodidi. Pills of hydrar gyro-iodide of potassium. R. Hydrarg. iodid. rubr. gr. viij. Potassii iodid. gr. viij. Sacchar. lact. gr. lxiv. Mucil. acac. q. s. ut fiant pilulae Axxij. Dose. — One to eight, daily. Puche. 1 Journal des Connaissances Medicates, Oct., Nov. 1838, Janvier, 1839; and An- nates de Chimie, Oct. 1838. 9 Ambrose Smith, American Journal of Pharmacy, Jan. 1841, p. 270. POTASSII IODIDUM. 595 Unguentum potassii hydrargyro-iodidi. Ointment of hydrar gyro-iodide of potassium. R. Hydrarg. iodid. rubr. gr. vij. Potass, iodid. Qij. Adipis 3J. To be applied to tumours, two or three times a day. Should it prove too irritating, the proportion of lard must be increasd. Hildreth. CXLIV. POTASSII 10'DIDUM. Sfnonymes. Kalium Iodatum, Iodidum Kalii, Kali Hydroiodinicum, K. Hydroiodicum, Hydroiodas Kalicus seu Lixivias, Ioduretum Potassicum, Iodhydras Kalicus seu Potassae, Potassii Ioduretum, Iodide or loduret of Potassium. In solution — Potassae Hydriodas, Potassii Proto-hydrio- das seu Protoxidi Hydriodas, Hydroiodas Kalicus seu Lixiviae, Iodhy- dras Kalicus seu Potassae, Hydriodate of Potassa. French. Hydriodate de Potasse, Iodure de Potassium. German. Iodkalium, lodwasserstoffsaures Kali, Kalium- iodiire, Iodinwasserstoff Kali, Hydriodsaures oder Hy d riodinsaures Kali, Kalihy dr oi odat . METHOD OF PREPARING. The process of Dr. Turner is, to take any quantity of solution oi caustic potassa, and to add to it gradually, at a gentle heat, iodine sufficient to neutralize the alkali; then evaporating to dryness, calcining strongly, dissolving in water, and crystallizing. Dr. William Gregory 1 suggested an improvement 'on this process, which has been regarded as one of the simplest. 2 'He adds iodine to a hot solution of potassa until the fluid assumes a yellowish- brown colour; then evaporates, and heats the residuum to low red- ness in a platinum crucible. The mass, which at first consists of iodide of potassium and iodate of potassa, thus loses all its oxygen, and becomes converted into iodide of potassium. The formula of Caillot and Baup is to take ten parts of iodine and fifty of distilled water ; put them into a matrass, and add, in small successive portions, of pure iron filings, five parts, — shaking the vessel each time. The liquor is then heated until it loses its colour, is filtered, and the substance on the filter is washed with boiling water, until the liquid is tasteless;. the liquor and the vari- ous liquids used in the washings are united, and the whole is heated in a sand bath. When the temperature approaches that of ebullition, enough of a solution of carbonate of potassa is added to precipitate all the oxide of iron as carbonate; it is then filtered, and the substance on the filter w T ashed until it is com- pletely exhausted. All the liquors are then united, tested by reddened litmus paper, and if there be any excess of base, a little hydr iodic acid is added. It is then evaporated in a sand bath, 1 Edinb. Med. and Surg. Journ., xxxvi. 369. for Oct. 1831. 3 Cogswell on Iodine, p. 85. 596 POTASSI IODIDUM. until a slight pellicle forms; the fire is now discontinued, and the salt is suffered to crystallize. Lastly, the crystals are washed with a little water, and dried. 1 Iodide of potassium is in white or transparent crystals. These are readily fused, and are volatilized at a red heat. They do not decompose, even when heated with access of air. They are readily soluble in water, and in alcohol, and the addition of the iodide facilitates greatly the solution of the iodine in water. The odour is slightly that of iodine, from the salt containing a little of that element, uncombined. Taste acrid and saline. It would seem that a slight contamination of iodide of potassium with carbonate of potassa is exceedingly common, as it can with difficulty be avoided in the manufacture of the salt; but Dr. Chris- tison 2 affirms, that he has examined specimens, where the carbo- nate, with its accompanying water, amounted to 90 parts in the 100. " Can we wonder, then," he asks, " that practitioners should complain of the iodide of potassium, that they have given it for months, nay, even for years, without observing any effect either on the constitution, or on the disease for which it was adminis- tered ?" It is sometimes adulterated, too, with nitrate of potassa, and the chlorides of potassium and sodium. 3 EFFECTS ON THE ECONOMY. As respects the action of iodide of potassium, and its administra- tion in disease, it is scarcely necessary to do more than refer to what has been said under the head of iodine. On the whole, its effects appear to accord with those of iodine; at least no difference is perceptible on the organism. It has been supposed, that it is better than pure iodine, where the object is to act especially on the urinary organs. 4 For external use, iodide of potassium is usually preferred to iodine. It is constantly given internally, and often in combination with the latter ; the solubility of which, as was before remarked, is aided by it. Many of the subjoined for- mulae contain both one and the other. As remarked under iodine, it is now administered in very large doses in a multitude of diseases of different nature, and often, doubtless, where it can render little or no service. Dr. Buchanan asserts, that he has given it in doses of ^ss., and the only precaution he observed was to make the patient drink 1 Jourdan's Pharmacopee Universale, i. 6fi2. Paris, 1828; also the London Phar- macopoeia, and Brande's Dictionary of Materia Medica, p. 317. Lond. 1839. This is essentially the process of the Pharmacopoeia of the United States (1842.) a Edinb. Med. and Surg. Journal, April, 1838; and Dispensatory, p. 253. Edinb. 1842; also, Pereira, Elements of Mat. Med. and Therap. '2d edit. i. 491. Lond. 1842 ; or 2d Amer. edit, by Uarson. Philad. 1846. 3 Report of the Committee on adulterated drugs, Dr. Huston, chairman, in Transac- tions of the Amer. Med. Assoc, iii., 291. Philad. 1850. * Riecke, Die neuern Arzneimittel, u. s. w. S. 306. See, also, Cogswell on Iodine, p. 96, POTASSII IODIDUM. 597 freely of diluents. It was chiefly to determine some physiological questions that he administered it in such large doses. Two drams of it were taken by a young man affected with gonorrhoea, and as soon as the medicine made its appearance in the urine, blood was drawn from the arm. On examining the blood, both the serum and crassamentum were found deeply impregnated with iodine. 1 On the other hand, Dr. Lawrie, of Glasgow, 2 considers it very un- certain, and at times dangerous, although he esteems it by far the best of the recent remedies, and prescribes it more frequently than any other medicine; and Mr. Mayo 5 affirms, that no medicine, where it does good, produces amendment, in constitutional syphi- lis, so speedily as it. Lugol and others appear to have used it mainly as a solvent to iodine, and Lugol considers it inferior to the latter as a therapeutical agent ; but no chemical or other prepos- session can set aside the testimony just cited ; or that of such ob- servers as Ricord, 4 C. J. B. Williams, 5 Joy, and a host of others. In the author's hands, it has appeared to afford as much benefit as any of the preparations of iodine, and M. Dorvault 6 regards it as embodying all the excellencies of iodine without its defects. For the testimony in regard to its beneficial and injurious effects, see Iodine, page 454. Cases of salivation from its use have been published by Sir Francis W. Smith. 7 According to the experiments of Magendie, 8 iodide of potassium is one of the substances that promote the coagulation of the blood. MODE OF ADMINISTRATION. Liquor potassii iodidi. Solution of iodide of potassium. Potio resolvens ex lodio, Solution de Coindet, CoindeVs Solution. R. Potassii iodidi gr. xxxvj. Aquse destillat. f gj. Solve. Dose. — The same as that of the tincture of iodine. Coindet fy Magendie. R. Potassii iodidi gj. Aquse destillat. f §j. Solve. Dose. — Fifteen drops three times a day, gradually increased to forty-five, in cases of ovarian dropsy, — frictions with iodine oint- ment being used at the same time. Elliotson. 1 London Medical Gazette, July 2, 1836. B Ibid. July 3, 1840, p. 591. 3 A Treatise on Syphilis, by Herbert Mayo, F. R. S. Lond. 1840. 4 Practical Treatise on Venereal Diseases, translated by Drummond, Amer. edit. Philad. 1843. Parker, Modern Treatment of Syphilitic Diseases, Amer. Med. Lib. edit. p. 77, Philad. 1840; and Bulletin General de Therap. Juillet, 1840. 5 Lectures on the Physiology and Diseases of the Chest, Bell's Medical Library edit, p. 246. Philad. 1839. 6 Iodognosie ou Monographic Chimique, Medicale et Pharmaceutique, deslodiques en general, et en particulier de I'lode et de l'lodide de Potassium. Paris, 1850; cited in Brit, and Foreign Med. Review, Jan. 1851 , p. 92. * Dublin Journal of Medical Science, July, 1840, and Jan. 1841. 8 Lec,ons sur le Sang; and translation in Lancet, for Jan. 26, 1839, p. 636. 598 POTASSII IODIDUM. Liquor potassii iodidi compo situs. Compound solution of iodide of potassium. (Lugol's solution.) R. Iodin. gj. Potassii iodid. 9'j« Aq. destillat. f ^vij. Solve. Dr. Bache 1 remarks, that " in the original it is seven ounces, but from the context of the author, this is evidently a misprint for se- ven drams." It is proper, however, to observe, that many of the successful cases were treated by the weaker solution, six drams of which contain only ^ of a grain, whilst six of the other contain 2.ths of a grain. Dose. — Six drops early in the morning, and in the middle of the day, in a glass of sugared water, in tetter, scirrhus, &c. Lugol. Lugol has a solution of three strengths for internal use: I. II. III. R. Iodin. gr. £. gr. i. gr. 1}. Potass, iodid. gr. iss. gr. ii. gr. iiss. Aq. destillat. f^viij. f ^viij. f -fviij. Dose. — Two-thirds^daily, at first; afterwards, the whole. Lugol recommends this threefold solution in the same cases as his threefold solution of iodine; the first being continued from fourteen days to three weeks; the second, from the fourth or fifth week of the treatment to its termination; the third, the strongest, he did not often use. As Riecke has observed, it would be better to have in the hospitals but one solution, which might be pre- scribed in varied doses. R. Iodin. gr. v. Potass, iodid. gr. x. Aquae destillat. f gxx. M. Dose. — f 3ij. to f ^vj. London Pharmacopoeia. Liquor iodini compositus. Compound solution of iodine. (LugoVs solution.) R. Iodin. gvj. Potass, iodid. ^iss. Aquae destillat. Oj. Dissolve the iodine and iodide of potassium in the water. Dose. — Ten to twenty drops, three times a day. Pharm. United States. R. Potassii iodid. Iodin. aa. gr. 78. (5 gram) Alcohol, at 90° C. gxiij. (50 gr.) Aquae destillat. §iij. (100 gr.) * Dispensatory of the United States, 4th edit. p. 374. Philad. 1839. POTASSII IODIDUM. 599 Rub the iodine and iodide of potassium in a mortar with a little of the water. Add the alcohol and the remainder of the water. This has been proposed as a substitute for the mixture of tinc- ture of iodine and water, used by M. Velpeau, with so much suc- cess, in the surgical treatment of dropsies. 1 Guibourt. Tinctura iodini composita. Compound tincture of iodine. R. Iodin. gj. Potass, iodid. ^ij. Alcohol. Oij. M. Dose. — Ten minims. Lond. Pharmacopoeia. The Pharmacopoeia of the United States adopts the same quan- tities; but the pint Imperial measure contains about one-fourth more than the pharmacopoeial pint of the United States. (Iodine paint.) R. Iodin. gr. lxiv. Potass, iodid. gr. xxx. Alcohol, f gj. M. Applied in rheumatic affections of the joints, by painting the parts freely with a camel's hair pencil. King's College Hospital. Mistura potassii iodidi composita. Compound mixture of iodide of potassium. R. Iodin. gr. ss. Potass, iodid. gss. Syrup, papav. f ^ss. Aq. destillat. Oss. Dose. — Two table-spoonfuls, three times a day, in cases of com- plication of syphilis with scrofula. Tyrrel. R. Iodin. gr. iss. Potassii iodid. gr. iij. Solve in Aquae menth. pip. f ^iv. Dose. — A spoonful two or three* times a day; — to children, a tea-spoonful. In cases of cancrum oris; also, in dropsy, gleet, and leucorrhcea. On renewing the prescription, the dose of the iodine may be increased one-half, and of the iodide one grain, each time. Coster fy Freidrich. R. Potass, iodid. ^iv. Syrup, althaeas f ^j. menth. pip. f £ij. Aquse lactucse f ^viij. Dose. — A spoonful, morning and evening, in a little water, in- creasing the dose to two spoonfuls. In cases of hypertrophy of the ventricles of the heart. Magendie. 1 Bouchardat, Annuaire de Therapeutique pour 1847, p. 244. Paris, 1847. 600 POTASSII IODIDUM. R. Potass, iodid. £iv. Tinct. digit, f 3J>. ad f gij. Syr. althaeae f Jiss. Aq. lactuc. f ^viij. — fi0r.naph.f3ij. M. Dose. — Morning and evening, a spoonful, in a little water. In hypertrophy of the ventricles of the heart with quickening of the heart's action. Magendie. R. Quassiae, Gentian, aa. £j. Aquae bullient. f ^xvj. Macera per horarn et cola. Liquor colat. add. Potass, iodid. gr. xxxvj. Potassse carbonat. ^ij. M. Dose. — A table-spoonful, three times a day, in a glass of water. Cumming. Pilulse potassii iodidi. , Pills of iodide of potassium. R. Potass, iodid. gr. xv. Aq. destillat. q. s. Spong. ust. Ext. dulcamar. aa. ^ij. Glycyrr. pulv. q. s. Fiant pilulae clxxx. Dose. — Six, two or three times a day, in scrofula, goitre, &c. VogL Unguentnm iodini compositum. Compound ointment of iodine. — Ioduretted ointment. R. Iodin. gss. Potass, iodid. gj. Alcohol, f 3J. Adipis ^ij. Rub the iodine and iodide with the alcohol, and mix with the lard. Pharm. Lond. $f United States. Unguentum *po t as sii iodidi, Ointment of iodide of potassium. R. Potass, iodid. ^ss. Adipis ^iss. M. Half a dram at first, and subsequently a whole dram, to be rubbed in, in goitre, scrofulous glandular affections, &c. This ointment is generally too weak, unless combined with the internal use of iodine in some form. Magendie. R. Potass, iodid. 9j. Adipis gss. M. The parts to be smeared with it two or three times a day, in moist tetter — serpigo. Between the applications to be dressed with dry lint. Tiinnermann. In dry tetter, the ointment applied is formed of oj. to ^iss. of the iodide to §j. of lard. POTASSII IODIDUM. 601 (Unguentum kali hydroiodici. Pharmacop. Borussic.) R. Potass, iodid. gj. Magnes. carb. gr. vj. Aq. destillat. guttas nonnullas. M. terendo cum Ung. rosat. gj. Or, R. Potass, iodid. Sodse carbon, depur. sice. aa. £ss. Ung. rosat. giv. ad gvj. M. A piece, of the size of a small bean, to be rubbed in, morning and evening, in chronic enlargement of the testis. Wallher. Messrs. T. and H. Smith, 1 of Edinburgh, having found it im- practicable to make a neat ointment of iodide of potassium by the ordinary method, have recommended the following: Dissolve the re- quisite quantity of the iodide in its own weight of distilled or some perfumed water, and then mix thoroughly in a mortar with the proper quantity of lard. The two will incorporate perfectly with a very little heating, and form a smooth ointment. R. Potass, iodid.'^ss. Ext. opii £)ss. Cerat. gj. M. As a dressing to malignant cancerous ulcers. Unguentum potassii iodidi compositum. Compound ointment of iodide of potassium. R. Iodin. gr. xij. Potass, iodid. ^iv. Adipis §ij. M. In scrofulous ophthalmia, ulcers, fyc. Lugol. R. Iodin. gr. xv. Potass, iodid. ^j. Tinct. opii f ^ij. Adipis ^ij. M. In painful scrofulous ulcers, ivhite sivellings, fyc. Lugol. Ungnentnm potassii iodidi et hydrargyri. Ointment of iodide of potassium and mercury. R. Potassii iodid. gr. xij. — xv. Ung. hydrarg. ciner. ^ss. M. In herpes exedens. Blasius. Ungnentnm potassii iodidi anodynum. Jlnodyne ointment of iodide of potassium. (Pommade iodee calmante.) R. Potass, iodid. gr. xv. Morphia? muriat. gss. Adipis gx. M. 1 London and Edinburgh Monthly Journal of Medical Science, Oct. 1841, 602 POTASSII IODIDUM. Applied to painful tumours of the mammas, night and morn- ing. Chomel. Em pi a strum potassii iodidi compositum- Compound plaster of iodide of potassium. R. Iodin. Potass, iodid. aa. 9ss. ad 9j. Emplastr. hydrarg. seu saponis. §ij. M. Applied in syphilitic and gouty swellings of the bones. Ebers. Linimentum potassii iodidi. Liniment of iodide of potassium. (Baume. hydriodate.) R. Potassii iodid. S£j. Alcohol. (20°) fgiv. M. R. Sapon. ex oleo animal, confect. ^iss. Alcohol. (20°) f!§iv. M. Mix these two solutions together: aromatize with a small quan- tity of oil of lavender, and before the mixture congeals pour it into wide-mouthed vials. 1 This liniment has been much used at Lausanne under the name Ge lee pour le goitre. Lotio potassii iodidi composita. Compound lotion of iodide of potassium. R. Iodin. gr. i. ad ij. Potassii iodid. gr. ij. ad gr. iv. Solve in Aquse destillat. f ^viij. This solution was commonly used by Lugol externally, inject- ed under the eyelids in strumous ophthalmia, fstulas, &c. Lugol. R. Iodin. gss. Potassii iodidi ^j. Solve in Aq. destillat. f £vj. This "rubefacient solution of iodine" may be used two or three times a week, w 7 hen the last prescription loses its effect, or when it is desirable to stimulate more actively. It is also added to baths — three or four ounces to an ordinary bath — as well as to poultices, being mixed with an ordinary cataplasm. Lugol. R. Iodin. 3j. Potass, iodid. 3 ij. Solve in Aquae destillat. f ^ij. This " caustic iodine solution" may be used when the last 1 F. Boudet, Journal de Pharmacie. Avril, 1842, p. 335; and Duhamel, in Amer. Journal of i'harmacy, July, 1842, p. 102. QUINIA. 603 loses its efficacy. It occasions a crust on the parts. Lugo! em- ploys it chiefly when the skin on the edges of the ulcers is greatly hypertrophied, red, and fungous, as well as in phagedenic or spreading tetters. It may be applied two or three times a week, or daily, should the case require it. Lugol. Collyrinm potassii iodidi compositum. Compound collyrinm of iodide of potassium. R. Iodin. gr. ss. ad gr. i. Potassii iodid. £)ss. Solve in Aq. rosse f jfiij. M. To be applied, four times a day, in cases of scrofulous ophthal- mia, with ulceration of the conjunctiva and cornea. Magendie QUINIA ET EJUS SALES. Synonyme. Quinia and its Salts. CXLV. QUINIA. Synonymes. Quinina, Quina, Quininum, Quinium, Chininum, Chininium ; Chinium, Kinium, Sal Essentiale Corticis Peruviani. French. Quinine, Kinine. German. Chinin, Quinin, Chinas toff. Quinia is a most important gift from modern analytical che- mistry to medicine. About thirty years have elapsed since the discovery of this substance, and, by general consent, it is re- garded as one of the most valuable remedies in the catalogue of the materia medica. The honour of the discovery — which had been facilitated by the investigations of other chemists, as to the composition of the cinchona barks — belongs to Pelletier and Ca- ventou, (1820, 1 ) and so rapidly and extensively was its efficacy promulgated, that in the year 1826, in two laboratories in Paris for the preparation of quinia, fifty-nine thousand ounces of the sulphate — the form best known, and most frequently prescribed — were prepared. For this discovery, the Royal Academy of Sci- ences of Paris awarded MM. Pelletier and Caventou the Mon- thyon prize often thousand francs. It would appear, from the observations of Henry and Plisson, that cinchonia and quinia exist in cinchona bark in combination with kinic acid and also with cinchonic red, which is an insoluble red colouring matter. 2 1 Annales de Chimieet de Physique, xv. 280 and 337. a Jour de Pharmacie, xiii. . 646 SPIRITUS PYRO-ACETICUS. according to Messrs. Ballard and Garrod, 1 was given by Dr. Has- tings. In this they are in error ; and the confusion has probably arisen from Dr. Hastings having also given the erroneous name " naphtha," to the pyro-acetic spirit, which was the article really used by him. METHOD OF PREPARING. Pyro-acetic spirit may be prepared by distilling a mixture of two parts of crystallized acetate of lead and one part of quick- lime in a salt glaze jar (graybeard) the lower part of the jar being coated with fire clay, and a bent glass tube, half an inch in dia- meter, being adapted to the mouth by a cork so as to form a dis- tillatory apparatus. The jar is supported on the mouth of a small furnace, by which the lower part only is heated to redness, and the vapours are conducted into a Liebig's condenser. The pro- duct is repeatedly redistilled from quick-lime, until its boiling point is constant at 132 . 2 It is a colourless, volatile, inflammable liquid, having a peculiar penetrating odour, and a pungent taste like that of peppermint. Its specific gravity is 0.792. As found in the shops, its density is generally not lower than 0.820. It is miscible with water, ether and alcohol in all proportions. If, when mixed with water, it be- comes turbid, it has not been freed from empyreumatic oil. EFFECTS ON THE ECONOMY. Dr. Hastings 3 states, that the reason why he was induced to deviate from the line of medical treatment of phthisis, which has so universally, and for so long a period, been in vogue, and to ad- mit a new method of management, was the fatal termination of all cases, whatever was the treatment adopted, during an experience of upwards of twenty years. "I was led," he says, "to the con- clusion, from a careful survey of the chemical analyses of tubercle made by Thenard, that it was defective, inasmuch as the compo- sition of the animal matter, which amounted to upwards of 98 parts out of 100, had not been investigated. From the greasy na- ture of tubercle in its crude state, there did not exist the slightest doubt in my mind, that carbon entered largely into its formation, and that its composition had a striking resemblance to fatty matter. In consequence of the loss of fat, so remarkable in the earlier stages of consumption, I determined to employ those compound agents, rich in carbon and hydrogen, which had not been previously used in medicine; not with the idea that they would make up the defi- ciency which the system had sustained in the progress of the dis- ease, but that such a change would, by that means, be introduced into the constitution as would act on the forces of the organism, 1 Elements of Mat. Med. and Therap. p. 391. Lond. 1845. 2 Bache. Dispensatory of the United States, 6th edit. p. 1291. Philad. 1845. 3 Op. cit. SPIRIT US PYRO-ACETICUS. 647 at the point of departure from health, whether that took place in the stomach, blood or elsewhere ; that change tending to such an affinity in the elements within the body, that the carbon, hydrogen, oxygen and nitrogen, instead of assisting in the formation of pro- ducts which threaten life, would tend to develop those materials only which are required for the preservation of health and the prolongation of existence. 5 ' Thirty-six cases, presenting all the phenomena of tubercular phthisis, are stated by him to have been cured by the pyro-acetic spirit — the cough, expectoration, sweats, &c, disappearing for the most part within a few weeks, and the physical signs indicative of structural lesions disappearing soon after. The statements of Dr. Hastings were very properly doubted by the best observers; but still it was deemed advisable to give the remedy a fair trial, and the result has been far from confirming them. In the author's experience no good has resulted from its use except what follows the employment of ordinary excitant expectorants, as creasote. Testimony in its favour from others has not, however, been want- ing. Mr. D. Wilson 1 narrates cases which appeared to exhibit all the functional and physical phenomena of phthisis, and were cured or relieved by it. In enumerating the cases in which he recommends the use of "naphtha," Dr. Hastings 2 observes, that the less complicated phthisis may be with other affections, the more suitable is it for treatment by this agent. When the pulse is at the ordinary stand- ard or thereabouts; when the hectic is slight; laryngeal and peri- toneal disease absent ; the functions of the stomach and bowels not much impaired ; the constitutional disturbance inconsiderable, and the physical signs denoting only a slight deposit of tubercles in one lung; the prognosis is favourable, and a speedy recovery may be anticipated. In many cases, this mild character of the disease is never witnessed, howsoever early they may be seen: for want of close observation, too, this period frequently escapes notice; hence, success depends upon an early and correct diagnosis. If naphtha be given in acute phthisis, when the cough is very harassing, with slight frothy expectoration ; respirations 30 to 40 per minute; p,ulse 120 to 140; hot skin; profuse night sweats; great thirst; appetite deficient or altogether wanting; and the physical signs denoting an extensive deposition of tubercles in both lungs, it will be found, he says, injurious rather than beneficial. If it be employed in chronic phthisis co-existing with disease in other organs, its value is di- minished in proportion to the extent of the complications, and their vitiating influence on the constitutional powers; and if it be perse- vered with in certain cases in which improvement had followed its use, after the appearance of intercurrent pneumonia, bronchitis or pleurisy, it will do great mischief. Many such cases, says Dr. 1 London Lancet, June 3d, 1834, p. 344, and Nov. 25, 1843, p. 250. a Op. cit. 648 SPIRITUS PYRO-ACETICUS. Hastings, give way to a short course of treatment with antimony, digitalis, &c, and then the pyro-acetic spirit may be again employed with the greatest advantage. Where haemoptysis is present, or where it has recently existed, it is generally contra-indicated. When phthisis is complicated with dyspepsia, little or no benefit will accrue from its use, until the latter affection is removed ; yet Dr. Hughes Bennett 1 ascribes all its agency in phthisis to its power of calming the irritability of the stomach, which occurs often in the disease, and for which, according to his experience, naphtha is the best remedy. Dr. Hastings states farther, that the disease is not amenable to the plan of treatment when the patients are in crowded hospitals, or in other situations where the atmosphere is impure. If doubt may be entertained in regard to the efficacy of pyro- acetic spirit in phthisis, there would seem to be none, that in cases of chronic bronchitis resembling phthisis it has produced, and may be expected to produce, benefit. Mr. Procter 2 has related a case, in which, after acute bronchitis, difficulty of breathing, cough, with well marked purulent expectoration, and nocturnal perspira- tion existed ; with great emaciation and occasional haemoptysis. A mixture was prescribed of pyro-acetic spirit f ^j; liquor opii se- dativus f ^ij.; of which the patient took fifteen drops three times a day in a little water. The medicine was continued for about two months, when the patient reported himself well. In the Re- port of the Hospital for Consumption and Diseases of the Chest, (Lond. 1849,) it is stated, that in some cases of bronchitis with profuse secretion it seemed useful, but it was not otherwise pro- ductive of benefit, and often proved hurtful. 3 It is in chronic bronchial affections that the pyro-acetic spirit will probably be almost wholly employed, provided it retains its place in the cata- logue of the materia medica ; and hence it has been classed else- where by the author with creasote, the balsams, &c, amongst ex- citant expectorants. 4 M. Lavirotte, of Lyons, and Dr. David W. Yandell 5 have re- commended it in diarrhoea. In 23 cases — 16 of diarrhoea, and 7 of dysentery — the results were favourable. Dr. Yandell gives it in the dose of twenty drops at intervals of three hours. Dr. Hastings 6 has also extolled it highly in gout, and in acute and chronic rheumatism. " For upwards of twelve months," he says, " I have employed pyro-acetic spirit in these affections, 1 On Cod-liver Oil. Edinb. 1848. 2 Lond. Med. Gazette, Nov. 17, 1843, p. 213. 3 British and Foreign Medico-chirurg. Rev. for April, 1850, p. 321. See, also, the similar sentiments of Dr. Theophilus Thomson, Dr. Golding Bird, and others, in Lancet, January 15, 1848. 4 General Therapeutics and Materia Medica, 4th edit. i. 240, Philad. 1850. * Western Journal of Medicine and Surgery, Sept. 1849. • Cited in Amer. Joum. of Pharmacy, New Series, xiii. 66, Philad. 1847. STRYCHNIA. 649 and my treatment has been attended with a success quite extra- ordinary, far exceeding the results usually obtained by colchicum, &c." His overstrained eulogies, however, of its effect in phthisis will render the profession slow to credit this assertion. MODE OF ADMINISTRATION. The dose in which Dr. Hastings generally administers the pyro- acetic spirit is from ten to twenty drops three times a day in a small quantity of water. After the second or third day he aug- ments the dose by about one-fourth, regulating its increase or de- crease according to the absence or presence of nausea, vomiting, or any other untoward symptom resulting from its use. As the disease advances he raises the dose to 40 and even 50 drops, and administers it four times instead of three times a day. STRYCHNIA ET EJUS SALES. Synonyme. Strychnia and its salts. CLXIII. STRYCHNIA. Synonymes. Strychnium, Strychninum, Strychna, Strychnine, Vauque- line. French. Strychnine. German. S try chnin, K rahena ugen sto f f, Krahenau gen - bitter. This alkaloid was discovered by Pelletier and Caventou 1 in nux vomica, St. Ignatius's bean, upas tieute, and in the wood of strychnos colubrina ; and experiment has shown, that these sub- stances are indebted for their medicinal properties to it. 2 In them, strychnia is found associated with another principle analogous to it in its properties — brucia. 3 In St. Ignatius's bean, there is less brucia than in nux vomica, so that it is best adapted for the pre- paration of strychnia; but it is not as easily obtained, and conse- quently nux vomica is almost always used. METHOD OF PREPARING. According to one form of preparation, liquid subacetate of lead is added to a solution of the alcoholic extract of nux vomica in water, until a precipitate is no longer thrown down ; the foreign matters being thus precipitated, the strychnia remains in solution with a proportion of colouring matter, and sometimes an excess of acetate of lead. The lead is now separated by sulphuretted hydro* gen; and the fluid is filtered and boiled with magnesia, which unites with the acetic acid, and precipitates the strychnia. The 1 Annales de Chimie, torn, viii. ix. and x. 3 Magendie, Annales de Chimie, x. 176. 1819. 8 See page 146. 650 STRYCHNIA. precipitate is next washed in cold water, and redissolved in alco- hol to separate it from the excess of magnesia, and by evaporating the alcohol, the strychnia is obtained. If it be not perfectly white, it must be dissolved in acetic, or hydrochloric acid, and be repre- cipitated by means of magnesia. The modes of preparation recommended in the Pharmacopoeias of London, Edinburgh, and the United States, differ from each other. The following is that contained in the last work (1842:) — Take of nux vomica, rasped, Tbiv.; lime, in powder, ^vj.; mu- riatic acid, f giij.; alcohol, dilute sulphuric acid, solution of am- monia, 'purified animal charcoal, water, each a sufficient quantity. Digest the nux vomica in two gallons of water, acidulated with a fiuidounce of the muriatic acid, for twenty-four hours; then boil for two hours, and strain with expression through a strong linen rag. Boil the residuum twice successively in the same quantity of acidulated w r ater, each time straining as before. Mix the decoc- tions, and evaporate to the consistence of thin syrup; then add the lime previously mixed with a pint of water, and boil for ten minutes, frequently stirring. Pour the mixture into a double linen bag, and, having washed the precipitate well with water, press, dry, and powder it. Treat the powder repeatedly with boiling alcohol until deprived of its bitterness; mix the liquors; and distil off the alcohol by means of a water bath. Mix the residue with water, and, having applied heat, drop in sufficient diluted sulphuric acid to neutralize and dissolve the strychnia; then add purified animal charcoal, boil for a few minutes, filter, evaporate and crystallize. Dissolve the crystals in water, and add sufficient solution of am- monia to precipitate the strychnia. Lastly, dry the precipitate on bibulous paper. 1 As thus prepared, it is in the form of a white powder. Strychnia, obtained by crystallization from an alcoholic solution, which has been diluted with a small quantity of water, and left to itself, appears under the form of microscopic crystals, constituting four-sided prisms, terminated by pyramids with four flattened or depressed faces. When crystallized rapidly, it is white and granu- lar, is insupportably bitter to the taste, and leaves an after taste similar to that caused by certain metallic salts; it has no smell, and is not changed by exposure to the air; is neither fusible nor volatile ; for, when subjected to the action of heat, it does not fuse, until the moment of its decomposition and carbonization, and it is decomposed by a -degree of heat inferior to that which destroys most vegetable substances. When exposed to the naked fire, it swells, becomes black, and yields an empyreumatic oil, a little water, acetic acid, carbonic acid and carburetted hydrogen. Dis- tilled with oxide of copper, it gives out much carbonic acid, and only slight traces of nitrogen. It is composed of oxygen, hydro- 1 Pharm. of the United States, p, 184. Philad. 1842. STRYCHNIA. 651 gen, carbon and nitrogen. Although strychnia has so strong a taste, it is scarcely soluble in water. At 50° Fahr., 6667 parts of water dissolve but one of it ; boiling water dissolves a little more than double, so that it may be said to be soluble in 2500 parts of boiling water. It is remarkable, however, that a solution made in the cold, and containing therefore only ^WOi part of its weight, may be diluted one hundred times, and still retain a very decided- ly bitter taste. It is more soluble in strong alcohol, little so in weak, and not much so in ether or fixed oils, although they acquire a bitter taste from it. On the other hand, it is very readily soluble in volatile oils, and the hot saturated solution, on cooling, deposits crystals. It has an alkaline reaction and forms, with acids, salts which are mostly crystallizable, and insupportably bitter, and are more soluble than pure strychnia. 1 Strychnia, being sold at a high price, is liable to adulteration. A respectable druggist of Philadelphia informed the author, that one of his customers was offered strychnia by another house at a price considerably lower than what he had to pay for it when purchased even in large quantities from respectable sources. He bought an eighth of an ounce of it at the rate of five dollars the ounce; when pure strychnia could not be offered at less than nine dollars per ounce. Some of this was tested, when it was found to consist of equal parts of flour or starch, and pure strychnia. EFFECTS ON THE ANIMAL ECONOMY IN HEALTH. The effects of strychnia on man and animals resemble, on the whole, those of the spirituous extract of nux vomica, except that they are more intense. According to Magendie, one-eighth of a grain is sufficient to kill a strong dog. Pope, who made experi- ments on dogs, found that one-twelfth of a grain was enough to paralyze the low T er limbs of a small dog in four or five minutes, and in half an hour to kill it. Christison 2 considers strychnia the strongest poison after hydrocyanic acid. He injected a solution of a third of a grain in alcohol into the, thorax of a wild boar, and in ten minutes the animal died. A dog was destroyed by one- sixth of a grain in two minutes; and he believes, that the same effect would be induced on man by half a grain introduced into a wound. Lembert 3 observed similar results from placing a grain in the thorax of a small dog, and from three grains introduced into the areolar tissue of a larger animal, on which tetanic spasms were induced in the thoracic muscles. Dr. Blake 4 injected a grain of strychnia, dissolved in a small quantity of acetic acid, into the veins of a dog. The first effect of the poison was to induce gene- 1 Magendie's Formulaire, &c. a Treatise on Poisons, 3d edit. Edinb. 1836; and Dispensatory, p. 895. Edinb. 1842. 3 Essai sur la Methode Endermique. Paris, 1828. 8vo. 4 Edinb. Med. and Surg. Journal, April, 1839, p. 338. 652 STRYCHNIA. ral convulsions in about thirty seconds after its injection, the action of the heart being at the same time rendered irregular, which Dr. Blake presumes was owing to the convulsive struggles of the animal. All external signs of life ceased in about a minute and a half after the injection of the poison, but the heart still continued to beat. He found that when strychnia was introduced into the cir- culation in so small a quantity as not to produce any general symptoms, it did not appear to exert the least influence on the heart. That the action of strychnia is analogous to that of nux vomica, has been proved by the experiments of Segalas, 1 Andral, 2 Bards- ley, 3 Redlich, Sandras, Luders, Hennemann, and numerous others. 4 It affects especially the vesicular matter of the spinal marrow, the reflex system of Dr. M. Hall, — less strikingly the brain: small doses, according to some, 5 excite the ganglionic system ; larger, the spinal marrow; consequently, it has been imagined, that it mio-ht be an efficacious remedy in nervous diseases, which are dependent upon spasmodic disorder of the ganglionic system, or upon diminished sensibility and torpor of the nerves of motion. 6 The observations of Cartoni led him to infer, first, that strych- nia has a special elective action on the nerves of motion in general, and chiefly on those which are concerned in the movements of the iris: secondly, that its action is diametrically opposed to that of substances, which occasion, and keep up, abnormous dilatation of the pupil ; and lastly, that " it is a precious and efficacious agent in certain diseases of the eyeball, which depend upon vital and organico-vital modifications of the system of ciliary nerves." 7 The following are the effects observed by Oppler from the in- ternal use of nitrate of strychnia : — a sensation of warmth and itching in the epigastrium; eructation; nausea; vertigo; slight ex- citement like that of intoxication; great vividness, with more or less confusion of mind; dull pain over the eyes; spots before the same; dilatation of the pupils; diplopia; tinnitus aurium; difficult articulation and deglutition ; slight trismus ; sense of formication in the paralyzed parts, with convulsive motions or twitchings, at times, in them ; at others, over the whole body, similar to electric shocks; tremors of the muscles; occasionally, violent spasms; teta- nus; asthma: palpitations; febrile heat; general sweating; prostra- tion ; pale or livid countenance ; pulse sometimes full and frequent, 1 Magendie's Journal de Physiologie, ii. 4. 3 Ibid. Juillet, 1823. 3 Hospital Facts and Observations, Illustrative of the Efficacy of Strychnia. Brucia, &c. Lond. 1830. 4 Petrequin, Gazette Medicale de Paris, No. 44, Nov. 1838. 5 Stumpf. art. Strychnos, Encyclopad. Worterb. der Medicin. Wissensch. xxxii. 480. Berlin, IS44. 6 See, on this subject, Pickford, of Heidelberg, cited from Gazette Med. de Paris, 5 Juin, 1844, in Amer. Journal of the Med. Sciences, July, 1844, p. 201. • Bouchardat, Annuaire de Therapeutique, &c. pour 1847, p. 3d. Paris, 1847. STRYCHNIA. 653 at others, small and contracted; great sensibility over the whole body ; involuntary laughter, succeeded always by difficulty of breathing and convulsions. The sleep was generally interrupted by convulsions ; the secretion of urine scanty, and occasionally suppressed. These symptoms came on gradually, and disappeared in the same manner, when the dose was moderate, in the course of some hours. Large doses, he says, induce death by a sudden shock to the nervous system ; smaller doses, when continued for a long time, may destroy by causing apoplexy, of which he saw many examples in his experiments on animals. 1 Dr. Blumhardt 2 has recorded a case of poisoning by strychnia, which occurred to him in Stuttgart. He was called to a young man, seventeen years old, who had swallowed two scruples of strychnia after dinner. A short time afterwards, experiencing great restlessness, he repented of what he had done, and imme- diately took four grains of tartar emetic, which excited considera- ble vomiting. When the physician arrived, about a quarter of an hour after the strychnia had been taken, he found the patient on his back in bed, with his head thrown back, rigid and incapable of motion, but with a constant inclination to turn towards the right side. He could only move the upper limbs freely. The counte- nance was pale and haggard ; the temperature of the skin natural, and the pulse quick and contracted. Consciousness remained un- affected ; the speech was rendered difficult by an occasional con- traction of the muscles that move the lower jaw ; but it could not properly be said to be interrupted: deglutition was unaffected* The trismus, however, became more and more frequent and vio- lent, and the respiration thereby unequal and suspended ; the pulse was small, suppressed and quick. The remedies — employed to save him — as tincture of iodine and acetate of morphia, were of no avail. With the periodical trismus was now associated spasmodic agitation of the whole body, to which — after a short interval — - succeeded opisthotonos with, violent symptoms of suffocation ; the trismus attained the highest degree, and the upper extremities were deprived of the influence of volition. With the increase of the general tonic spasm, the respiration was always more difficult and oppressed, and for a time wholly ceased ; the pulsation of the heart and arteries became irregular, less distinct, and at length imperceptible. In this condition, the skin acquired a bluish ap- pearance ; the countenance was puffed and of a violet hue; the lips dark-blue, the neck swollen, the eyes protruded, fixed and di- rected towards the right side; the pupils enlarged and immovable, and the conjunctiva injected. At this period, the patient was en- tirely unconscious ; but from this condition he aw T oke once, and all 1 See, also, Tanquerel des Planches, Eseai sur la Parahys'e tie Plomb. Paris, 1834, 2 Medicinisch. Correspondenz-Blatt. in Encyclog. des Sciences Medicales, Sept. 1837, 42 654 STRYCHNIA. the symptoms became mitigated ; during this remission, the mus- cles influenced by the spinal marrow remained cramped, except the upper extremities, which could be moved voluntarily. In a quarter of an hour, the tetanic attack returned in its violence, with intense commotion of the whole body; this ended in asphyxia, from which he again recovered to consciousness. The same thing happened in a third attack. In the fourth, he succumbed under the power of the poison. The whole scene, from the taking of the poison to the occurrence of death, lasted an hour and a half. During the last attack, as doubt existed whether he w 7 as really dead, the median vein of the left arm, w T hich w T as turgid, was opened, and after the vessel was emptied of its thick, black blood, which resembled that of an animal, several bubbles of air, from the size of a pea to that of a small cherry, were forced out by pressure. The dissection was made twenty hours after death. In spite of the elevated summer heat, there were no signs of putrefac- tion. The whole of the body was uncommonly rigid. The mus- cles of the back were of a brownish-red colour, almost like that of smoked meat. On opening the spinal canal, a considerable quan- tity of thick, dark-coloured blood, like that of an animal, flowed out. The plexus venosi spinales were turgid with the same kind of blood, as well as the vessels of the pia mater. Under this membrane, especially in the cervical portion, some watery fluid was effused. The upper portions of the spinal marrow were soft, pappy in some places, but lower down it became gradually harder. Within the cavity of the cranium, the same turgid condition of vessels existed ; all the veins of the dura mater appeared as if in- jected; the veins of the pia mater were likewise engorged; and the "whole mass of the brain indicated an unusual supply of blood, so that the cortical substance appeared quite blue. The cerebellum was softer than usual. In the cavities of the abdomen and thorax, a striking poverty of blood w ? as perceptible. The heart was shrunken and empty, as well as the large vessels of the thorax. The stomach was full of solid food, which appeared to have un- dergone no change; its blood-vessels contained a considerable quantity of blood, and the mucous coat exhibited marked redness over its whole surface; but this was especially concentrated about the cardia and the fundus ; the small intestine was likewise redder than natural, as is commonly the case in those who have died whilst digestion w r as going on. The liver was tolerably supplied with blood; the gall-bladder empty. 1 When strychnia is used endermically, as is not unfrequently the case, the course of the phenomena is somewhat different. G. H. Richter employed it in this way in many cases of hemiple- 1 For other cases, see Christison on Poisons, 1st Amer. edit. p. 6S5. Philad. 1845: and James Wilson, London and Edinburgh Monthly Journal of Medical Science, Dec. 1S43; cited at length in Amer. Journal of the Med. Sciences, April, 1846, p. 52S; and Taylor, On Poisons, Amer. edit, by R, E. Griffith, p. G22. Philad. 18 #8. STRYCHNIA, 655 gia, in one of which it occasioned symptoms of actual poisoning. When the dose exceeded a quarter of a grain, a feeling arose in the part to which it was applied as if needles were run into the skin ; this gradually spread over the whole limb ; the temperature of the body was augmented ; the pulse was quickened, full and hard ; the breathing constrained ; pain was experienced in the same side of the head ; the secretion of urine was increased, and a general perspiration broke out, which persisted for about an hour, after which the pricking of the surface, and the excitement of the vessels ceased. To these symptoms — and seldom later than two hours after the application of the agent — convulsive movements succeeded in the paralyzed limbs like those induced by electricity, which augmented in violence and in frequency with the increase of the dose, — being strongest and most severe during the night, at which time the limbs were moved involuntarily. When awake, a feeling of stiffness was experienced in all the limbs, which passed off when they w r ere used. On digestion, defecation, and the appetite, the nitrate of strychnia seldom ex- erted any influence. Only in one case — in which no effects were induced on the nervous system, when the dose was gradually carried to three grains — was obstinate constipation induced. In general, when it was begun with in the dose of one-eighth of a grain, and on the next day one-fourth was given, on the third day one-half, and afterwards the dose was increased daily by one- fourth of a grain, until one and a quarter were taken, — the fol- lowing unpleasant symptoms supervened. The patient experienced twitchings earlier than before, and first in the paralyzed limbs. As these became, from minute to minute, more violent, a pene- trating pain was felt in the occiput, with vertigo and tinnitus aurium. The twitchings now extended over the affected arm, and, subsequently, to the sound side, whereupon the vertigo and headach increased, and insensibility, with difficult and stertorous breathing, ensued. The pulse now became very full, hard, slow, and intermitting; the countenance bluish-red and turgid; the paralyzed lower extremities of a marbled blue ; the pupils very much dilated, and the mouth open, — the convulsions being occa- sionally so strong as to toss him to and fro on the bed. When these phenomena declared themselves, Richter removed the dress- ing from the surface, which appeared inflamed, and still contained a quantity of strychnia that had not been absorbed ; the parts were then washed and sprinkled immediately — according to Lem- bert's and Lesieur's recommendation — w T ith two grains of acetate of morphia ; the face was washed with cold water, the soles of the feet brushed, and other excitants administered. 1 1 See some Experiments relative to the action of Strychnia on the Nervous System, by H. Stannius, in Miiller's Archiv. Heft. ii. 1831 ; cited in Brit, and For. Med. Review, for Jan. 1838, p. 221, 656 STRYCHNIA. Dr. Christison 1 considers, that strychnia is not a cumulative poison ; yet the author has seen one or two cases which would favour the contrary opinion, 2 and Dr. F. A. Gebhard, 3 of Moscow, under view of the dangerous effects it often induces, thinks that some other remedy should be sought for, even in those cases in which it has been found advantageous. The continued employ- ment of strychnia in small doses, or its administration in larger, appears to him to cause, in some unknown manner, such a change in the blood as to result unexpectedly and suddenly in a powerful reaction in the nervous system, marked by convulsions, tetanus, exhaustion, paralysis and death. Dr. Gebhard proposes, as a sub- stitute, one of the most energetic articles of the materia medica — veratria. Morphia appears to be the most powerful antidote : under its use the dangerous symptoms rapidly disappear; consciousness re- turns; the patient sleeps for some hours, and a general perspira- tion breaks out, after which he awakes with a feeling of dulness, and with stiffness of the limbs, which soon, however, vanish. In respect to the topical application of strychnia by the endermic method, A. L. Richter 4 remarks, that the preparations of strych- nia produce much more powerful local effects than those of mor- phia ; they maintain the abraded portions of the skin in an in- flamed state, promote suppuration more than morphia, and occa- sion violent itching and burning, with a feeling as if needles were run into the skin. Artus. recommends, from his investigations, pure baryta (Aetzbaryt) as an antidote. It forms an inso- luble precipitate with strychnia, and he esteems it to be more cer- tain than the tinctures of iodine and bromine recommended by Donne, 5 the chloride of barium, or the infusions of tar and galfs recommended by Raspail. 6 The effects, referred to above, were chiefly obtained from the administration of the nitrate, but they may be esteemed applicable to all the preparations of strychnia, as we know nothing of any difference in their action. It is probable, however, that the salts of strychnia, owing to their greater solubility, may have more action than strychnia itself, although the muriatic and acetic, or lactic acids, which are almost always present in the stomach, it might be presumed, would readily unite with it. EFFECTS ON THE ECONOMY IN DISEASE. The following remarks apply equally to pure strychnia, and its 1 Dispensatory, p. 895. Edinb. 1842. : See, also, Pereira, Elements of Mat. Med. and Therap. ii. 1310. Lond. 1842; or 2d American edition, by Carson. Philad. 1840. 3 Zeitschiift fur Therapie, u. s. w. Freiburg, Dec. 1844, No. 3, cited in Amer. Journal of the Medi al Sciences, Jan. 1840, p. 202. 4 Die Endermatische Methode, u. s. w. Berlin, 1835. * Journal de Chimie Med. v. 494. Paris, 1829, ' Nouveau Systeme de Chimie Organique. Paris, 1833, STRYCHNIA. 657 salts, and to the alcoholic extract of nux vomica, (see page 538,) ■which is preferred by some. 1 It has been administered in Paralysis, especially in that arising from the action of lead, in which Bally, Lembert, Bardsley, Andral, Rayer, and Tanquerel 2 have employed it beneficially. In paraplegia and hemiplegia it has been prescribed by Lesieur, G. H. Richter, Romberg, Bards- ley, Bally, Lafaye, Oesterlen, Reinhardt, Heyfelder, Faye, Mart, Schaible, Raciborski, A. T. Thomson, 3 Gellie, 4 Petrequin, 5 Toul- mouche, 6 Badeley, 7 and numerous others. 8 From the results of their observations it would seem, that strychnia is most efficacious in paraplegia ; less so in hemiplegia, although it is said to have been given with advantage in the latter affection ; but its adminis- tration in hemiplegia requires special circumspection, particularly when the paralysis has succeeded to apoplexy. 9 The results of the observations of M. Toulmouche induce him to believe, that strychnia will only succeed in paralysis or other affections " that proceed from some lesion of spinal innervation, occasioned by excessive masturbation or indulgence in venereal pleasures, by the abuse of spirituous or narcotic liquors, by the. action of the emanations of lead," &c; and that it is never suc- cessful in paralysis which is owing to an inflammatory condition of the brain or spinal marrow. He is of opinion that strychnia has a directly excitant effect upon the spinal marrow, and secondarily on the organs that receive their nerves from it. Romberg affirms that, as a general rule, in cases of paralysis dependent upon dis- ease of the central organs of the nervous system, he has never seen any striking effect from the endermic use of strychnia, and that great care is needed lest it should react injuriously on the brain. He considers it especially adapted for cases of paralysis that are dependent upon some affection of the spinal marrow in- duced by mechanical concussion; as well as for the local paralysis that succeeds to rheumatism, suppressed exanthems, &c. In paralysis of the upper eyelid, it has been employed suc- cessfully by M. Saint Martin, in the w r ay of inoculation, as pro- posed by M. Lafargue in the case of morphia (note page 520,) two centigrammes — from one-fourth to one-third of a grain — of the sulphate being introduced into twelve small punctures around the orbit. The operation was continued for six days, with com- 1 Petrequin, Bulletin General de Therapeutique, Mars, 1840. 2 Gazette Medicale pour 1835, p. 383. 8 Lond. Med. Gaz. April, 1831. « La Lancette Franchise, 29 Aout, 1837. * Op. chat. 6 Gazette Med. de Paris, No, 5, 1841. ' Lond. Med. Gaz. July 12, 1846, p. 496. 8 Petrequin, Gazette Medicale, Nov. 1838; and l'Experience, Oct. 1843. 9 See Bally, Considerations sur la Strychnine, &c, in Bulletin General de Thera- peutique, Fev. 1838. OtSS' STRYCHNIA, plete success. 1 The same result, as shown hereafter, has followed its use by inoculation in amaurosis. Dr. Favell 2 contends, that the forms of paralysis most likely to be benefited by it are those dependent upon cold, poisons, ant", certain molecular changes in the brain and nerves, altogether inap- preciable by post mortem examination. He considers, that the most dangerous symptoms resulting from an over dose are gene- rally caused by the influence of the drug on the nerves distributed to the heart. Dr. Benton, of Illinois, 3 affirms, that he has em- ployed it with the happiest results in some forms of coma attend- ing fevers in malarious districts. The phenomenon occurred in re- mittent fever, and seemed wholly independent of organic lesion; — the secretions being natural, the tongue and skin moist, and all the symptoms improving, excepting those referable to the eneephalon. In such cases, strychnia in doses of one-twelfth of a grain^ every six hours, afforded relief in from 24 to 48 hours. Dr. Pereira 4 has seen it very serviceable in that shaking or trembling action of the muscles, which is produced by habitual intoxication. G. H. Richter cured a case of aphonia by it, and Dr. P. H. Clarke, 5 of West Tennessee, considers, that it not only proved beneficial in loss of voice caused by relaxation of the muscles of the larynx, but in chronic bronchitis. It has been much used internally, and successfully, in amblyopia and amau- rosis, by Short, Liston, 6 Guthrie, Middlemore, 7 Henderson, Ym- nari, 8 Mart, Petrequin, 9 Dusterburg/ Debreyne, 11 and others, Mr. Tyrrell and Mr. Lawrence, 12 however, affirm that they have found it inefficacious in amaurosis. In these cases, it is generally used endermically on the temporal region. Dr. Stevenson 33 de- rived benefit from it — when applied in this way — in cases of amaurosis of many years' duration. Half a grain was repeated twice a day until tremors of the limbs were produced. He em- ployed it in the same manner in other cases of local paralysis, In cases of amaurosis, Henderson advises, in addition, that a solution of strychnia should be dropped into the eye; and it has likewise been used in the form of inoculation, in the manner described hereafter. It has been given successfully in paralysis of the bladder by Schaible, Bally, Hennemann, Behrend, 14 and 1 Bouchardat, Annuaire de Therapeutique pour 1S49, p. 70. 2 Provincial Medical and Surgical Journal, Dec. 31, 1845. 3 Bullet, of Med. Science. * Med. Gazette, vol. xk. s Illinois and Indiana Med. and Surg. Journ. April and May, 1647. 8 Lond. Med. Gaz. v. 541 and 575. ' Midland Medical and Surgical Reporter, May and August, 1831. 3 Bouchardat, Annuaire de Therapeutique, pour 1841, p. 8. Paris, 1841. 9 Bulletin General de Therapeutique, Juillet. 1838. 10 Cited in London Medical Gazette, August 5, 1842, p. 733. ■* Noticed in Medico-Chirurg. Review, Oct. 1844. a A Treatise on Diseases of the Eye, Amer. edit, by Hays, p. 519. Philad. 1843, 13 Transactions of the Medical and Physical Society of Calcutta, vol. v. 11 Medicin. Zeitung, Sept. 1S37, S, 190. STRYCHNIA. 659 others; and in paralysis of the facial nerve, by Drs. O'Brien, 1 Beales, 2 and Joslin. 3 In two cases of paralysis of the rectum in elderly people, accompanying a disordered state of the bowels, the author found the best effects from the endermic use of strychnia — in the quantity of a quarter of a grain, night and morning, to a blistered surface on the sacrum. In high grades oj 'paraplegia , the internal use of the remedy is to be preferred, but in general the endermic administration is more advisable. In paralysis of the limbs, a spot is selected in the -vicinity of the spinal marrow. Strychnia is likewise given in other affections. Very favoura- ble reports have been made, as to its efficacy in irregular gout, by Wendt, who rubs on the affected parts an ointment composed of a grain and a half of nitrate of strychnia to two drams of lard; and in Neuralgia. Mart found it beneficial in tic douloureux and in nervous headach ; Magnus in a case of neuralgia of the arm; and several successful cases have been published by Dr. Pidduck.* The sulphate of strychnia, in doses of one-twelfth of a grain, two or three times a day, occasionally combined with sedatives and quinia, has been highly recommended by Dr. John Waters. 5 Traumatic Tetanus. In this disease it has been extolled by Luders, and a case, occurring in a negro girl, which terminated favourably under its use, in the dose of one-twelfth of a grain every two hours., has been reported by Dr. P. M. Kollock. 6 In hysteria, hypochondriasis, and dyspepsia? it has been ad- vised by Schmidtmann, and Basedow, but morphia appears to render more essential service. In chorea? Romberg and Professor Trousseau, 8 Dr. A. Ross, 9 Dr. Griscom, 10 and Dr. B. R. Hogan, 11 saw good effects from it Professor Trousseau administers a syrup of the sulphate during or after meals, in cautiously increased doses until convulsive move- ments take place. These are to be kept up for about eight days ? when, by diminishing the dose, a mere muscular stiffness should be maintained for a similar period, and the remedy be persevered in for eight or ten days after all irregular movements have ceased* Eight cases are cited in proof of his assertions; but Dr. Cowan 12 1 Med. Chirurg. Review, and L'Experience, Nov. 1838. 2 New York Jeuraal of Medicine and Surgery, July, 1839, p. 201. * Amer. Journ. of the Med. Sciences, Oct. 1842, p, 322. 4 Lond. Medical Gazette, Aug. 7, 1840, p. 759. 3 Cowan's Address, Trans, of the Provin. Med. and Surg. Ass. p. 62. Lond. 1845„ 5 Southern Medical and Surgical Journal, Oct. 1847, * Melconibe, in London Medical Gazette, for March 4, 1837, p. 850. 8 Journal de Medecine de Beau, Juin et Juillet, 1844, and Traite de Therapeutique &c, i. 798. Paris, 1847. Also, Union Medicate, Juin, 1849, cited in Rankings Half- yearly Abstract, July to Dec. 1849. Amer. edit. p. 41. 9 London Lancet, June 7, 1845, p. 636. i0 American Journal of the Med. Sciences, April, 1846, p. 471. - 1 New Orleans Med. and Surg. Journal, Sep. 1846. ** Retrospective Address, in Transactions of the Provincial Medical and Surgical As- sociation, xiii. 58. Lond. 1845. 660 STRYCHNIA. doubts whether success should justify the employment of a remedy so difficult to regulate, especially in cases which seldom resist ordinary and well known treatment. The experience of Professor Trousseau is confirmed by that of M. Rougier. 1 More recently, M. Trousseau 2 has published his mode of administering this power- ful article. This consists in employing very small doses, increasing them by regular gradations, until slight tetanic rigidity is produced ; then suspending the medicine or continuing the last dose, but never increasing it beyond that point. He states, that an itching of the skin and scalp generally precedes the rigidity, and that the masse- ter muscle is first affected. Hence he advises, that the child should be frequently asked whether it has any difficulty in open- ing the mouth, and thus the earliest toxical effects may be recog- nised. In retention of urine from loss of power after parturition, Dr. Cory 3 administered a sixteenth of a grain of strychnia three times a day, with apparent advantage; and it was given, with good re- sults, in a case of retention of urine following scarlatina, by Dr. Geo. L. Upshur, of Norfolk, Va. 4 It has likewise been advised in epilepsy* and catalepsy. In a successful case related by Dr. Weyland, nitrate of strychnia was taken in such quantity as to produce the peculiar tetanic effects of strychnia. Fricke has administered it successfully in — Syphilitic Osteocopi. It has also been given with benefit in cases of Dysentery and Diarrhoea, by Bardsley, Recamier, Geddings, 6 and others; and has been used endermically in cholera — two or three grains being applied to the blistered surface on the nape of the neck. By MM. Dreyfus, Grimaud d' Angers and Potton it was given internally in the same affection to allay vomiting: — a quarter to a half a grain being added to three ounces of water, and prescribed in the dose of a spoonful every hour. 7 Dr. Ryan 8 asserts, that he has repeatedly known a few of the pills — the for- mula for which is given below — check a profuse diarrhoea with rice-coloured evacuations, and even when the extremities were blue, in malignant cholera. In the same disease Mr. C. E. Jen- kins 9 gives a pill of one-eighteenth, of a grain every quarter of an hour, washing it down with copious draughts of cold water. He 1 American Journal of the Medical Sciences, Oct. 1844 ; cited from Medical Times, Aug. 31, 1844. 2 Revue Medico-chirurgicale, Janv, 1850. * Medico-Chirurgical Review, July, 1839. 4 Medical Examiner, April, 1847, p. 213. 5 Brofferio, in Repertorio Medico-Chir. di Torino, 1825, and Revue Medicale, iv. 488. Paris, 1825 ; and Weyland, Wochenschrift fur die gesammte Heilkunde, cited in Encyc. des Sciences Med. Janv. 1851 , p. 65. 6 N. American Archives, No. 2, Nov. 1834. 1 Merat and f3e Lens, Diet, de Mat. Med. art. Strychnine. 8 Formulary, 3d edit. p. 335. Lond. 1839. 9 London Lancet, Sep. 2, 1848. STRYCHNIA. 661 finds the first three or four pills probably ejected, but the subse- quent doses are retained, and their good effect is speedily perceived. On the other hand, Dr. Ranking 1 combined it with an aperient extract with advantage in habitual constipation; and M. Ho- molle 2 relates three cases in which he found milligramme — gr. .0154 — doses, repeated every hour, completely efficacious, after various other means had been used in vain, in relieving urgent symptoms of internal strangulation. It has likewise been beneficial in nervous vomiting and gas- tralgia, in the former of which two teaspoonfuls of a solution of 5 centigrammes — gr. f , — in 100 grammes — ^iijj — of water, are given every quarter of an hour. M. Debout has seen the vo- miting arrested after the fourth or fifth dose. In gastralgia he gives the same dose night and morning only. 3 In gleet, unaccompanied by stricture, Dr. C. Johnson 4 has found good effects from an injection of strychnia, according to the for- mula given hereafter. Jlmenorrhaza. Of twelve cases of suppressed menstruation, treated by Dr. Bardsley, ten were cured, and two relieved. Dr. Churchill 5 also had two cases, in which the cure by it was com- plete and permanent. Lastly. From its efficacy in analogous af- fections of the digestive mucous membrane, Dr. Stokes 6 thinks there is good reason to hope that it may prove useful in bronchi- tis. It has been employed, indeed, in all the cases in which the alcoholic extract of nux vomica has been found of service, than which it is of course to be more relied upon, in consequence of its greater uniformity, — nux vomica itself being often found unequal. Intermittent Fever. This powerful agent has been recently recommended in this disease by Dr. S. E. M'Kinley, 7 of Tennessee, who states, that nO remedy acts " with more certainty, as a per- manent cure, if persisted in for two or more weeks." He gives from one-sixteenth to one-eighth of a grain every three hours, gradually augmenting the dose, " until, in some cases, one grain may be given three or four times a day, and without any toxical symptoms arising whatever." It need scarcely be said, however, that so potent an article must be administered with the greatest^ caution, and the cases must be rare in which it need be had recourse to to such an extent as to cause apprehension of the unpleasant results that appear to be produced at times by its cumulating in the system. 1 L'Union Medicate, No. 138-9, 1848, cited in Brit, and For. Med. Chir. Rev. April, 1849, p. 539. 2 Ibid. * Bouchardat, Annuaire de Therapeutique pour 1849, p. 71. 4 American Journal of the Medical Sciences, April, 1850, p. 541. s Outlines of the Principal Diseases of Females, Amer. Med. Library edit. p. 54. Fhilad. 1839. 6 Treatise on Diseases of the Chest, p. 125. Dublin, 1837, or Amer. Med. Library edit. Philad- 1838. ' Medical Examiner, July, 1850, p. 382. 662 STRYCHNIA. In very obstinate cases, Dr. Keller, 1 of Philadelphia, prescribes the extract of nux vomica in combination with arsenic, sulphate of quinia and extract of quassia. MODE OF ADMINISTRATION. Pure strychnia is best exhibited internally, in the form of pill, or in spirituous solution; but if a little acid, especially the acetic, be added to it, it may be given in watery solution, as in this way a salt of strychnia may be formed extemporaneously. The dose is from one-sixteenth to one-eighth of a grain, which may be gra- dually increased until a grain is taken. In ordinary cases it will be sufficient to raise the dose to half a grain, two or three times a day ; but if any circumstance should arise to cause its discontinuance, it ought not to be recommended in doses as large as the last, but with small doses, as at the beginning. In the endermic applica- tion of the remedy, we sprinkle, twice a day, a quarter of a grain on the denuded surface, and slowly increase the quantity to half a grain or more should this be necessary. If the larger doses do not act more beneficially, it will be advisable to discontinue it for a few days — after which the smaller doses may again exert a signal influence — rather than to carry the dose still higher. M. Petrequin 2 thinks that the endermic use of strychnia fre- quently fails, owing to the vesicated surface to which it is applied becoming covered with a layer of coagulable lymph, in conse- quence of which the strychnia is unable to make its appropriate impression. This layer of lymph should be removed as far as possible at each application; and as the vesicated surface daily becomes less and less sensible, the dose must be proportionally increased. M. Petrequin recommends, that a third or a fourth of a grain of strychnia should be mixed with two or three grains of powdered nux vomica, and the compound be sprinkled on the surface ; but it would seem to be preferable to increase the dose of strychnia than to place so much insoluble and irritating pow- der on the sensitive surface. It has also been introduced by inoculation in the neighbourhood of the eye in cases of amaurosis? A grain of the sulphate 'was in one case dissolved in two drops of water: the first day twelve inoculations were practised, — six above the eye in the course of the supra-orbitar nerve; and six under and on the side of the nose, where the ethmoidal filaments and nasal branch terminate, and whence arise the filaments that go to the iris. On that, day, there was no effect ; but the next day slight tremors occurred in the neighbourhood of the inoculated spots. After a Vest of two ' Nord Amerikanischer Monatsbericht fur Natur und Heilkunde, Sept. 1, 1850, S. 103. 2 Bulletin General de Therapeutique, Mars, 1840. 8 Verlegh, Gazetta Medica di Milano, April, 1844, cited in London and Edinburgh Monthly Journal of the Medical Sciences, Aug. 1844, p. 713. STRYCHNIA. 663 days, the inoculations were repeated, and the number of punctures increased to eighteen. The patient now became sensible of a slight haziness. After five successive inoculations, carried to the length of thirty punctures, the patient began to distinguish objects ; after the eighth, vision was completely restored, the contraction of the pupil gradually increased, and the other symptoms diminished, after five grains of the sulphate had been used. During the same time, inoculations were had recourse to in the neighbourhood of the other eye. After the lapse of two months, the patient was per- fectly restored. PHuIbb strychniae. Pills of strychnia, R. Strychnine pur. gr. ij. Confect. rosee gss. Divide in pilulas xxiv. Dose. — One to two, morning and evening. Magendie. R. Strychniae gr. j. Confect. ros. gss. Glycyrrhiz. pulv. ^ss. Divide in pilulas xij. Dose. — One, night and morning. The quantity may be in- creased to four or five daily. Ryan. R. Strychniae gr. ij. Ext. valerian, q. s. lit fiant pil. xxxij. Dose. — One, every morning, fasting, for five days : — afterwards one, morning and evening, in torpid amaurosis, Fumari. Tinctura strychnia. R. Strychniae pur. gr. iij. Alcohol 36° (.837) f gj. M. Dose. — Six to twenty-four drops, twice or thrice a day. Magendie. Mistnra strychniae. Mixture of strychnia, (Potion stimulante.) R. Aq. destillat. fgij. Strychniae gr. i. Sacch. gij. Acid. acet. gtt. ij. M. Dose. — A dessert-spoonful, morning and evening. — Magendie. Collyrium strychniae. Collyrium of strychnia. R. Strychniae gr. ij. — iv. — vj. — viij. Acid. acet. dil. Aq. destillat. aa. f gj. M. Two drops to be let fall into the eye, a few times a day, in amaurosis, Henderson. 664 STRYCHNIiE ACETAS. Injectio stry chnise. Injection of strychnia. R. Strychnia? gr. ij. Acid, nitric, fort. gtt. iv. Aqusefgij. M. A dram to be injected three times a day in gleet. Christopher Johnson. TJnguentum stry chnise. Ointment of strychnia. R. Strychniae gr. xvj. Adipis 3J. M. Used in friction on paralyzed parts. Sandras. 1 It may be well to dissolve the strychnia, before admixture, in a little alcohol. Linimentum strychnia. Liniment of strychnia. R. Strychnias gr. xxiv. 01. oliv. § j. M. Twelve drops of the oil to be rubbed on the temples four times a day in cases of amaurosis. Cunier. CLXIV. STRYCHNIiE ACE'TAS. Synonymes. Strychniae Acetas, Strychnium seii Strychninum Aceticura, Acetas Strychnii seu Strychnicus, Acetate of Strychnia or Strychnine. German. Essigsaures Strychnin, Strychninacetat. In addition to the acetate, formed extemporaneously, as men- tioned under Strychnia, the proper acetate of strychnia has been administered, especially by Liiders and Fricke. It may be made, like the acetate of quinia, from the direct combination of strychnia with acetic acid. According to Thenard, it is very soluble, and crystallizes with difficulty. Even when diluted 40,000 times, its solution occasions a sense of bitterness on the tongue. The following formulae have been given by the physicians cited. Guttse stryclinisB acetatis. Drops of acetate of strychnia. R. Strychnia? acet. gr. iij. Alcohol, f 3J. Aq. cinnam. f ^vij. M. Dose. — Five drops, twice a day, gradually increasing the dose. Liiders. 1 Bouchardat, Nouveau Formulaire Magistral, p, 113. Paris, 1S45. STRYCHNIJE IODAS. 665 Tinctura stryclinisB acetatis. Tincture of acetate of strychnia. R. Strychnise acet. gr. iss. Alcohol, f^ss. M. Dose. — From three or four to twenty or thirty drops to be taken at bed-time in cases of syphilitic pains of the hones. Fr icke. CLXV. STRYCH'NLE I'ODAS. Synonymes. Strychnin SB Iodas, Strychnina lodata, Strychnlum sen Strychninum lodicum, Iodas Strychnii seu Strychnicus, Iodate of Stiychnia or Strychnine. German. Iodsaures Strychnin, Strychnin jodat. METHOD OF PREPARING. The preparation of this salt, according to Magendie, is easy. It is sufficient to add a concentrated solution of iodic acid to pow- dered strychnia: in a moment, the mass swells up, absorbs water, becomes thicker, and at times very consistent. It is now treated with boiling alcohol, filtered, and left to spontaneous evaporation. In this way, beautiful crystals of iodide of strychnia are obtained. The iodic acid, proper for this preparation, is procured, according to Geiger, in the following manner. Nine parts of iodide of baryta are boiled with two parts of oil of vitriol, previously diluted with ten times as much water, for half an hour. It is then filtered, and evaporated by a gentle heat to the consistence of a thin syrup, and is exposed to the air for spontaneous evaporation. Iodate of strychnia may likewise be formed by double decom- position, by mixing a soluble iodate, as iodate of soda, with a so- lution of sulphate or muriate of strychnia. The iodate of strych- nia is precipitated, which may be treated with boiling alcohol, and crystallized as above directed. The iodide is of a white colour, and crystallizes in beautiful prismatic needles : it is but slightly soluble in cold water, but more so in boiling water and alcohol. EFFECTS ON THE ECONOMY. " This salt, 55 says Magendie, "is one of the most active poisons with which I am acquainted. A single grain is sufficient to de- stroy a strong dog w T ith tetanic symptoms, -tit acts, likewise, powerfully on the diseased organism. I gave it to several persons with a success which far exceeded my expectations. It proved effectual in some old paraplegic affections, which had been esteemed incurable, and after all the usual remedies had been administered in vain. 55 ' He gave it in pills, each of which contained one-eighth of a grain. One of these was prescribed night and morning, and the dose was gradually increased, until ultimately a grain was 666 STRYCHNINE IODAS. taken in the twenty-four hours. The greatest circumspection was, however, necessary in its use. Magendie is of opinion, that the hydriodate of strychnia, strych- nium hydroiodicum, hydriodas seu iodhydras strychnia seu strych- nicus; Germ. Iodwasserstoffsaures Strychnin, iodwas- s erst off St rye h n in, might be advantageously introduced into medicine. It is prepared by mixing a solution of iodide of po- tassium with a concentrated solution of acetate of strychnia : a white crystalline powder is precipitated, which is soluble in alco- hol, and is pure hydriodate of strychnia. It does not appear to have been used as yet in medicine. An iodide of iodhydrate of strychnia ; French, Iodurc d' Iodhydrate de strychnine, has likewise been proposed. It is prepared by pouring a solution of ioduretted iodide of potassium into a solution of a salt of strychnia. A flocculent precipitate is formed of a light chestnut hue, which is dried and treated with boiling alcohol. On cooling, the alcohol suffers crystals of iodu- retted iodhydrate of strychnia to be deposited. It has the form of semi-transparent needles, of a deep ruby red colour ; is soluble in alcohol and ether; but completely insoluble in water, even when slightly acidulated. M. Bouchardat 1 has administered this preparation to dogs, in the dose of three decigrammes (gr. 4.63.) It poisoned them like strychnia, but the action was much longer in developing itself. In the dose of five centigrammes, (gr. .771,) it occasioned, in about an hour, convulsive shocks, which persisted for some time ; but the animal completely recovered. He thinks the advantage it pos- sesses over strychnia is in being less poisonous and more persist- ent. It is always identical in composition, and easy to obtain pure. The dose is a centigramme (about a sixth of a grain) a day, gradually increasing it. A double iodide of zinc and strychnia has also been prepared, which, according to M. Bouchardat, is a well defined salt, crystal- lizing regularly in beautiful needles of a brilliant white colour. It is composed of one atom of iodhydrate of strychnia, and one of iodide of zinc, and is soluble in water and in alcohol. When given to animals, it acts like strychnia and its salts ; but requires double the dose. It is prepared by digesting for several days, in hot water, the iodide of iodhydrate of strychnia and zinc; the boiling liquid is filtered, and, on cooling, the salt crystallizes. M. Bouchardat 2 thinks it may replace strychnia with advantage, — be- ing more manageable ; and he suggests, that it may be a valuable agent in many serious neuroses, and especially in epilepsy. 1 Nouveau Formulaire Magistral, p. 114. Paris, 1 845. * Ibid. p. 114. STRYCHNIA NITRAS. 667 CLXVI. STRYCH'NLE NITRAS, Synonymes. Strychninae Nitras, Strychnium seu Strychninum Nitricum, Nitras Strychnii seu Strychnicus, Nitrate of Strychnia or Strychnine. German. Salpe t er saure s Strychnin, Stry chninnitrat. This preparation of strychnia has been more used in Germany than any other. 1 It has been received into the Prussian Pharma- copoeia, (Landespharmakopoe,) where "it is directed to be prepared in the following manner: METHOD OF PREPARING. On eight pounds of nux vomica, sixteen pounds of spirit of wine (Kornbranntwein) are poured, and the liquid is distilled to one-half. The nux vomica is then freed from the liquor by filtering, dried and reduced to coarse powder. This is digested two or three times, with a sufficient quantity of the spirit, and after digestion it is strained. The tinctures are then subjected to dis- tillation, and what remains is evaporated along with the fluid that remained after the boiling : to this acetate of lead, dissolved in a sufficient quantity of distilled water, is added so long as a pre- cipitate falls. The fluid, separated as much as possible from the precipitate, by means of the filter, is now evaporated to one-half, by a gentle heat. When cold, it is mixed with two ounces of calcined magnesia, and suffered to stand three days, when the de- posit is separated by the aid of the filter, washed, and dried. This, after having been rubbed to powder, is digested two or three times in alcohol, and the tinctures are subjected to distillation, until only a few ounces remain. The strychnia, which, on cooling, appears in the retort in the form of a white powder, is separated by the filter, washed two or three times with rectified spirit of wine diluted with an equal quantity of common water, and neu- tralized by a proper quantity of dilute nitric acid. The filtered fluid is evaporated by a gentle heat so as to allow the formation of crystals. These crystals are needle-shaped, colourless, of a silkv splendour, and a very bitter taste : they are soluble with difficulty in alcohol, but dissolve in ether. MODE OF ADMINISTRATION. The dose and mode of administering the nitrate of strychnia are the same as in the case of pure strychnia. Its endermic application will sometimes succeed when the internal administration has been more limited in its results. The experiments instituted by Dr. Stannius, and others, and referred to in a former page, were w T ith nitrate of strychnia. 1 Stumpf. art. Strychnos. Encyclop'ad. Worteib. der Medicin. Wissench. xxsii. 484. Berlin, 1844. 663 SULPHURIS CARBURETUM. Magendie found, in his experiments, that this salt completely prevented the coagulation of the blood. 1 CLXVII. STRYCH'NLE SULPHAS. Synontmes. Strychninae Sulphas, Strychnium seu Strychninum Sulphuri- cum, Sulphas Strychnii seu Strychnicus, Sulphate of Strychnia or Strychnine. German. Schwefelsaures Strychnin, Strychninusulphat. The same effects have been observed from this preparation as from the others. It is also dispensed in the same forms and doses. It may be obtained by the simple union of strychnia with sul- phuric acid. According to Pelletier, 100 parts of the alkaloid saturate 10.4S6 of the acid. It is soluble in less than sixteen parts of cold water, and crystallizes, when neutral, in transpa- rent cubes ; when acid, in needles. Its taste is extraordinarily bit- ter. It is decomposed by every soluble salifiable base. Sulphate of strychnia is much used by M. Trousseau, (see page 570 :) he prescribes it in the form of Syrupus strychnia snlphatis. Syrup of sulphate of strychnia. (Strop de strychnine. — Trousseau.) R. Strychnia? sulphat. gr. 3.85 (25 cent.) Syrup. Oj. (500 grammes) M. Trousseau. CLXVIII. SUL'PHURIS CARBURETUM. Svnonymes. Sulphuretum Carbonii seu Carbonei, Carbonium seu Carbo- neum Sulphuratum, Alcohol Sulphuris, Bisulphuretum Carbonii, Car- bonii Bisulphuretum, Sulfidum Carbonii, Sulphuret of Carbon, Bisulphu- ret of Carbon, Sulphide of Carbon, Carburet of Sulphur, Alcohol of Sulphur. French. Sulfure de Carbon, Carbure de Soufre, Soufre Carbure, Alcool de Sou f re. German. S ch vvef e Jalkohol , Schwef elkohlenst off, Fliissiger Kohlenschwefel, Kohlensulfurid. Carburet of sulphur or sulphuret of carbon was discovered by Lampadius in the year 1796. It is a transparent and colourless fluid at the ordinary temperature ; has a very penetrating and dis- agreeable odour ; and a taste cooling at first, but afterwards burning, acrid, and somewhat aromatic. Its specific gravity is 1.272. It boils at 106° of Fahrenheit. It is not decomposed at ; Lecons sur le Sang; or translation in Lond. Lancet, Jan, 26. 1839, p. 637. SULPHURIS CARBURETUM. 669 the highest temperatures ; but volatilizes rapidly in the air, and burns readily. It is not soluble in water, but is so in alcohol, ether, and the fixed and volatile oils. Water separates it im- mediately from those solutions. It unites intimately with the alkalies ; but, of the acids, aqua regia — which is a mixture of the nitric and muriatic acids — alone lays hold of it. It dissolves potassa, camphor, sulphur, and phosphorus. Lampadius, in the first instance, regarded sulphuret of carbon as a compound of sul- phur and hydrogen ; it is now, however, decided, that it consists of sulphur and carbon, — according to Vauquelin, in the proportion of So or 86 to 15 or 14 ; according to Berzelius and Marcet, of 84.84 to 10.16. METHOD OF PREPARING. The following method is recommended by Mitscherlich :* The temperature at which sulphur enters into ebullition is not sufficient to make the two substances combine, but if burning coals be placed in contact with vapours of sulphur, the combination takes place immediately. With this view, a tube of porcelain may be used, or, what is better, one of cast iron, lined internally with a coating of clay by running it several times through a paste of clay and water, and heating the tube each time. In this man- ner, the crust of dry clay will become strong enough to prevent the sulphur from attacking the iron. The tube is then filled with strongly calcined coals, and is heated to redness in an oblong fur- nace. One end of the tube is closed by a cork, and a small hole is made at the upper part of the tube, through which the sulphur is introduced, and which is closed by a plug. The other end, which has passed through the furnace, is likewise closed by a large cork, traversed by a glass tube. To make the stoppers close the tube hermetically, they are boiled with glue. The long glass tube passes into a large jar, through a hole in which it is adapted hermetically by means of a cork. The ordinary aperture of the jar is closed by a cork in which a tube is fitted hermetically, which passes through the window. At the bottom of the jar is con- tained a little water. The long tube passing from the furnace to the jar may be kept cool by water made to drop upon it, or by covering it with snow or ice. When the charcoal is heated to, red- ness, small fragments of sulphur are dropped in, from time to time, by means of the aperture before mentioned, which must be care- fully closed each time afterwards. The sulphur, on melting, runs towards the hottest parts of the tube, to which a slight inclination has been given on placing it in the furnace. It enters into ebulli- tion, and is transformed into sulphureous vapour, which, by pass- ing over the hot coals, combines with them: the sulphuret of car- 1 Elemens de Chimie, traduits par M. B. Valerius, i. 156. Bruxelles, 1835. 43 670 SULPHURIS CARBURETUM. bon or carburet of sulphur, formed, condenses in the long tube, from which it runs into the jar, and falls to the bottom of the wa- ter. As the coal always retains a little hydrogen, the sulphur likewise unites with it, to form a gaseous body, which is carried off by the tube passing through the window. Carburet of sulphur is preserved in well-stopped bottles, and is covered with about an inch of w T ater, whence it can be best ob- tained for use by means of a small glass or ivory syringe. EFFECTS ON THE ECONOMY. Dr. Snow 1 diffused its vapour through air, and noticed the ef- fects on mice. He concludes that a single deep inspiration of air saturated with it, at a summer temperature, would produce instant death. It did not cause muscular relaxation before dissolution; but tremulous convulsions continued until the last. They super- vened, or were threatened, almost as soon as complete insensibility to external impressions was established. Carburet of sulphur holds a place amongst the transient or dif- fusible stimulants. 2 Its most marked effects are said to consist in its " exciting the function of cutaneous transpiration to copious sweating; increasing the secretion of urine, elevating the tem- perature of the body, quickening the pulse, and causing congestions towards the head and those parts of the body whose vitality may have been already somewhat augmented." 3 Its most striking agency is exhibited in the more active exercise of the functions of the skin. According to Mansfeld, it acts likewise as an emmena- gogue; but, in this respect, probably only like similar excitants. On account of its great volatility, it produces on the skin the feeling of considerable cold. The discoverer of the carburet of sulphur first recommended it as a remedial agent. 4 He particularly advised it, both internally and externally, in rheumatic and gouty affections. In Freiburg, a mixture of one part of camphor, two of carburet of sulphur, and four of alcohol, is a very common external application in rheu- matic pains. Kappe found decided advantage from it in gout and rheumatism ; and Mansfeld and Wutzer, resting upon a series of observations, maintain, that in rheumatism unaccompanied by fever, or where the fever is slight, it exceeds every other remedy of the class. Dr. Otto, 5 of Copenhagen, prescribes four drops of a mixture composed of one part of carburet of sulphur, and four parts of highly rectified spirit of wine, to be taken every two ■ London Med. Gazette, June 23, 1848. 3 Wutzer, Journ. de Chimie Med.; cited in Amer. Journ. Med. Sciences, Nov. 1831, p. 215. 8 Riecke, Die neuern Arzneimittol, S. 100; und 2te Auflage, S. 166. Stuttgart, 1840. 4 Lampadius, in Bulletin des Sciences Medicates de Ferussac, xi. 315. 4 Annates de Chimie Medicate, cited in American Journal of the Medical Sciences, for Nov. 1836, p. 222. SULPHURIS CARBURETUM. 671 hours : and he directs the affected part to be rubbed with an em- brocation, composed of one part of sulphuret of carbon, and four parts of olive oil. The cure, he states, is ordinarily effected in from eight to fifteen days. In deep-rooted dyscrasies, however, these gentlemen found no advantage from it. On the other hand, in trials at the Berlin Charite, it was found to be of no avail in chronic rheumatism, although it was used for a long time, and given in by no means small doses. 1 Mansfeld, also, employed it in cases of after-pains, rubbing it, without admixture, on the abdomen; and he affirms, that good elfects resulted from it, even when ergot had failed. In hysteric fainting, the same gentleman found it useful when internally ex- hibited. Lampadius likewise recommended it in fainting, as well as in asphyxia. Krimer found it extremely efficacious in asphyxia from carbonic acid, but he frequently thought it necessary to pre- mise blood-letting. In this way, he treated eleven cases, and only one — in which apoplexy had already supervened — terminated fatally. The same physician exhibited it in some cases of drunk- enness, attended with loss of consciousness, and found its effects very beneficial. He gave it with great advantage once in a case of goitre; and, in incarcerated hernia, no agent, he says, facilitates so much the taxis as the cold produced by dropping carburet of sulphur on the tumour. 2 Lampadius found, that slight burns were instantaneously cured by it. Dr. Turnbull affirms, that the vapour of this substance was useful in cases of indurated lym- phatic glands, and for the removal of deafness, dependent upon want of nervous energy, and deficiency of cerumen. It is applied by means of a bottle having a proper sized mouth, and containing a fluidram of the bisulphuret, imbibed by a piece of sponge. In the case of indurated lymphatic glands, the part is first well moist- ened with water. When the vapour is applied to the ear, the bottle, the neck of which must be small to fit the meatus, is held close to the organ, until considerable warmth is induced. 3 Clarus recommends it in hypertrophy of the coats of the stomach, and in contraction of the oesophagus — when administered according to the formula given below. Every thing, indeed, says Riecke, encourages its farther trial as a remedial agent. 4 It has been employed re- cently by Dr. Simpson, 5 of Edinburgh, as an anesthetic. By one or two to whom it was exhibited, it was declared to be more pleasant than chloroform; but in several it produced disagreeable encephalic disorder. Its effects as an ansesthetic were powerful, 1 G. Simon, art. SehwefelkohlenstofF, Encyclopad. Worterb. der Medicinisch. Wissen- schaft. xxxi. 270. Berlin, 1843. 2 Journal de Pharmacie, and American Journal of Pharmacy, ix. 264. 3 Pharm. Journ. and Transact, ii, 352; cited in Dispensatory of the United States, (ith edit, p 1235. Fhilad. 1845. 4 Die neuern Arzneimittel, u. s. w. S. 110. 6 Pharmaceutical Journal, vii. 517. 672 SULPHURIS CARBURETUM. and very rapid, but difficult of regulation ; and its deranging in- fluence continued for some time after it was exhibited. Dr. Simp- son employed it in obstetrical cases, when the same objections were found to apply to it. MODE OF ADMINISTRATION. Carburet of sulphur may be given internally in doses of from one drop to four, every five or ten minutes, in cases of fainting and asphyxia; but where such a rapid analeptic agency is not de- manded, it may be given every two or three hours. It may be administered dropped on sugar or in a spoonful of sugared water or barley water. Clarus thinks it is best given in cow's milk. Externally, it is either applied pure, when a rapid development of cold is needed — as in cases of burns and incarcerated hernia — or dissolved in alcohol or oil. GuttaB sulphuris carbureti. Drops of carburet of sulphur. R. Sulphur, carbur. f 51J. either, sulphur, f g % M. Dose. — A few drops on sugar. Lampadius* R. Sulphur, carbur. f £j. Alcohol, f 3 ss. M. Dose. — Four to six drops, every two hours, in rheumatism. Wutzer. R. Sulphur, carbur. f gj. Alcohol, f 31J. M. Dose. — Five, ten, or fifteen drops, three times a day, in cases of rheumatism. Wutzer. Mistura sulphuris carbureti. Mixture of carburet of sulphur. R. Sulphur, carbur. 9j. Lact. vaccin. f jfvj. Sacch. gij. M. Dose. — A table-spoonful, four times a day, or oftener. Clarus. Embrocatio sulphuris carbureti, Embrocation of carburet of sulphur. R. Sulphur, carbur. ^ss. Olei amygd. dulc. 3J. M. To be rubbed in, in cases of old gouty nodes. Mansfeld and Otto. x R. Sulphur, carbur. f gij. 01. oliv. seu Linim. amraon. camphor, f gij. M. To be rubbed in, in cases of rheumatism. Wutzer. 1 Bibliothek for Lsger, 1833 ; cited in Brit, and For. Med. Review, July, 1836, p. 252 SULPHURIS IODIDUM. 673 R. Camphor, gij. Solve in Sulphur, carbur. f 3SS. Adde Alcohol, f gj. M. To be used in friction, in cases of rheumatism, and especially in rheumatic odontalgia. Lampadius. CLXIX. SULPHURIS IODIDUM. Sy^onymes. Sulphuris Ioduretum, Sulphur Iodatum seu Ioduratum, Ioduret or Iodide of Sulphur. French. Soufre Iodure, Iodure de Soufre. German. Iodschwefel, Iodinschwefel, Schwefeliodiir. METHOD OF PREPARING. Iodide of sulphur is prepared by heating slightly a mixture of four parts of iodine, and one of sublimed sulphur. The excess of iodine is driven off, and the iodide of sulphur remains as a grayish- black mass, very deliquescent, and readily decomposed by water. M. G. Van Melekebeke x has proposed the following form: — Take of iodine, two parts; washed sulphur, one part. Bruise them together, and introduce the mixture into a glass tube, pressing it down until the tube is well filled ; then seal hermetically. Heat at first gently, until the mixture begins to become of a darker colour; then augment the heat so as to fuse the iodide; keep it for some time in this state, and turn the tube constantly, that the action may be uniform; remove it from the fire, and shake it until the iodide begins to congeal, and until vapours of iodine no longer form; open the tube, and compress again the iodide, in order to have it in fine cylinders. M. Van Melekebeke recommends this as a very expeditious process, and one which enables the phar- macien to prepare the iodide in very small quantity. The com- mittee of the Societe des Sciences Medicates et JVaturelles of Ma- lines approve of the process, but suggest, that the proportion of iodine to sulphur should be three to one. The following form for its preparation has been introduced into the last edition of the Pharmacopoeia of the United States: — Take of iodine, jiv. ; sulphur, ^j. Rub the iodine and sulphur together in a glass, porcelain, or marble mortar, until they are thoroughly mixed. Put the mixture into a matrass; close the orifice loosely, and apply a gentle heat so as to darken the mass without melting it. When the colour has become uniformly dark throughout, in- crease the heat so as to melt the iodide; then incline the matrass in different directions, in order to return into the mass any portion of iodine which may have condensed on the inner surface of the 1 Archives de la Medecine Beige, Mars, 1842, p. 307. 674 SULPHURIS IODIDUM. vessel : lastly, allow the matrass to cool, break it, and put the iodide into bottles, which are to be well stopped. EFFECTS ON THE ECONOMY. Biett has used this agent in squamous, pustular, and papular diseases of the skin. It has been found especially effective in psoriasis, in the form of friction. Patients, who had been long affected with diseases of this kind, which had resisted every other remedy, were cured in four or five months by iodide of sulphur alone. To prevent relapses, Biett advises that the frictions should be continued after the eruptions have scaled off. He found it equally efficacious in the lepra vulgaris of Willan; and in acne — the gutta rosacea of Alibert — when the inflammation of the skin had passed away. Even acne indurata was often completely cured by it. 1 He found it also beneficial in inveterate porrigo of the scalp.* At times, after the rubbing, a diffuse red inflammation of the skin arises, with subsequent desquamation; and, in particular cases, the inflammation extends even to the subjacent areolar mem- brane. In old standing lepra, Rayer 3 prefers it for external use to calomel and white precipitate; and he ranks it highly, with the iodides of mercury, for the cure of lupus non exedens ; and by Dr. Volmar 1 it has been used, with great success, in herpes pustulosus labialis. It is likewise extolled by Lugol as a very active thera- peutical agent. Cless affirms, that in chronic squamous affections of the skin, especially in psoriasis, he has employed it with ad- vantage, but he was not able to cure lepra vulgaris with it. It has been strongly recommended in tinea capitis, in the proportion of ten grains of the iodide to an ounce of lard. A writer in an English periodical 5 affirms, that he was induced to make trial of it in some obstinate cases, and was much astonished at the remarka- ble pow T er it possessed over the disease. He rubbed it on the head, night and morning, and increased the strength of the ointment ac- cording as the affected part w r as able to bear the stimulus, until the iodide bore the proportion of half a dram to the ounce of lard or spermaceti cerate. Dr. Wilson has recommended, that the surface in porrigo, after ablution with warm water, should be rubbed gently twice a day with a liniment composed of iodid. sulphur gss., ol. oliv., ^j. In porrigo decalvans it has been found beneficial, made into an ointment with 18 or 20 parts of lard, and rubbed on very gently night and morning. Dr. W. Davidson, 6 too, has ex- * See, also, Rayer, Traite Theorique et Pratique des Maladies de la Peau; and Cop- land, Dictionary of Practical Medicine, art. Acne. 2 Cazenave et Schedel, Maladies de la Peau, p. 219; and Cogswell on Iodine, p. 120. Edinb. 1837. 3 Diseases of the Skin, p. 634. * Die neuesten Entdeckung. in d. Mat. Med.; cited by Pereira, Elements of Mat. Med. ii. 477, 2d edit. Lond. 1842; or 2d Amer. edit, by Carson. Philad. 1846. 5 London Medical Gazette, for Sept. 9, 1837, p 879. See, also, M. Cazenave, cited in American Journal of the Medical Sciences, Oct. 1841. p. 460. ' London and Edinburgh Monthly Journal of Medical Science, Dec. 1841: also, J. J. Ross, ibid. Sept. 1842, p. 792. UREA. 675 tolled it highly. He affirms, that although it does not seem to have so much power over lepra and psoriasis as over porrigo, it has succeeded more frequently than any agent he has tried, with the exception of blistering by cantharides. The author has certain- ly obtained far more satisfactory results from the use of iodide of sulphur in chronic cutaneous diseases in general, and especially in porrigo, eczema, and psoriasis, than from any other external agent; and such is the result of the observations of M. Es- colar. 1 The inhalation of the vapour of this substance has been em- ployed in humoral asthma by Dr. Copland, 2 with temporary benefit; and fumigations of iodine and sulphur have been used ad- vantageously in certain atonic ulcers and chronic cutaneous dis- eases. 3 With this view, the sulphur and iodine may be combined extemporaneously, — say four parts of iodine to one part of sulphur. MODE OF ADMINISTRATION. Ungnentum sulphuris iodidi. Ointment of iodide of sulphur. R. Sulphur, iodid. 9j. — £ss. Adipis ^j. M. et fiat unguentum. Biett, — Bayer. CLXX. URE'A. Synonyp^ies. Ureum, Uricum, Nephrine, Nephrin. French. Uree, Extrait Savonneux de FUrine. German. Hams toff. This immediate principle of the urine of man and quadrupeds was discovered in an impure state by Rouelle, in 1773; and since then it has been studied by Cruickshanks, Fourcroy and Vauque- lin, Berzelius, Proust, and Liebig more especially. 4 METHOD OF PREPARING. Urea is obtained by placing a mixture of equal volumes of urine, reduced to the consistence of syrup, and nitric acid at 20° in a re- frigerative bath ; by which means crystallized nitrate of urea is precipitated. On dissolving this in cold water, and decomposing by carbonate of potassa, reducing it almost to dryness, and treating the residue by alcohol at 40°, which takes up the urea, crystals may be obtained by evaporation, which may subsequently be pro- cured colourless by the agency of animal charcoal. 1 Bouchardat, Annuaire de Therapeutique pour 1848, p. 196. Paris, 1348. 3 Diet, of Practical Medicine, art. Asthma. s London Lancet, vol. i. 1 838. * Annales de Chimie et de Physique, x. 369, and Merat and De Lens, art. Uree. 676 UREA. M. Henry, 1 who was not satisfied with the scanty product yielded by this process, recommends the following: — Add to fresh urine a slight excess of subacetate of lead; a precipitate is thus formed, which consists of oxide of lead united to the various acids of the urine, together with the mucus, and a great part of the animal matter; the decanted liquor is then treated with sulphuric acid in slight excess to separate the lead, and, afterwards, in the progress of the evaporation, to decompose the salts of soda and lime that may have been formed. After having separated the white precipitate, concentrate rapidly over a steady fire, adding a portion of animal charcoal during the ebullition. When the whole has become a clear syrup, pass it through linen of close texture, and then reduce it one-third by evaporation. On cooling, the liquid is converted into a yellow mass, crystallized in needles, and formed of a great proportion of urea and some salts. The crys- tals, being drained and pressed, are added to those obtained from the mother waters treated in a similar manner. They are next treated with a very small quantity of carbonate of soda, with the view of separating any remaining acetate of lime, and then digest- ed in alcohol of 38° to 40°. The alcoholic solution being filtered, and the alcohol separated by distillation, the urea remains, which may be crystallized afresh from water, if necessary. 2 Urea, thus obtained, is in silky or prismatic needles, is very soluble, and of a cooling taste. The following improved method of preparation has been pro- posed by Prof. Liebig. 3 Twenty-eight parts of ferrocyanuret of potassium perfectly dried are mixed with fourteen parts of per- oxide of manganese, both being reduced to as fine a powder as possible; the mixture is then heated on an iron plate, not in a cru- cible, over a coal fire to a feeble red heat. At this temperature it inflames, and is gradually extinguished. By shaking it several times, at intervals, it is prevented from becoming agglutinated, and the access of air is facilitated. The mass, on cooling, is treated with cold water, and the liquor is mixed with twenty parts and a half of dry sulphate of ammonia of commerce, prepared by satu- rating sulphuric acid with carbonate of ammonia, and evaporating it to dryness. It is w r ell to put to one side the first concentrated washings afforded by the ferrocyanuret of potassium; to dissolve in the last washings, in the cold, the sulphate of ammonia, and to mix them with the first. Commonly, an abundant precipitate of sulphate of potassa forms immediately. The supernatant liquid is poured off, and evaporated in a salt water bath, or rather in a 1 Journal de Pharmacie, xi. 161. Paris, 1829. 3 Manual of Materia Medica and Pharmacy; by H. M. Edwards and P. Vavasseur, p. 231. Philada. 1829. * Annalen der Chimie und Pharmacie, B. xxxviii.; and Journal de Pharmacie, Aout, 1841, p. 502. UREA. 677 warm place, — care being taken to prevent ebullition. Fresh crys- talline plates of sulphate of potassa are deposited, and the liquor is decanted as far as possible. The decanted liquor is then eva- porated to dryness, and the residuum is treated with boiling alcohol of eighty to ninety per cent. This dissolves the urea, which crystallizes by the cooling and evaporation of the alcohol, whilst the sulphates do not dissolve. EFFECTS ON THE ECONOMY. The experiments of M. Segalas have established, that urea is devoid of any noxious action on animals into whose veins it has been injected, and, consequently, that we cannot ascribe the serious symptoms to it which arise from the absorption of urine in certain morbid cases. They demonstrate, farther, what has been con- firmed by the trials of Fouquier, that urea is a diuretic, and, there- fore, might be useful in dropsy, and it has been so prescribed by him and by M. Segalas. Fouquier employed it, also, but unsuc- cessfully, in diabetes. 1 Laennec used it with advantage in a case of dropsy. In two cases reported by Mr. Kingdon, 2 he found that Nitrate of Urea, — JVitras Urece, Urea JVitrica; French, Nitrate d'Uree; German, Salpetersaures Harnsto ff — acted as a very powerful diuretic; reducing, in a comparatively short time, anasarcous swellings of some standing, when ordinary diuretics had failed. In the first case, he gave one grain of the nitrate with one grain of calomel, in the form of pill, every night and morning for twelve days. The urine became copious, and the swelling disappeared. In the second case, a grain and a half of the nitrate was given alone three times a day. The like suc- cess attended this case: in ten days the anasarca had disappeared. Urea was also prescribed by M. Piorry in albuminuria.* According to Prof. Fee, 4 urea is received into the lists of the Materia Medica in the Batavian Pharmacopoeia, and in some others less known. It has also been admitted into the French Pharmacopoeia. MODE OF ADMINISTRATION. Urea has been given in solution in distilled water, sweetened, in the dose of twenty-four to thirty grains, and even as high as several drams, in the day. 1 Journal de Physiol, de Magendie, ii. 344, and Magendie, Formulaire pour la Pre- paration, &c, de plusieurs nouveaux Medicamens. a London Lancet, Sept. 7, 1844, p. 729. * A sclieri brenner, Die neueren Arzneimittel, S. 268. Erlangen, 1848. 4 Cours. d'Hist. Naturelle Pharm. ii. 764 ; cited in Merat and De Lens, Diet, de Mat. Med. art. Uree. 678 VERATRIA. CLXXT. VERATRIA Synonymes. Veratrina, Veratrinum. Veratrium, Veratrine. French. Veratrine. German. Veratrin, Niesswurzstoff. This alkaloid, which was discovered in 1819, by MM. Pelle- tier and Caventou, 1 and almost at the same time by Meissner, 2 is commonly prepared from the seeds of veratrum sabadilla — Saba- dilla or Cevadilla of the Pharmacopoeia of the United States. It is contained in several of the plants belonging to the family Colchicaceae. METHOD OF PREPARING. Cevadilla is repeatedly treated with boiling alcohol. The tinc- tures, filtered when almost boiling, allow whitish flakes of wax to be deposited on cooling; the dissolved matters, brought to the con- sistence of an extract, are now dissolved in cold water, and filtered, whereby a small quantity of fatty matter remains on the filter. The solution is then slowly evaporated, when a yellowish orange- coloured precipitate is formed, which possesses the characters of the colouring matter found in almost all woody vegetables. On adding a solution of acetate of lead to the still deeply coloured liquid, a new and very abundant yellow precipitate is thrown down, which can be separated by means of the filter. The liquor, now nearly colourless, contains, besides other substances, acetate of lead, which had been added in excess; this is separated by means of a stream of sulphuretted hydrogen; the liquor is then filtered, and concentrated by evaporation; treated by magnesia, and again filtered. The magnesian precipitate is digested in boil- ing alcohol, and on evaporating the alcoholic liquors, a pulveru- lent, extremely acrid matter is obtained, which possesses all the properties of the alkalies. It appears at first yellowish; but by solutions in alcohol, and subsequent precipitations, caused by pouring water into the alcoholic solutions, it is obtained in the form of a very white and perfectly inodorous powder. 3 Veratria has been received into the London and United States Pharmacopoeias. 4 In these it is directed to be prepared as fol- lows: — Take of cevadilla, bruised, two pounds; alcohol, three gallons; diluted sulphuric acid, solution of ammonia, purified animal charcoal, magnesia, each a sufficient quantity. Boil the cevadilla in a gallon of the alcohol, in a retort w T ith a receiver attached, for Bn hour, and pour off the liquor. To the residue 1 Annales de Chimie et de Physique, xiv. 69. a Gilbert's Annalen der Physik, lxv. 335. * Magendie's Formulaire pour la Preparation, &c, de plusieurs nouveaux Medicamens. 4 Pharra. of the United States, p. 237. Philada. 1842. For Righini's method of obtaining what M. Soubeiran calls '■'■medicinal veratrine? see Journal de Pharmacie, Oct. 1837. VERATRIA. 679 add another gallon of the alcohol, together with the portion re- cently distilled, again boil for an hour, and pour off the liquor. Repeat the boiling a third time with the remaining alcohol, and with that distilled in the previous operation. Press the cevadilla, mix and strain the liquors, and by means of a water bath distil off the alcohol. Boil the residue three or four times in water acidu- lated with sulphuric acid, mix and strain the liquors, and evapo- rate to the consistence of syrup. Add magnesia in slight excess, shake the mixture frequently ; then express and wash what re- mains. Repeat the expression and washing two or three times, and, having dried the residue, digest it with a gentle heat several times in alcohol, and strain after each digestion. Distil off the alcohol from the mixed liquors; boil the residue for fifteen minutes in water with a little sulphuric acid and purified animal charcoal, and strain. Having thoroughly washed what remains, mix the washings with the strained liquor, evaporate with a moderate heat to the consistence of syrup, and drop in as much solution of ammo- nia as may be necessary to precipitate the veratria. Lastly, sepa- rate and dry the precipitate. The following is the rationale of this process. The cevadilla gives up its veratria united with a vegetable acid to the alcohol; and when the alcohol extract is treated with water and sulphuric acid, an impure solution of sulphate of veratria is obtained. The magnesia decomposes this, setting free the veratria, which is taken up by alcohol. The alcohol is then distilled off, and the extract is boiled in water with sulphuric acid and animal charcoal: the acid unites with the veratria, whilst the charcoal abstracts the colouring matter. Ammonia, added to the strained solution, unites with the sulphuric acid, and the veratria is precipitated. 1 Veratria — commercial or medicinal veratria — as prepared by the last process, is pulverulent, of a grayish-white colour, in- odorous, and of a bitter acrid taste, causing a sensation of tingling with numbness in the tongue. It is scarcely at all soluble in cold water; but boiling water dissolves one thousandth part of its weight, and becomes sensibly acrid. It is very soluble in ether, and still more so in alcohol. It is not soluble in alkalies, but is so in all the vegetable acids: with these it forms uncrystallizable salts, which, on evaporation, present the appearance of gum. The sulphate alone affords rudiments of crystals when its acid is in excess. Nitric acid combines with it; but, if added in excess, it does not colour it red, as in the case of morphia, brucia, and im- pure strychnia, but very rapidly resolves the vegetable substance into its elements, and gives rise to a yellow detonating matter. Veratria has an alkaline reaction. When exposed to heat, it liquefies at a temperature of 122° Fahrenheit, and has a waxy 1 Pereira, Elements of Mat. Med. and Therap. 2d edit. ii. 961 ; or 2d Amer. edit, bv Carson. Philad. 1846. Commercial ver atria, 680 VERATRIA. appearance. On cooling, it forms a translucent mass, having the appearance of amber. When distilled on the naked fire, it swells up, is decomposed, forms water, much oil, and leaves behind a bulky coal. According to Couerbe, 1 when prepared in the modes above mentioned, it still contains several other substances, sabadillina, veratria, gum-resin of sabadilla, and a black greasy substance, which unites the other matters, and conceals their properties. These may be separated from each other by the successive action of water, ether and alcohol, as in the following table : { 1. Sabadillina, which . ,- . ..,. crystallizes on cooling, yields to boiling; water < n J . r , . -P c . t ° ] Z. Resin oj veratria, left in the cold solution. 3. Veratria, soluble in insoluble in boiling ,, ^ r . • 6 \ 4. Gum resin oj veratria, insoluble in ether, but ( soluble in alcohol. On account of its very high price, and want of well defined external characters, the veratria of the shops is said to be very subject to adulteration ; and there would not seem to be any good criterion for ascertaining its degree of purity. 2 Simon, an apothecary of Berlin, has affirmed, that he has found two alkaloids in veratrum album ; one of which possesses the pro- perty of being precipitated from its solution in acetic or phos- phoric acid by sulphuric acid and its salts, like baryta ; hence he has given it the name barytin? EFFECTS ON THE ANIMAL ECONOMY. Regarding the effects of veratria on animals, Magendie 4 has the following remarks : — A very small quantity of the acetate placed in the nostrils of a dog, instantly excited violent sneezing, which continued for a long time. One or two grains, placed in the mouth, immediately occasioned profuse ptyalism. When a small quantity was introduced into any part of the intestinal canal, and the body was opened to notice its effects, the intestine was ob- served to be much indurated, and to relax and contract alternately for a certain length of time. The part of the mucous membrane with which the veratria is made to come in contact, is inflamed ; the irritation spreads, and vomiting and purging are excited. In 1 Annales de Chiraie et de Physique, ii. 308. a Christison, Dispensatory, p. 806. Edinb. 1342. See, as regards its adulteration with lime, Versmann, cited in Med. Examiner, Oct. 194n, p. 626. 3 Pharmaceut. Centralblatt, 1837, p. 191, and Medicinische Annalen, B. iv. H. i.; S. 9. Heidelb. 1838. 4 Journal de Physiologie Experimen. i. 56; and Formulaire pour la Preparation, &c. de plusieurs Medicamens, VERATRIA. 681 much stronger doses, the circulation is accelerated, as well as the respiration ; and tetanus supervenes, soon followed by death. The effects are still more rapid, if one or two grains be thrown into the cavity of the pleura, or tunica vaginalis. In less than ten minutes death occurs, preceded by tetanic convulsions. The same quantity, thrown into the jugular vein, induced tetanus and death in a few seconds. Dissection showed, that, even in this case, the veratria had acted on the intestinal canal, the mucous membrane of which was found injected. The lungs, also, exhibited traces of inflammation and engorgement. Veratria, in large doses, would, doubtless, exhibit the same effects on the human organism. The taste is very acrid, but without bitterness : it excites a copious flow of saliva, even when a small quantity only has been introduced into the mouth. Al- though it has no smell, it must not be brought too close to the nose, when in the state of powder, as it occasions, even in very minute quantity, violent sneezing, which may prove dangerous. A quarter of a grain immediately induces copious evacuations, and, in a somewhat larger dose, more or less violent vomiting. According to Turnbull, who has* immoderately extolled this remedy, its effect is very different, according as it is exhibited internally or externally. Externally, it may be applied for weeks and months, without the supervention of any of the effects that succeed its internal administration. Exhibited in this way, it diminishes internal nervous excitement; assuages pain, but does not act on the intestinal canal. In dropsical cases, it is stated to be one of the greatest promoters of the urinary secretion that we possess. The part of the skin on which it is rubbed, either in solution or ointment, even when the friction has been continued for a long time, exhibits no evidence of irritation ; when, however, the dose has attained a certain extent, the patients feel a conside- rable degree of heat, and a kind of pricking sensation in the rubbed part, whence it may be concluded, that the article is active, pure and genuine: under more prolonged use, this feeling of warmth and pricking extends over the surface of the whole body ; and, in some cases, involuntary twitchings have been observed in the muscles of the mouth and eyelids. These symptoms, however, pass off, when the frictions are discontinued for a day or two. Only in a few cases, according to Turnbull, was any eruption in- duced by its application. The endermic use of the remedy always, however, excited so much irritation as to prevent its repetition. Thus much for Turnbull : — His views and experience have by no means been confirmed by the generality of observers. The external application of veratria cannot always be used without local irritation ensuing. An English physician, labouring under rheumatism of the arm, rubbed upon it an ointment composed of twenty grains of veratria to an ounce of lard ; and, immediately 682 VERATRIA. afterwards, so much pain was induced in the part, that he was obliged to take opium to obtain rest; an eczematous eruption sub- sequently appeared on the arm, but the rheumatism remained. Ebers applied it endermically, but witnessed nothing more than a violent burning in the part, such as is commonly the case with other agents. He frequently observed the pricking sensation men- tioned by Turnbull, and it was often to such an extent as to be almost insupportable. According to the trials of Ebers, its diu- retic effect was not restricted to dropsy, but was usually evinced in other diseases. The sensorium appears never to have been implicated, but when applied in small doses over the pit of the stomach, it produced striking effects on the spinal marrow, and the nerves connected therewith, — as the nerves of the thorax and abdomen: violent pain was experienced, which spread through the whole extent of the nerves distributed to the parietes of the ab- domen, with a sense of traction along the spinal marrow, twitch- ings, great anxiety, orthopnosa, nausea and vomiting, and a feel- ing which the patient was unable to describe, except that it was almost intolerable. When given internally, veratria speedily caused nausea, retch- ing, vertigo, and complete loss of appetite; so that Ebers soon abandoned its internal use, and, like Turnbull, gave the preference to the external. Owing to its presumed effects on the nervous system, and es- pecially on the spinal marrow, and the nerves connected with it, it was suggested in nervous diseases — particularly in neuralgia, prosopalgia, and ischias — in which it is said to have been most efficacious, by Turnbull, Ebers, 1 Bruck, Suffert, 2 Professor S. Jackson, 3 Cunier, 4 Calve, 5 F. A. Gebhard, 6 and others. In no class of diseases, according to the first of these writers, have the beneficial effects of the ointment of veratria exhibited themselves more strikingly, and by no other remedy has the same amount of relief been induced in so short a time. Even in tic douloureux, a single friction is said to have been sufficient to remove the dis- ease without relapse. Two circumstances chiefly have here to be borne in mind, — first, the extent of the pain, for when it is not concentrated on a point, but spreads along the branches of the nerves, the cure is easier, and a weaker ointment is needed ; and, secondly, the duration of the affection. In long protracted cases, 1 Camper's Wochenschrift. 1837, No. 47. 2 Berlin, Median. Centralzeitung, 1837, p. 673, and Heidelberg. Medicin. Annal. B. iv. H.1,8. 11. 3 American Journal of Pharmacy, vol. iii. new series, p. 186*. Philad. 1838. 4 Bulletin Medical Belae Dec. 1837, and Ballet. General de Therap., Dec. 1838. See, also, Forcke, Physi ologisch therapeuiische Untersujhun^on ubsr das Ve atria, Hannov. 1837; cited in Bib. Genenle, Encyclog. des Sciences Medicales, Aout, 1838. ' Cited in Braithwaite's Retrospect, x. 24. Amer. edit. New York, 1845. 6 Z^itschrift far Taeranie ui 1 Pharmaco lynaroik. Freiburg. Dec 1814; cited in Amer. Journ. of the Med. Sciences, Jan. 1846, p. 203. VERATRIA. 683 a complete cure is far more difficult, and can, in general, be effected only after a long period. The paroxysms, however, may be relieved by an ointment composed of from twenty to forty grains to an ounce of lard. In this case, it must be strongly rubbed in, so as to excite itching, — care being taken, however, that the ointment does not touch the conjunctiva, as the smallest quantity of veratria would induce violent inflammation. In many cases of prosopalgia M. Lafargue 1 introduced it by inoculation with singularly good effects. The plan he pursues is nearly the same as that for vaccination. Several punctures are made with the point of a lancet charged with a saturated solution of the alkaloid. Each puncture becomes at once the seat of a sharp pain, which is usually compared by the patient to a continued deep pricking with the point of a needle. This unpleasant sensation lasts for from five to fifteen minutes, and then gradually subsides; and with it the red areola that has formed around the punctured spot. M. Lafargue recommends, that in severe cases the inocu- lation should be repeated morning and evening; and that as many as ten or twelve punctures should be made at a time. He has used the same method with decidedly good effects, in several cases of partial paralysis. Ebers, likewise, found advantage from its use in chorea, hypo- chondriasis and hysteria; and Turnbull, and F. A. Gebhard, 2 in paralysis. Both Ebers and Turnbull extol it in rheumatism and gout, in relation to which Ebers remarks, that it has appeared to him more efficacious when the nervous system, or some nervous branches were predominantly affected, and when the gastric af- fection was entirely removed. In the cases treated with it, relief was sooner obtained, and the cure w T as more speedy and complete, than when other agents were employed ; the secretion of urine was augmented; restlessness disappeared ; and sleep returned, without any evidence of narcosis. As regards acute rheumatism, Turn- bull remarks, that veratria is not to be preferred to antiphlogistics; in these cases, a weaker ointment must be used (ten grains to the ounce:) in chronic cases, the quantity may be carried much higher; and — especially when extensive organic changes have supervened in the parts — it must be continued for a great length of time. In lumbago, ischias and rheumatism of the chest, not more than one or two rubbings were generally necessary. In gout, according to Turnbull, it may be exhibited both internally and externally ; in the former mode of administration, he compared its efficacy with that of colchicum: the latter has been recommended by Sir C. Scudamore. It was likewise found, by Bardsley, 3 very advan- tageous in chronic rheumatism. In cases of severe local suffer- 1 Cited in Edinb. Med. and Surg. Journal, Oct. 1843. 3 Op. cit. 3 Hospital Facts and Observations, illustrative of the Efficacy of Strychnia, Brucia, Veratria, Iodine, &c. Lond. ] 830. 684 VERATRIA. ing, the ointment composed of veratria and opium, the form for which is given hereafter, has afforded marked relief. In two epidemics of hooping cough, Dr. F. A. Gebhard 1 found that great benefit was experienced, where the second stage was of protracted duration, from rubbing it over the vertebrse of the neck and upper part of the back. Dr. Bushnan has strongly recommended the ointment in dysmenorrhea, which he supposes may be frequently owing to perversion of the nervous action of the lower portion of the spinal nerve ; and in certain spasmodic affections of the larynx, presumed by Dr. Tunstall 2 to be connected with a morbid condi- tion of the superior portion of the spinal marrow, it is asserted to have been efficacious. It has also been used in amaurosis, the ointment being rubbed on the temples and forehead for a few minutes, once or twice in twenty-four hours. The friction should be continued until it causes redness, heat, and stinging. Messrs. Lawrence 3 and Tyrrel, however, affirm, that it is wholly ineffica- cious. Veratria would seem to have been most efficacious in cases of dropsy. " Unadulterated veratria," says Ebers, " acts often on the urinary secretion with magical powers, and it may seem fabulous, when I state, that friction with a very weak ointment two or three times in the twenty-four hours on the inner part of the thigh, or the back, epigastric region, or around the navel, has excited such a copious secretion of urine, that the patient, under its long conti- nuance, began to feel weak; and the anasarca, and even the drop- sical accumulation in the abdomen, in a short time almost disap- peared — circumstances which indicate the caution that ought to be observed in apportioning the dose, when we are satisfied of the goodness of the article." He properly remarks, however, that veratria, by augmenting the secretion of urine, may not remove the dropsy; still, by occasioning the absorption of the fluid, it allows the physician to examine as to the existence of organic mischief. Ebers gave it in many of the lighter hydropic cases, ivhich fol- low intermiltents and other forms of fever, and often with great and rapid success; likewise, in twenty-four more serious cases, fifteen of which recovered, and one experienced relief: eight very complicated cases terminated fatally, and in four of these di- uresis occurred ; in four not. Dr. F. A. Gebhard 4 found more marked effects from it in dropsies consequent upon long and exhausting disease ; and particularly in cases which supervene on a severe typhoid epidemic, which he witnessed. Fricker 5 1 Op. cit. Q Provincial Med. and Surg. Journal. Au^. 14, 1841. 3 A Treatise on the Diseases of the Eye, Amer. edit, by Hays, p. 519. Philad. 1843. * Op. cit. 5 Wurtemb. Medic. CorrespondenzbJatt. B. vi. S. 157 and 341; and Heidelb. Medicin. Annal. B. iv. fl. i. S. 15. VERATRIA. 685 likewise obtained very good effects from the use of an ointment of it in dropsy; but, on the other hand, Spath found it of no avail. Turnbull observed, from the internal use of veratria, as well as from its application to the pit of the stomach, a diminution in the frequency and force of the pulsations of the heart ; and, in cases where they were more excited than natural, restoration of a regu- lar circulation. He exhibited it, consequently, in heart diseases ± especially in those of gouty and rheumatic diathesis, in simple nervous and gouty palpitation, and as a diuretic in organic heart diseases, in which it frequently seemed to afford relief. The observation of Turnbull — that the external application of veratria, in chronic rheumatism with swellings of the joints, caused them to disappear — induced him to try it in glandular swellings: he found, that in goitre, swellings of the mammary glands unaccompanied with pain, buboes, and scrofulous tu- mours of various parts, even in cases in which iodine had failed, it rendered essential service. It has, according to him, the advan- tage, that the skin is not subsequently irritated by it, and when, after the rubbing, the superfluous ointment is washed off with soap and water, the affected parts can soon afterwards be exposed to the air. Of an ointment formed of ten grains of veratria to half an ounce of lard, a piece, about the size of a nut, is rubbed in for ten minutes twice a day, and every week the strength of the ointment is increased. Magendie 1 recommends, that veratria should be given, also, as a drastic cathartic, especially where a speedy action on the bowels is needed. Prescribed with this view, it has been found effective in several aged persons, in whom a collection of excrement had formed in the large intestine. Turnbull advises it in the dose of half a grain — in the opposite condition of the bowels — diarrhoea — a disease, in which, it is well known, our ordinary cathartics often prove serviceable. It would appear, as before remarked, that veratria is an article which is frequently adulterated. Such, at least, is the opinion of many practitioners, and in this way they account for the discord- ance amongst observers as to its virtues. 2 The article with which Ebers made his first trials was obtained from the French labora- tories; and it exhibited the whole power of this heroic agent: on employing, however, a new preparation, he found the latter en- tirely useless; whilst from another he derived all the benefit ob- tained from the first. The observations of Ebers would induce us to make farther trials with it, but the author must confess that his experience, thus far, has by no means confirmed the eulogiums of 1 Formulaire pour la Preparation, &c, de plusieurs nouveaux Medicamens. 2 Ebers; and Riecke, Die neuern Arzneimittel, u. s. w. S. 407, and 2te Auflage, SL 641. Stuttgart, 1840. 44 686 VER ATRIA. Turnbull; and this, he thinks, is the general sentiment of the pro- fession. 1 It has often been used externally by him as well as by other American physicians, but it has almost always fallen short of the mark. 3 MODE OF ADMINISTRATION. Veratria may be given either in pill or in spirituous solution ; the dose being from one-twelfth to one-sixth of a grain several times a day. Externally, it is best administered in the form of ointment, or endermically. Liquor veratriae. Solution of veratria. R. Veratriae gr. j. Aq. destillat. f gij. M. A dessert-spoonful to be taken in one or two ounces of sugared water, in cases of tic douloureux. Magendie. Pilulsa veratriae. Pills of veratria. R. Veratriae gr. ss. Acaciae ^j. Syrup, acac. q. s. ut fiant pilulae vj. Dose. — One pill, to be repeated two or three times a day, ac- cording to circumstances. Magendie. R. Veratriae gr. j. Glycyrr. pulv. gr. xii, Ext. hyoscyam. gr. vj. M. fiant pilulae xij. Dose. — One, three times a day. Turnbull. Tinctura veratriae. Tincture of veratria. R. Veratriae gr. iv. 3 Alcohol, f^j. M. Dose. — Ten, fifteen, twenty, to twenty-five drops in a glass of water. — Given in dropsy. Magendie. Magendie recommends that the tincture should also be used externally, in cases of dropsy or gout. Linimentum veratria, Liniment of veratria. R. Veratriae gr. viij. Solve in Alcohol. Tinct. sapon. caraphorat. aa f ^ss. M. 1 Gully's translation of Magen die's Formulary ; and Joy, in Tweedie's Library of Me* dicine, v. 28!). Lond. 1840; or 2d Amer. edit. Philad. 1842. * See, on the preparation, employment, action, and medicinal virtues of Veratria, Ebers, in Hnfeland's Journal, B. lxxxvi. 1838. • In the P hn rtr, n copse llnincrselle of Jourdan, (ii. 643,) there is the serious error of directing §iv. in the preparation of this tincture, in place of four grains! VERATRIA, m (Huile de Veratrine.) B. Veratriae gr. xvss. (1 gram.) Olei jecoris aselli gviss. (25 gram.) M. Used in the form of friction in inveterate neuralgia. 1 Jourdain\ \ Unguentnm veratriae. Ointment of veratria, B* Veratriae gr. v. x. vel xx, Adipis §j. Misce intime. For external use. The size of a hazel-nut to be carefully rubbed in, morning and evening, or oftener, for from five to fif- teen minutes. TurnbulL Ro Ve rat rise 9j„ Tere cum 01. olivse 3J. Et adde Unguent, cetacei gvij. Misce. Unguentum veratriee et opii. Ointment of veratria and opium* B. Veratriae gss. Opii pulv. gu Adipis ^iss. M. To be rubbed on the part in severe bodily suffering from rheu^ matism. The uncertainty in the action of the ointment of veratria having attracted the attention of M. Sauvan, 3 he found, by accident, that the difference did not proceed from the veratria, but from the fatty matter employed. With fresh pure lard, the ointment was of bad quality ; whilst with bad or rancid lard, a satisfactory ointment was obtained. Sulphate op Veratria — Veratrim Sulphas — possesses the same virtues as veratria. Magendie gives the following form for internal administration; — Solutio veratrisB sulphatis. Solution of sulphate of veratria* B. Veratriae sulphat. gr. j. Aquae destillat. f %\\. Misce. Dose. — f 3j. to f 3iv. in a mixture. The preparation has beeft suggested as a substitute for the Eau medicinale d'Husson* 1 Bouchardat, Annuaire de Therapeutique, &c. pour 1847, p. 36. Paris, 184&, s Ibid, pour 1843, p. 43. Paris, 1843, 68S ZINCI CHLORIDUM, CLXXIT. ZINCI CHLORIDUM. Synonymes. Zinci Chlorurelum, Zincum Chloraturn seu Muriaticum Oxydatum seu Salitum, Chloruretum Zincicum seu Zinci, Chlore- tum Zinci seu Zincicum, Butyrum Zinci, Murias Zinci seu Zincicus, Chloride, Chloruret, Hydrochlorate, Muriate, or Butter of Zinc. German. Zinkchlorid, Salzsaures oder Chlorwasserstoff- saures Zink, Salzsaures Zinkoxyd, Chlorzink, Zink- chloriir, Zinkbutter. METHOD OF PREPARING. Chloride of zinc results, — when to any given quantity of pure muriatic acid, pure oxide of zinc is added, by the aid of gentle heat, until no more is dissolved: the solution is then filtered, and evaporated in a porcelain dish to dryness; whereby a jelly-like — and by high drying, firm white, and by careless drying, light brownish — substance, remains, of an austere, sourish, metallic taste, which must be rubbed to powder, and preserved in a close- ly-stopped vessel. In the last edition of the Pharmacopoeia of the United States (1842) it is directed to be prepared as follows: — Take of zinc, in small pieces, Siiss.; nitric acid, prepared chalk, each 3i.; muriatic acid, a sufficient quantity. To the zinc, in a glass or porcelain vessel, add gradually sufficient muria- tic acid to dissolve it ; then strain ; add the nitric acid, and evapo- rate to dryness. Dissolve the dry mass in water, add the chalk, and, having allowed the mixture to stand for twenty-four hours, filter, and again evaporate to dryness. Chloride of zinc is very deliquescent in the air, forming butter of zinc {butyrum zinci, German, Zinkbutter.) It is very soluble in water, alcohol, and ether. EFFECTS ON THE ECONOMY. Chloride of zinc has been exhibited both internally and exter- nally, but chiefly in the latter mode, especially in this country. Papenguth 1 found a very dilute solution, applied in the form of lo- tion, useful in flabby scrofulous ulcerations; and in sinuous ulcers, in the form of injection. It has been especially recommend- ed as a caustic that does not exert any disagreeable influence, like corrosive sublimate, arsenic, or potassa fusa; — neither causing violent pain in the affected parts, nor any kind of irritative fever; nor disordering the digestive organs, as some of the articles just mentioned. Hancke, indeed, advises, that arsenic should be en- tirely banished from therapeutics as a caustic agent, and that chloride of zinc should be substituted for it. He employed it with success in old atonic ulcerations of the feet, in the strength of two grains to the fluidounce of distilled water : w T ith this he wetted lint, and applied it two or three times a day. With like success, he used it 1 Nouveau Journal de Medecine, 1819. Z1NCI CHLORIDUM. 689 in old syphilitic ulcers, with extremely morhid surfaces and secretions: the chloride destroyed the degenerate formations, and effected cicatrization. In scrofulous and malignant herpetic ulcers, he prescribed a concentrated solution ; in pityriasis he used it as a wash, and in wounds and ulcerations with fungous for- mations, he applied it in a concentrated state: in phagedenic ulcers of the face, it effected a more certain cure than the method of Cosme, — the chloride being strewed, a line thick, in a dry state, over the whole surface of the ulcer, the edges surrounded with adhesive plaster, and a plaster placed over the chloride of zinc, with compresses and an appropriate bandage. In nsevi materni, an- giectasis, &c, he applied it in the same manner, as well as in the pustule maligne, (Milzbrandkarbunkel.) Mr. Carmichael 1 states, however, that he has used it in several instances, and has come to the conclusion, that, although not so objectionable as the arsenious acid, on account of the poisonous nature of the latter, it excites as much pain and inflammation, 2 without destroying, to the same extent, the carcinomatous substance, A case of phagedenic ulcer of the septum narium, which had resisted all the topical applications made to it — corrosive chloride of mercury, arsenious acid, red oxide of mercury, sulphuric acid, nitric acid, &c, was treated by Dr. Zwerina of Vienna, with a solution of chloride of zinc, — a grain and a half of the salt to an ounce of distilled water, — with entire success. The scabs being re- moved, the sore was pencilled over several times a day with the solution. At the end of a fortnight, a healthy granulating surface was found beneath the thick crust, which now covered the sore, and this being removed from time to time, and the solution re- applied, at the end of five weeks the cicatrix was perfect and the patient well. 3 The chloride has also been prescribed internally in cases of can- cerous ulcerations, and with apparent benefit. Mr. Tuson 4 gives cases in which its internal and external use combined was produc- tive of great advantage. He gave half a grain of the chloride every morning after breakfast in a wine-glassful of carraway water. By Mr. Guthrie, chloride of zinc has been used in necrosis to penetrate the hardened case of new bone. It attacks the animal tissue of the bone, destroys it, and thus causes the earthy matter to soften and become detached. The sequestrum is by this means exposed with little pain or disturbance of the part, and may be 1 Dublin Medical Press, March 4, 1840. 2 See, also, Vogt, Pharmakodynamik, i. 363, 2te Auflage; cited by Pereira, Elements of Mat. Med. i. 821, 2d edit. Lond. 1842, or 2d Amer. edit. Philad. 1S46. s Cited in Lond. and Edinb. Monthly Journal of Medical Science, July, 1843, p. G50. * London Lancet, Jan. 13, 1844, p. 502; and Tuson on the Female Breast, p. 399. Lond. 1846. 890 zmci CHLORIDUM. dealt with according to circumstances. 1 Mr. Callaway, 9 of Guy's Hospital, London, employed it with considerable success in the cure of cutaneous and subcutaneous nasvi materni. It was directed to be rubbed on the part until the skin became slightly discoloured, and to be repeated at intervals. Mr. Alexander Ure and Mr. Liston, 3 found it extremely useful in the varieties of ero- sive ulcers called lupus, which were often speedily checked, and the disease permanently cured by the local use of it. They applied it in a paste, made with one part of the chloride and two or three parts of the anhydrous sulphate of lime — a modification of Can- quoin's formula (see below,) recommended some year3 ago. 4 One or two applications of the paste were generally sufficient to pro- duce a proper eschar, and when this was detached, the sore was treated with water dressing. 5 A case is related by Dr. Davidson/ of malignant ulcer under the left ear, which was cured by the unmixed chloride of zinc, applied repeatedly until the ulcer assumed a healthy character. Hancke used it likewise for the formation of issues, which it established in from six to eight hours; and,, lastly, to excite rubefaction on the surface, either applied in the form of solution of the chloride in water or wine, or mixed with oil or lard into an ointment, and rubbed on the skin: in this way ? a gritty kind of eruption of a scarlet hue is induced, which is said to have afforded relief m paralysis of the limbs. Wendt, Vogt, and Canquoin have highly extolled the chloride as a caustic, and it has been largely employed by the physicians and surgeons of this continent, especially in the Philadelphia Hos- pital, and Pennsylvania Hospital, in similar cases to those men- tioned above. Dr. Davidson 7 is of opinion, that it is only superior to many other caustics in cases where the destruction of a consi- derable thickness of texture is required, or. where the removal of an excrescence by a caustic is preferred by the patient to the knife t the nitrate of silver seems, he considers, to be superior in pro- moling a sound action, when the unhealthy surface or stratum of the ulcer is superficial. Hancke 8 has used the chloride internally, with advantage, in cases of epilepsy, as well as in St. Vitus' 's dance; and has pre- scribed it, united with hydrocyanic acid, in prosopalgia. Hufe- land, also, extols a solution of it in all those neuroses in which the 1 James, Retrospective Address before the Provincial Medical Association, in the Trans- actions of the Association. Lond. 1840. 3 British Annals of Medicine, May 19, 1837. * London Lancet, Sept. 21, 1844, p. 775. 4 London Medical Gazette, Dec. 19, 1835. 5 Lond. Med. Gaz., Dec. 3, 1836. See a case of noli me tanner e of the nostril, and one of phagedenic ulcer nftke arm, cured, in London Lancet, cited in Boston Med. and Surg. Journ. Nov. 4, 1840, p. 215. 6 Edinb. Medical and Surgical Journal, Jan. 1 838. ' Op. cit., and American Journal of the Medical Sciences, May, 1839, p» 238*. 8 Rust's Magazine, xxii. 373; and Journal de Pharmacie, xvL 549. ZINCI CHLORIDUM. 691 oxide of zinc is indicated, and especially in such patients as are not readily impressible. 1 By Dr. Stanelli, 2 when liquefied by ex- posure to the air, it is considered an excellent remedy in toothach. By means of a camel's hair pencil, a small quantity is applied to the cavity of the tooth, and in the space of a few minutes the most acute sufferings are said to be appeased. Before using it, it is indispensable to surround the tooth carefully with cotton wadding, and when it has been applied, to fill the cavity well with the cotton. The mouth is finally washed with a little warm water. M. Gaudriot 3 considers, that when properly diluted, it has great effect in curing simple blennorrhcea of the urethra and vagina. To remove the disease readily in men, it is generally sufficient to use the injection given below thrice a day for two or three days. The first injections are almost always followed by more or less swelling of the glands, but this does not prevent their continuance. In women, four or six of the suppositories mentioned below are sufficient to produce a cure. The first ge- nerally occasions swelling, with more or less heat of the vulva ; but these symptoms soon disappear. Several years since, a patent was obtained by Sir William Bur- nett for a process, discovered by him, for preserving timber, can- vass, &c, from dry rot, mildew, &c. The preserving substance is chloride of zinc in solution. It was entirely effectual. Since then the solution has been employed as a disinfectant of dead bodies, and the testimonials of Messrs. Bowman, Sharpey, and W. V. Pettigrew, have been publicly given in its favour. 4 Mr. Petti- grew, in a letter to Sir William, dated March 24, 1846, says, "I have now used extensively your preparation for the preservation of animal matter, and find that it succeeds most completely. From the 3d to the 28th of February, I lectured upon the superior ex- tremity. The arm, when received, was green in colour, and highly offensive. I injected the arteries with the fluid, mixed in the proportion of one pound of chloride of zinc to three gallons of water, and as the dissection proceeded, the surface of the limb was sponged about every alternate day with the solution. It was per- fectly restored to its former fresh condition. I have also placed various portions of the body in the solution, and they at present remain quite free from putrefaction. All our subjects are now in- jected with the fluid, immediately they arrive; and I do not hesi- tate to say, that our dissecting room is more free from unpleasant odour than any room of the kind in the metropolis, and the great advantage this fluid possesses over all others we have as yet tried s See Merat and De Lens, art. Zinc (chlorure de.) 2 Cited in London Medical Gazette, Feb. 16, 1844, p. 672. 3 Journ. des Connaissances Med. Sept. 1840; cited in Brit, and For. Med. Rev. April, 1841, p. 527. £ London Medical Gazette, cited in Medical Examiner, June, 1846, p. 374. 692 ZINCI CHLORIDUM. is, — that it has no effect upon the knives. I cannot but consider it one of the greatest boons conferred upon the profession. Dis- section may be carried on in the hottest weather, without the slightest injury to the breath, or offence from smell. " The value of chloride of zinc as an antiseptic has been fully es- tablished in the dissecting rooms of Philadelphia and elsewhere ; but there is no reason for believing that it is a disinfectant in the sense of destroying contagious or other morbific miasmata. It is an ex- cellent antibromic, but as it does not give off any antiseptic vapour, its action is restricted to the substances with which it is brought into immediate contact. Dr. Stratton, 1 however, is disposed to be- lieve, that it acted as a true disinfectant by destroying miasmata in the Quebec Marine and Emigrant Hospital, of which he had charge in the autumn of 1847. He found, that one ounce of the strong fluid was sufficient for every ten persons. This strong fluid, known under the name of Sir William "Burnett's Disinfecting and Antiseptic Fluid," contains 25 grains of zinc in every fluidram ; and in using it one pint is mixed with five gallons of water. 2 He removes the disagreeable odour in hospital wards full of typhus and dysentery cases, by waving flannel cloths wet with a dilute fluid — one part to 40 of water — two or three times a day, for a few minutes at a time, and by sprinkling some of it on the floor. "Next to perfect ventilation," he says, "I would place the use of Burnett's solution of the chloride of zinc. On many occasions, as in badly constructed buildings, in cold weather, and on board ship in stormy weather, ventilation is impracticable, and recourse must be had to some other means of improving the quality of the air, and it appears to me, that the chloride of zinc solution is much superior to all the other artificial methods of doing so, including Ledoyen's solution of the nitrate of lead." (See Plumei Nitras.) Dr. Stratton saw a case of lupus, in which the "Burnett fluid " was as effectual as, and more convenient than, the solid chloride of zinc. The fluid diluted — one to 130 parts of w T ater — was found very beneficial as an application to chronic and scrofulous ulcers by Dr. Allan, Mr. Erasmus Wilson, and others; and in mercurial sore throat by Mr. Flynn. In the proportion of one part to sixty or eighty of water — it is said to be an excellent lotion in erysipe- las, and a valuable lotion or bath in psora, prurigo, pruritus, and other cutaneous diseases. When introduced of the full strength on the point of a pen into the cavity of a tooth, it has proved ser- viceable in some cases of toothach. Diluted with one hundred and forty parts of water, it removes the fcetor from gangrenous frost-bites. Dr. Stratton has no doubt, that it will be found a good remedy, when diluted with one-hundred and forty parts of 1 Edinb. Med. and Surg. Joum. Oct. 1848, p. 2S7. a Pharmaceutical Journal vii., GO and 107, Lond. 1847. ZINCI CHLORIDUM. 693 water as an injection in fetid otorrhosa ; and as a gargle in some throat diseases. It has also been used as an injection in gonor- rhoea. The action of the diluted fluid on cancerous and other sores, is like that of other antiseptics ; it removes the fcetor, and induces a new action in the part of the system of nutrition im- plicated in the ulceration. MODE OF ADMINISTRATION. GuttSB zinci chloridi. D?*ops of chloride of zinc. JEther Zinci. R. Zinci chlorid. gr. j. Sp. aether, muriat. seu sulphuric, f gij. Solve. Dose. — Five drops, every four hours, in a little sugared water; gradually increasing the dose to ten drops, in chorea, epilepsy, prosopalgia, &c. Huf eland §* Uaiike. 1 Lotio zinci chloridi. Lotion of chloride of zinc. R. Zinci chlorid. gr. viij. Ext. aloes aquos. £)ij. Aquae destillat. f §iv. Solve. Applied to the dressings, in cases of atonic scrofulous ul- cers. Vogt. Or, the aloes may be admitted. Injectio zinci chloridi. Injection of chloride of zinc. R. Zinci chlorid. liquid. 2 gtt. xxiv. — xxxvi. Aquae destillat. f ^iv. Filter through paper. A small quantity of this to be injected about an inch along the urethra, two or three times a day. Gaudriot. Suppositorium zinci chloridi. Suppository of chloride of zinc. R. Zinci chlorid. liquid, gtt. v. Morphiee sulphat. gr. ss. Mix with three drams of the following paste; R. Mucilag. tragacanth. p. vj. Sacchar. pulv. p. iij. Amyli pulv. p. ix. One of these must be introduced every day, or every other day. Gaudriot. 1 Lincke, Vollstandiges Recept-Taschenbuch. u. s. w. ii. 780. Leipz. 1841. 2 ''Liquid chloride of zinc consists of a concentrated solution of pure zinc in pure chlo- rohydric acid." — Lincke, loc. cit. 694 ZINCI CYANURETUM. Chloride of zinc may be applied as a caustic, by means of a moistened hair pencil, either alone or mixed with an equal portion of oxide of zinc, or sulphate of lime, or according to the following forms : — Pasta zinci chloridi. Paste of chloride of zinc. Pate de Canquoin. Canquoinh caustic paste. A. B. C. R. Zinci chlorid. p. i. i. i. Farinse tritici p. iv. iij. ij. Aquse fontan. 1 q. s. ut fiat pasta. R. Zinci chlorid. p. j. Farinae tritici p. iss. Antimonii chloridi p. ss. Aq. font. q. s. ut fiat pasta. CLXXIII. ZINCI CYANURETUM. Synonymes. Zinci Cyanidum, Zincum Cyanogenatum seu Cyanatum sen Borussicum seu Zooticum seu Hydrocyanicum seu Hydrocyanicum sine Ferro ; Cyanetum seu Cyanuretum Zincicum seu Zinci sine Ferro, Cyanetum Zinci, Prussias seu Hydrocyanas seu Cyanhydras Zinci seu Zincicus, Hydrocyanate 5 Prussiate, or Cyanuret of Zinc. French. Cyanure de Zinc. German. Cyanzink, Blausaures Zink oder Zinkoxyd, Blau- storlzink, Zinkcyaniir. This preparation was used in Germany for a long time before the process was made known. 2 METHOD OF PREPARING. According to Kunze, it is directed in the Leipzic shops to be prepared as follows: 3 — Any quantity of pure sulphate of zinc is dissolved in ten times as much distilled water ; the fluid is then filtered, and decomposed by a solution of cyanuret of potassium, or cyanuret of calcium, added by drops so long as a precipitate is formed. This precipitate, which consists of cyanuret of zinc, must be carefully washed, dried, and preserved in a glass jar, from which the entrance of light is prevented. 4 It is admitted into the Parisian " Codex." Cyanuret of zinc has the appearance of a white, tasteless pow- der, which is insoluble in water and alcohol, but dissolves in the stronger acids, with the disengagement of hydrocyanic acid. Well 1 To each ounce of the chloride of zinc twenty-four to thirty drops of water may be added. 2 Magendie, Formulaire pour la Preparation, &c. de plusieurs nouveaux Medica- mens, &c. 3 Riecke, Die neuern Arzneimittel, u. s. w. S. 410. Stuttgart, 1837, * For M. Pelletier's method, see Magendie, Formulaire, &c. ZINCI FERROCYANURETUM. 695 prepared and rubbed, it has a strong odour of hydrocyanic acid, and when moistened, or exposed to heat, it gives off hydrocyanic acid. As to its medicinal effects, and mode of administration, they are analogous to those of the following preparation: they are there- fore given together. CLXXIV. ZINCI FERROCYANURETUM. Synonymes. Zinci Ferrocyanidum seu Ferrohydrocyanas, Cyanetum sen Cyanuretum Zinci et Ferri seu Ferrosozincicum, Cyanuretum Ferro- zincicum, Zincum Ferrohydrocyanicum seu Ferroborussicum seu Ferrocyanogenatum seu Ferrocyanatum, Prussias Zinci et Ferri ? Hy- drocyanas Zinci Ferruginosus, Ferrohydrocyanas Zinci, Ferrocyanuret, Ferro-hydrocyanate or Ferrocyanate of Zinc. German. Eisenblausaures Zink, Blausaures Eisenzink, Ei- senhaltiges Blausaures Zink, Blausaures Eisenoxy- du 1 -Zink ox yd, Z i n ke i sency aniir, Eisenzinkcyanur, Cyaneisenzink. METHOD OF PREPARING. According to Schindler, 1 this preparation is best made by the mutual decomposition of boiling hot solutions of eighty-three parts of sulphate of zinc, and sixty parts o$ ferrocyanuret of potassi- um. If the sulphate of zinc be not entirely free from iron, the salt will have a bluish lustre, which, after long washing with lime water, becomes of a reddish hue. If the bluish colour be mani- fested, some more sulphate of zinc must be added, and it must be digested until the precipitate appears entirely white. Ferrocyanuret of zinc forms a white, insoluble, almost inodorous powder, which is somewhat soluble in the stronger acids, without exhaling a smell of hydrocyanic^acid in the cold; but by boiling, hydrocyanic acid is slowly disengaged. EFFECTS ON THE ECONOMY. Hufeland recommends the cyanuret, or perhaps, the ferrocya- nuret of zinc in nervous diseases. According to him, from one to four grains may be given for a dose, two or three times a day, without any injurious effects; — the only inconvenience being, at times, slight nausea, but no diarrhoea, or disposition to obstruc- tions, and no narcotic symptoms. In cardialgia, it afforded, in his hands, essential service, as well as in some cases of epilepsy and in paralysis. Henning, 2 likewise found it useful in cramp of the stomach, hysteria, and spasmodic diseases of children induced by worms. In epileptic attacks from teething, he also gave it with advantage; the dose being from half a grain to a grain, three or four times a day. Clarus gave cyanuret of zinc in 1 Riecke, op. cit. S. 411, und 2te Auflage, S. 646. Stuttgart, 1840. 3 Hufeland's Journal, 1823, 696 ZINCI FERROCYANURETUM. epilepsy, but he observed no other result than less frequent and less severe attacks. Pohl saw no very decided effect from it in the dose of from one-fourth to half a grain. In the Berlin Poly- clinic Institute, advantage accrued from it in two cases of *S7. Vitus' s dance; it was begun with in the dose of one-third of a grain twice a day, which was gradually raised to fourteen grains a day. Klokow gave the cyanuret of zinc — which Riecke sug- gests 1 was the cyanuret of zinc and potassium, (Cyanzink- cyankalium,) in spasmodic affections, — beginning at first with one-tenth of a grain, — as larger doses occasioned colic, diar- rhoea, and vomiting — and, when the patient became accustomed to it, gradually augmenting the dose to half a grain. Success, he affirms, followed its administration. 2 Muhrbeck gave it in violent periodical cephalalgia in the region of the left frontal sinus with great benefit. He began with one-twelfth of a grain, and gradu- ally raised the dose to a grain and a half. Muller and Gunther confirm the reports of its efficacy in St. Vitus' s dance: the first gave daily a grain; the latter, from half a grain to a grain, four times a day. Kopp, who distinguishes the two preparations from each other, instituted experiments with both. He used the ferro- cyanuret of zinc with advantage in cramp of the stomach, general nervous disorder, nervous debility, neuralgia, nervous headach, and nocturnal pains in the bones. He gave it in the form of pow- der, with sugar of milk, every two hours, or four times a day, in doses of one-twelfth to one-eighth of a grain, gradually increasing them. According to his observations, it occasions, with many persons, obstructions, but does not disorder the stomach. Kopp found the cyanuret still more efficacious in the same disorders. Impressible patients, who suffered under unusual sensibility of the abdomen, took four powders daily, of one-sixteenth of a grain each, with marked benefit. In one case of neuralgia, in a man, he raised the dose very gradually to half a grain, four times a day. When, however, this quantity was exceeded, and the patient took five-eighths of a grain four times a day, hyperemia occurred in the head, with constipation. In two cases of chorea of one side of the body, the ferrocyanuret had no effect whatever. Riecke 3 asserts that his father used it several times with advantage in scir- rhus of the pylorus. The cyanuret was applied externally, by Von Ammon, in scro- fulous and incipient rheumatic inflammation of the eyes, as well as in catarrhal inflammation of the eyelids: he prescribed it sus- pended by means of gum Arabic in a mixture of cherry-laurel water and laudanum. M. Carrier 4 believes, that preparations of hydrocyanic acid have great efficacy in healing ulcers of the cor- nea, and causing the absorption of opacities. The compound 1 Op. cit S. 413. a Hufeland und Osann's Journal, B. lxx. St. 2. 3 Op. citat S. 414. 4 Cited in Provincial Med. and Surg. Journal, Feb. 10, 1844, p. 378. ZINCI FERROCYANURETUM. 697 "which he prefers is one part of cyanuret of zinc to twenty-five of lard. MODE OF ADMINISTRATION. On account of the insolubility of both the cyanuret and ferro- cyanuret, they are best given in pill or powder. The common dose of the cyanuret is from one-sixteenth to one- twelfth of a grain several times a day, gradually increasing it to a quarter of a grain : of the ferrocyanuret, the dose is from one to four grains, two or three times a day. Riecke 1 advises — to pre- vent confusion — that when these articles are ordered, they .should be respectively denominated Zincum hydrocyanicum sine ferro and Zincum ferro hydrocyanicum. Pilnlse zinci cyanureti. Pills of cyanuret of zinc. R. Zinci cyanur. gr. xv. Ext. glycyrrh. gij. Misce et fiant pilulae lx. Dose. — One, morning, noon, and night, gradually increasing the quantity. Kopp. R. Zinci cyanuret. gr. vj. Magnesiae gr. iv. Cinnam. puJr. gr. iij. Misce. This dose to be repeated every four hours, in nervous affections of the stomach, especially in cases of cramp. Henning. Mistura zinci f errocyanureti. Mixture of ferrocyanuret of zinc. R. Zinci ferrocyanur. gr. iv. Aquae destillat. f ^ij. M. Dose. — A fourth part, four times a day, in chorea. Lincke. 2 Pulveres zinci ferrocyanureti. Powders of ferrocyanuret of zinc. R. Zinci ferrocyanur. gr. ij. — viij. Sacchar. gj. M. et divide in part. vj. Dose. — One to be given every tw r o hours in cardialgia. Von Hildenbrand. Pilulse zinci ferrocyanureti. Pills of ferrocyanuret of zinc. R. Zinci ferrocyanuret. gr. xv. Valerian, pulv. gss. Extract, valerian, q. s. ut fiant pil. lx. [ Dose. — One, morning and evening, in chorea. Rosensteil 8r Heckenroth. 3 1 Op. citat. 3 Vollstandiges Recept-Taschenbuch, ii. 778, Leipz. 1841. 8 Lincke, op. cit. 698 ZINCI IODIDUM. CLXXV. ZINCI IODIDUM. Synonymes. Zincura Iodatum, Zinci Ioduretum, Iodetum Zinci seu Zincicum, Protoioduretum Zinci, Iodide or Ioduret of Zinc. German. Iodzink, Zinkiodiir. This preparation is made by boiling together iodine and zinc in atomic proportions, or rather with an excess of zinc, in a flask of water, to dryness, and subliming the residue. Iodide of zinc is thus procured in beautiful, colourless, prismatic crystals. 1 It is very deliquescent, and cannot easily be retained in the solid form. When heated in open vessels, it is resolved into iodine and oxide of zinc. It is very liable to undergo spontaneous decomposition, and, to prevent this, Dr. A. T. Thomson proposes that a syrup should be made of it, on the same plan as the syrup of iodide of iron. EFFECTS ON THE ECONOMY. Iodide of zinc has a caustic taste, and when applied to a de- nuded surface gives rise to considerable smarting. Dr. Ure 2 re- commends an ointment, formed of a dram to an ounce of lard, in cases where the external use of iodide of potassium is indicated. Proutet advises it as a collyrium in scrofulous ophthalmia, of the strength of fifteen grains to six fluidounces of distilled water; and it has been employed to form an astringent injection, in the proportion of one or two grains to an ounce of water, in gonor- rhoea. Dr. J. J. Ross 3 used a solution of from 10 to 30 grains to the fluidounceof water, with much advantage, in enlarged tonsils. It was applied by means of a sponge tied to a quill. After the use of the solution for some time, he applied the iodide, rendered liquid by deliquescence, by means of a camel's hair brush. A double iodide of zinc and morphta ; French, Iodure double de zinc et de morphine, is described by M. Bouchardat. 4 It is ob- tained by boiling a gramme (gr. 15.44,) of iodide of iodhydrate of morphia, with 59 grammes (nearly f gij.) of water, and 10 grammes (3iiss.) of zinc, after they have acted upon each other for some days. The boiling liquor is filtered; and a salt, is ob- tained, which crystallizes readily in needles arranged in beautiful radiated groups. The salt is the iodide of zinc and morphia, which is very soluble in water and in alcohol. The compound is con- sidered to combine the properties of morphia and the salts of zinc. M. Bouchardat has prescribed it as an anodyne and anti-spasmodic. He makes about a grain and a half into eight pills, of which he 1 Annales de Chimie, xci. * Dictionary of Chemistry, 2d edition, p. 516. * Cited in United States Dispensatory, 6th edition, p. 1267. Philad. 1845. 4 Nouveau Formulaire Magistral, p. 70. Paris, 1845. ZINCI VALERIANAS. 699 gives one or two in the day, in gastralgia " and other nervous affections." For the Double Iodide of Zinc and Strychnia, see Strych- nia. CLXXVI. ZINCI VALERIANAS. Stnonymes. Zincum Valerianicum, Valerianate of Zinc. French. Valerianate de Zinc. German. Valeriansaures Zinkoxyd, B aid riansaur es Zink. This salt was first proposed by Prince Louis Lucien Bonaparte. It has been much used by the Italian physicians, and has been more recently introduced into medical practice in France and elsewhere. METHOD OF PREPARING. Valerianate of zinc is prepared by saturating valerianic acid with the carbonate, or, still better, with perfectly pure oxide, of zinc recently precipitated. The action is assisted by heat ; and the hot solution is filtered, and allowed to crystallize on a gently heated sandbath. 1 It may also be prepared by double decomposi- tion from valerianate of baryta and sulphate of zinc? — or, after the formula of the Dublin college, by the double decomposition of valerianate of soda and sulphate of zinc. 2. The crystals form light pearly plates of a brilliant white colour. Cold water dissolves one-fiftieth of its weight of the salt, and boil- ing water one-fortieth. It is scarcely soluble in ether. One hundred parts of boiling alcohol dissolve six parts. 4 On these points, however, chemists are not in exact accordance. EFFECTS ON THE ECONOMY. The " physiological effects" of the valerianate of zinc, accord- ing to M. Devay, 5 are scarcely more marked than those of vale- rian or zinc taken separately. A dose of 15 centigrammes (gr. 2.316) which would be sufficient to check a paroxysm of neural- gia, and to moderate an attack of violent hemicrania, produces on the healthy economy only slight headach, transient giddiness, and slight depravation of hearing. It has been chiefly prescribed in facial neuralgia and hemicrania, which have resisted the ordi- 1 See a note on the preparation of the valerianate of zinc, by Wm. Procter, Jr., in the American Journal of Pharmacy, April, 1845; and Bouchardat, Annuaire de Therap. &c, pour 1845. p. 95. Paris, 1845. a Bouchardat, op. cit. p. 87. Paris, 1845; and in Nouveau Formulaire Magistral, p. 107. Paris, 1845. * The Pharmacopoeia of the King and Queen's College of Physicians in Ireland, 1850. p. 169. Dublin, 1850. * Journal de Pharmacie, Aout, 1844: Chemical Gazette, Nov. 1,1844; and Lond. and Edinb. Monthly Journ. of Med. Science, Jan. 1845. 1 Gazette Medicale de Paris, 29 Juin, 1844. 700 ZINCI VALERIANAS. nary antispasmodics and antiperiodics, and M. Devay, in such cases, has found it eminently successful. Four cases of obstinate neu- ralgia are recorded by Mr. Joseph Bell, 1 which yielded to this remedy after the failure of other powerful agents. He gave it in half-grain doses every six hours. It has also been prescribed in other neuroses, — nervous headachy for example, by Boccacini and Heiberg. 3 In epilepsy ', M. Devay prescribed it, but had not given it for a sufficiently long period to be able to deduce any thing posi- tive in regard to its action. M. Cerulli 3 gave it in three cases of supra-orbitar and infra-orbitar neuralgia. It proved success- ful in doses of a grain and a half daily, taken at the moment of the accession of the paroxysm. Its effect does not seem, however, to have been energetic ; for, in one case, the cure was not complete under thirty days ; in another under forty, and in the third under fifty. It has been suggested, however, that notwithstanding its reputed brilliant success, it may be questioned, whether it be in reality a more efficacious remedy than the ordinary salts of zinc, and whether much of its success amongst a certain class be not in a great degree attributable to the rarity, and the high price of the drug. 4 That such is the case, Dr. Johnson says, is to a certain extent proved by the observations of Dr. Fario, an Italian phy- sician, cited and commented on in a French periodical. 5 Dr. Fario has employed it externally in certain affections of the eye, as blennorrhea of the eyelids, ulcers, or recent spots on the cornea, as well as in cases of chronic conjunctivitis, in which a mild astringent and sedative agent is indicated. 6 MODE OF ADMINISTRATION. The dose of valerianate of zinc given by M. Devay was 10 cen- tigrammes (gr. 1.54) in the day; but there is no reason, he says, why it should not be carried much higher — to 40 centigrammes (gr. 6.17) for example. The Italian physicians, who would seem to have obtained the most success from its administration, do not, however, give it in a larger dose than a grain and a half. It is best administered in the pilular form. For external use, as a col- lyrium, from two to four grains may be dissolved in two ounces of distilled w r ater. 1 Cited in Ranking's Half-yearly Abstract, January to June, 1846, p. 173. * Aschenhrenner, Die neueren Arzneimittel, u. s. w. S. 281, Erlangen, 1848. 3 Gazette Medicale de Paris, Jan. 1844. 4 Dr. Geo. Johnson, in Ranking 1 , op. cit. p. 348. 8 Gazette Medicale de Paris, Jan. 1844. 8 Aschenbrenner, op. cit. S. 282. SUPPLEMENT. CLXXVII. Ac"idum Chro'micum, Chromic acid, Peroxide of Chro- mium: French, Acidechromique; German, Chromsdure. Chromic acid nearly pure may be obtained by the following process. One hun- dred measures of a cold saturated solution of bichromate of potassa are mixed with one hundred and fifty measures of oil of vitriol, and the whole is suffered to cool. The chromic acid crystallizes in brilliant crimson-red prisms. The mother liquor is poured off, and the crys- tals are placed to drain upon a tile closely covered by a glass or bell jar. 1 They are of a ruby-red colour, prismatic and deliquescent, of a sour, acrid, and metallic taste, soluble in water, — the solution being constantly reduced by contact with organic matter. It is in consequence of chromic acid being a powerful oxygenizing agent, — yielding half its oxygen readily to organic substances, and be- ing reduced to sesquioxide, — that Dr. Ure 3 has employed it as an es- charotic. It is, he says, exceedingly convenient of application, as it consists of a thick crystalline pap, which, when rightly managed, does not spread beyond the prescribed limits : and its erodent operation terminates with its passing into the state of inert pulverulent sesqui- oxide. In a case of external hemorrhoids, the acid was applied twice at an interval of two days. It caused acute burning pain both times, destruction to a considerable amount of the diseased texture, conso- lidation of the remainder, and permanent relief. The troublesome sores produced on the hands and arms of dyers, who use bichromate of potassa, are ascribed by Dr. Ducatel, 3 of Baltimore, to the action, of the free chromic acid. CLXXVIII. Ac"idtjm Ni'tricum, Nitric acid; French, Jlcide nz- trique; German, S alp eters dure. Nitric acid, of the specific gravity 1.500, destroys instantaneously the vitality of the surface to which it is applied. The depth of the slough which is to follow may be regulated, in some degree, by the quantity of acid laid on the part; and its extent, laterally, may be confined with sufficient precision to the limits of its first application by instantly smearing the whole over with olive oil, which neutralizes its farther corrosive powers by combining and forming with it a new, but no longer corrosive, compound. The se- paration of the slough after the application of nitric acid leaves a healthy suppurating surface, which contracts and heals over very quickly. 1 Warrington, Proceedings of Chem. Soc. i. 18, cited in Fownes's Elementary Che- mistry, Amer. edit. p. 245. Philad. 1845. 3 London Medical Gazette, March 21, 1845, p. 787. 3 Manual of Practical Toxicology. Baltimore, 1833, 45 702 SUPPLEMENT. — ADANSONIA DIGITATA. Such is the testimony of the late Dr. Houston, of Dublin, 1 in regard to the action of nitric acid as an escharotic. He has proposed it as such in certain forms of hemorrhoidal affections, and especially in that which he terms "vascular tumour" and which he regards as an af- fection of the mucous and submucous tissue exclusively, having usual- ly for its basis a knuckle or bunch of varicose veins ; but it may also be a distinct and independent growth, the result of some other irrita- tion in the region, but giving rise ultimately to the formation of a va- ricose condition of the part. In such cases, he has found the appli- cation of nitric acid, s. g. 1.500, of eminent service. It combines, he affirms, all the advantages possessed by excision or ligature, without any of the disadvantages. He directs the application to be made in the following manner: — Let the patient strain as in the night chair, so as to bring the tumours fully into view : and while they are so down let him either lean over the back of a chair, or lie down in the bent posture, on the side on which the disease exists, with the nates over the edge of the bed. Let a piece of wood, cut into the shape of a dress- ing-case spatula, be dipped in the acid ; and then, with as much of the acid adhering to it as it will carry without dripping, let it be rubbed on the tumour to the desired extent. The due effect of the acid on the part is shown by its becoming of a grayish white colour. If a superficial slough be all that is required, a single application may be enough ; if a more deep one, then two or three applications may be required ; and if a still more deep one, two or three applications of the wood dipped in the acid may be made in quick succession, which being finished the part may be well smeared over with olive oil. The prolapsed parts should then be pushed back within the sphincter, the patient put to bed, and an opiate administered. The pain is sharp and burning at first, but it goes off in two or three hours, and does not return again in the same form. In no case has he heard of serious consequences from the use of the remedy; and the symp- toms usually following its application are so mild as not absolutely to require confinement to bed more than a few hours. On the third or fourth day, Dr. Houston recommends that a cathartic draught should be given ; when the bowels will be found to yield to the medicine, generally without either pain or prolapsus of the rectum. In a sub- sequent communication, 2 he urges, that the only case which the nitric acid will serve is the internal bleeding pile ;■ — "that soft, red, straw- berry-like elevation of the mucous membrane," for which he uses the term, " vascular tumour." The safety and efficacy of this mode of practice have been con- firmed by the testimony of Mr. Cusack, of Dublin. CLXXIX. Adansoxia Digitata, Baobab Tree. The bark of this tree is anative of Senegal; of the Natural Order, Bomb ace se : Sexual System, Monadelphia Polyandria. It has been brought forward as a valuable antiperiodic by Duchassaing, who thinks it a fit substitute for cinchona. It is mucilaginous, and has scarcely any taste or smell. It 1 Dublin Journal of Medical Science, March, 1843. 3 Ibid. Sept. 1844, p. 32. SUPPLEMENT. — APIS MELLIFICA. 703 is recommended by M. Duchassaing in decoction ; half an ounce of the bark being boiled in a pint of water until the liquid is reduced to two-thirds. From the quantity of mucilage it contains, it is apt to un- dergo decomposition. This may be prevented by adding a small quan- tity of sulphuric acid, which precipitates the mucilage, or by the addi- tion of spirit. In a great many cases in which it was prescribed by him, it rendered eminent service. 1 Its employment was suggested by the negroes, who make constant use of it in the marsh fevers of the country. M. Saint-Pierre 3 has prescribed it in the last two years in a locality in Burgundy, where intermittents are endemic. He was only able, however, to give it in seven cases, owing to his not being pos- sessed of a sufficient quantity of the remedy; but they all terminated favourably. According to him, " the taste of the decoction is in no respect disagreeable, and its action is unaccompanied by any of the inconveniences that may follow the action of the sulphate of quinia." CLXXX. ApisMELLiF'iGA,Jl.Domestica, Bee, Honey Bee; French, Jibeille mellifiqiie,Jl. Domestique ; German, Biene, Honi g-biene. The bee appears to have been employed in medicine in the middle ages in cases of alopecia. It was dried or grilled and reduced to pow- der ; 3 and in this form was mixed, in the dose of half a dram, with ex- tract of juniper, and extolled as an excellent diuretic. " No one ven- tures at the present day," says M. H. Cloquet, 4 " to propose such a remedial agent ; for although the Materia Medica has still need of an extensive reform, both in its agents and language, it no longer admits such absurdities ; and scarcely dare we add, that the distilled ivater of bees has been also recommended, and in the same cases, — that an in- fusion of them in diuretic wine or in cenogala was all-powerful in dropsy and calculous affections, and cured ischuria ; that the remains of those found dead in honey strengthened the eyes and the ears, and was applied with success in cancerous ulcers of the lips. All these follies and a thousand others which Pliny and Galen first published, have been repeated by Houiller, Alexander Benedictine, and a crowd of other authors of the middle age of medicine, who have given us their reveries in the place of theories founded on experience, and have contributed to perpetuate errors rather than dissipate them. The belief that the prolonged use of those insects might produce sterility; that by immediately crushing them upon a wound all its consequences might be obviated, and that they were capable of inciting to love, was not less ridiculous." 5 Yet the employment of the bee as a therapeutical agent has been revived. Dr. F. H. Gordon, 6 of Wilson County, Tennessee, affirms, that he succeeded in removing the strangury, which was a common attendant on an epidemic metritis by an infusion of the bee, made as 1 Pharmaceutical Journal, cited in American Journal of Pharmacy, Oct. 1848, p. 328„ a Archives Generates de Medecine, Aofit, 1850, p. 535. 3 Schroderi Dilucidati Zoologia ; and the second volume of the works of Ettmuller; fol. Latin, p. 304. Lyons, 1690; cited in Faune des Medecins, par H. Cloquet, i. 93. Paris, 1822. * Op. cit. s See, also, Merat and De Lens, art. Abeille, Diet, de Mat. Med. et de Therap. s Western Journal of Medicine and Surgery, Nov, 1845, p. 392, 704 SUPPLEMENT. — BISMUTHI VALERIANAS. follows: — "Sweep forty to sixty bees into a pan of water, so as to make them manageable: put the whole into a teacup: pour one gill of boiling water on them, and cover the cup securely. When it has remained twenty minutes, pour off the infusion, and let the patient take the whole at a draught." This remedy, he asserts, relieved the strangury in from two to fifteen minutes with great certainty. He refers to other practitioners, who have " given the remedy numerous fair trials," and, so far as he has learned, all estimate it highly. He has tried it repeatedly in retention of urine from inflammation of the bladder, and from the effects of cantharides, and found it to be more prompt and certain than any other remedy; and he says, "there can be no question that 'bee tea' will prove a valuable accession to our Materia Medica. How far it may be found useful in ischuria and dysuria from every variety of cause remains to be tested; and its known value affords abundant encouragement for farther investi- gation." Dr. Gordon affirms that it was introduced into medicine some years ago by an old woman in the habitual practice of mid- wifery, in the County of Smith, Tennessee; but it is doubtless one of those cases in which a remedy formerly in use has been abandoned by the profession, but retained by the people. Since the publication of Dr. Gordon's communication, the infusion has been used by others. Dr. Flint, of Buffalo, 1 states, that it had been recently tried in that city with immediate relief, in a case in which the introduction of the catheter had been attempted without success; and that it was subsequently repeated daily, with the same results, until the occasion for its administration ceased. Dr. Gordon considers the infusion to act as a narcotic; and that its properties are probably owing to the virus ejected with the sting. The tea, when recently made, has a smell identical with that of the incensed bee, and is then efficacious; but if the infusion be permitted to stand and cool, and especially to remain uncovered, the character- istic odour and taste disappear, and it is correspondingly inefficient. Hence, he infers, the virus is volatile, and requires care to prevent its escape. " Whether," he adds, " this valuable virus may not be col- lected and concentrated, or combined with some chemical element, so as to render it portable and convenient, is a matter of interest, and well worth the attention of the chemist." CLXXXI. Bismtj'tiii Valeria'nas, Bismuthum Valerianicum, German, V aler i a n s a u r e s Wismut h — is formed by mixing a neutral solution of nitrate of bismuth with, valerianate of soda, washing the precipitate with water, and drying with a gentle heat. It forms a white powder, which is insoluble in water; and has been recom- mended by Righini 2 in gastrodynia, chronic gasfralgia, and especially in neuralgia and nervous palpitation. The dose is from half a grain to two grains, three or four times a day, in the form of powder or pill. 1 Buffalo Journal, cited in New York Journal of Medicine, Sept. 1S46, p. 2G5. 2 Aschenbrenner, Die neueven Arzneimittel, u, s. w. S. 51. Erlangen, 1848. SUPPLEMENT. CARBONIS TMCHLORIDUM. 705 CLXXXII. Cadmi'i Sulphas, Sulphas Melini sen Klaprothii, Cad- mium seii Klaprothium sen Melinum Sulphuricum, Sulphas Cad- ?nicus, Sulphate of Cadmium; French, Sulfate de Cadmium; German, Schwefelsaures Cadmium, Sch wefelsaures Klaprothium, is obtained by dissolving carbonate of cadmium in dilute sulphuric acid, and evaporating the neutral liquid so that it may crystallize. The crystals are colourless, rectangular prisms, which effloresce in the air, and are readily soluble in water. Sulphate of cadmium, which wajs referred to in a former edition of this work, 1 has been almost exclusively prescribed of late in different diseases of the eyes. Rosenbaum, 3 Kopp, 3 Gr*afe, Ansiaux, Radius 4 and others, 5 employed it successfully in specks of the cornea. In chronic ophthalmia, accompanied by a scrofulous, syphilitic or other dyserasia, it was used with advantage by Daynac and Giordano; and by Lincke, 6 it was prescribed as an injection in torpid chronic in- flammation and blennorrhcea of the meatus auditorius, membrana tympani and middle ear, being thrown both into the meatus and the Eustachian tube. It does not appear to differ materially in its medicinal properties from sulphate of zinc To form a collyrium, from one to eight grains may be dissolved in an ounce of water. As an eye ointment, Radius used it in the quan- tity of from one to two grains to 9iv. or gj. of lard. As an injection in otorrhcea, Lincke employed it in the strength of from gj. to gss. in Jiv. of infusion of roses. CLXXXIII. Careo'nis Trtchlo'ribum, Carbonis Sesquichloridum, Carboneum Trichloratum, Trichloretum Carbonei^Carbonicum Chlo- ratum, Ter chloride or Sesquichloride of Carbon ; French, Trichlorure ou Sesquichlorure de Carbon; German, Dreifach Chlorkohlen- stofT, KohlenstofTtrichlorid , is formed by the action of chlorine or chlorohydric ether, under the influence of sunlight. It is in needle- shaped crystals, pulverizable, colourless or white; tasteless, and of a peculiar camphoraceous aromatic odour. It is very sparingly solu- ble in water; soluble in alcohol, and still more so in ether; and dis- solves in fixed and volatile oils. It may be obtained, likewise, by the action of chlorine, on the Dutch liquid or chloride of olefiant gas. Terchloride of carbon has been employed by Dr. King with advan- tage in cholera morbus, and it is affirmed by Dr. Jones Lamprey, 7 that it was originally used as a remedy in the treatment of cholera by a physician of Calcutta. It had been also prescribed, in 1843, in 1 Third edit, preface, p. iv., Philada. 1841. 3 Herat & De Lens, Dictionnaire Universel de Mat. Med. i. 320. Bruxelles, 1838. 3 Dierbach, Die neuesten Entdeckungen in der Mat. Med. i. 541. Heidelb. unci Leipz. 1837. * Auserlesene Heilformeln, S. 123. Leipz. 1836. 6 Riecke, Nacfctrage zur ersten Auflage der neuerra Arzneimittel, S. 27, Stuttgart, 11840; Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 54. Erlangen, 1848; and Pereira, The Elements of Mat. Med. and Therap. 3d edit. i. 722. Lend. 1849. e Vollstandiges Recept-Taschenbuch, L 311. Leipz. 1840. * Medical Times, Jan. 6, 1849. 706 SUPPLEMENT. — COJTIA. London, as an excitant and antiseptic. Mr. Tuson had found it effec- tual in correcting thefcetor of foul ulcers. 1 M. Troschel, chief phy- sician to a cholera hospital in Berlin, having read the observations of Dr. King, determined upon submitting it to trial in cholera, and he was encouraged to this course by the results of experiments made by the Russian physicians in St. Petersburg. The substance being, at first, of high price, and obtainable only in small quantity, M. Troschei administered it in the moderate dose of about four grains, repeating it every half hour, or every two or three hours, according to circum- stances; and he affirms, that in many cases he succeeded in breaking and shortening the asphyxial period, and establishing reaction. 3 M. Manget also appears to have found it of great advantage under the same circumstances; and he had numerous opportunities for testing its efficacy as physician to the Bureau de Bienfaisance of the fifth arrondissement of Paris, where cholera made great ravages. He gave- it in the same dose, in a spoonful of syrup of gum. M. Manget re- gards it as one of the most powerful diaphoretics we possess. 3 Like many other anticholeric remedies, its merits have doubtless been greatly exaggerated. CLXXXIY. Coni'a, Caniinum, Conicinum, Cicutinum, Coneine 7 Conine, Conicine, Cicutine; French, Coneine; German, Coniin. The active principle of conium or hemlock was discovered and care- fully examined by Geiger, in 1831; but it had not attracted much at- tention from therapeutists. It is most easily obtained, according to Dr. Christison, 4 by cautiously distilling from a muriate of lime bath a mix- ture of strong solution of potassa with the alcoholic extract of the unripe fruit. The alkaloid passes over with the water, and floats upon it like an oil. It contains some water, w T hich may be removed by chloride of calcium, and also a little ammonia, which is separated by keeping it for a few hours in vacuo. It is a colourless oleaginous fluid, of an intense, peculiar, suffocating odour; and an extremely acrid benumbing taste; is sparingly soluble in water; very soluble in alcohol and ether, and in fixed and volatile oils. It is a most ener- getic poison, appearing to act on the nervous centres — the spinal cord particularly — like hemlock, but unlike strychnia, which irritates the spinal marrow, and induces violent and permanent spasms of the muscles. 5 A few drops kill a small animal in a few minutes — the effects being gradual paralysis, slight convulsive tremors, and death from suspension of the respiration, without any apparent alteration in the blood, or depression of the heart's action. The salts of conia, from being more soluble, are even more energetic than it. 6 AVhen conia is administered in medicinal doses, it acts as a sedative on the nervous centres ; and may cause incoherence and even deli- rium ; the movements are enfeebled, and paralysis may succeed; the pulsations of the heart are less strong and less frequent, and the re- 1 Medical Times, Dec. 2, 1848. * Dr. Lamprey, op. cit. 3 Annuaire de Therapeutique pour 1850, p. 50. 4 Dispensatory, Amer. edit, by R. E. Griffith, p. 410. Philad. 1848. * Richard, Elements d'Histoire Naturelle Medicale, iii. 184. Paris, 1849. s Christison, op. cit; and A Treatise on Poisons, Amer. edit. p. 655. Philad. I84tk SUPPLEMENT. — COTYLEDON UMBILICUS. 707 spiratory organs feel the influence of this state of nervous stupor. According to Nega, 1 the phenomena that indicate the narcotic influ- ence succeed each other in the following order : — feebleness, paraly- sis of the voluntary muscles, anaesthesia, general indisposition, vomit- ing, paralysis of the stomach, diminished frequency and force of the pulsations of the heart, stupor, vertigo and syncope. The diseases in which Nega employed it with benefit were hyper- esthesia, neuralgia, and spasmodic affections.- — He instances parti- cularly, hypersesthesia of the fifth and tenth pairs of nerves, and the accidents resulting from them, otalgia, odontalgia, tic douloureux of the face, photophobia and spasms of the eyelids, for which it had been recommended by Fronmiiller, and has since been given by Spengler, 2 sthenic nervous affections of the larynx, brachial, intercostal, and, particularly, sciatic neuralgia; and, in short, all diseases in which pain is a symptom, or a complication of any gravity; and it is af- firmed that, like conium, it renders ulcers of a malignant nature less painful, and of a better appearance; aids in the resolution of scrofu- lous tumours, and prolongs the first stage of the development of tubercles, and he found it of service in hooping-cough. In inter- mittent fever, it produced no result. Such, however, was not the result of the observations of Wertheim, 3 of Vienna, who appears to have obtained excellent effects from it in that disease, when the pulse was full and hard, indicating an inflammatory state. On the other hand, when it was feeble and accelerated, and the fever was asthenic, he prescribed leukolein, described hereafter. Conia may be given either in watery, alcoholic or ethereal solution, or united with dilute acids. Wertheim always prescribed it in watery solution, — one sixty-fourth or one thirty-secondth to one-six- teenth of a grain in six ounces of distilled water, of which two spoon- fuls [cuillerees a bouches) were given every two hours. Fronmiiller dissolved throe or four drops in a scruple of alcohol; and added half an ounce of distilled water. Of this, from fifteen to thirty drops were given three times a day. It has also been used endermically — in the dose of two drops mixed with acetic acid — and in enemata, to the €xtent o[ three drops. 4 CLXXXV. Cotyle'don Umbili'cus, Cotyledon Umbilicus Veneris, Navelwort, Venus* s Navelwort ; French, Nombrilde Venus; Family, Oassulaceee; Sexual System, Pentandria Pentagynia. This plant, which grows in Europe on old walls and rocks, has been long used in medicine, but was almost unknown to practitioners of the present •day, when its employment was revived in a new direction. The leaves are emollient, and have been applied externally to hemorrhoids and to inflamed parts. Of late, the inspissated juice has been brought £ Zeitschrift fur Klinische Medicin. H. 1. Breslau, 1850; cited in Archives Gene- rales de Med. Juin, 1850, p. 224. 9 Cited by Von Gorup-Besanez, in Canstatt und Eisenmann's Jahresbericht, u. s. w. im Jahre 1849, v. 171. Erlang. 1850. 3 Archives Generates de Med. loc. cit.; Gazette Medicale de Paris, 1849, p. 748, and Bouchardat, Annuaire de Therapeutique pour 1850, p. 177. 4 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S, 89, Erlangen, 1848. 708 SUPPLEMENT. — FEL BOVINUM. forward to swell the uncertain crowd of antiepileptic remedies, by Mr. Salter 1 and Dr. Bullar. "Encore un remede contre Fepilepsiel" exclaims M. Bouchardat. 2 The juice was first used with advantage; and afterwards an extract was prepared from it, which exerted the same effects. Dr. Bullar 3 urges its protracted use. He has pre- scribed it in a considerable number of cases — several of which were of a very hopeless kind, — and in all there was a' marked diminution in the violence and frequency of the attacks. In many cases he thought it was "certainly" nervo-tonic, — the improved nervous tone being shown by quieter sleep, fewer dreams, better spirits, more ability to take exercise, and a consciousness of general improvement. He is not aware that it has any other action on the body. The juice is obtained by bruising the leaves and leaf-stalks in a mortar, and expressing it from the bruised mass through a cloth. One tea-spoonful of this is given twice a day. Of the extract, Dr. Bullar has prescribed five grains twice, and occasionally, thrice, a day. As in the case of artemisia, 4 it is to be feared, that the virtues of cotyledon umbilicus have been exaggerated. Dr. Ranking 5 is properly of opinion, that the cases given in illustration are too few in number to be worthy of much confidence; and he is " disposed to agree with Dr. Marshall Hall, thai there is no * medicine specially adapted to the cure of epilepsy; and that the only rational treatment consists in a judicious employment of hygienic measures, including diet, exer- cise,' " &c. It was not necessary to affiliate this view on Dr. Hall, as most intelligent practitioners had arrived at the same conclusion, and not a few had promulgated it to the world. In a note from the author's friend, Dr. Francis G. Smith, dated, Philadelphia, Jan. 9, 1851, he states, that he had used the extract in two cases, — the one, that of a female approaching puberty; — the other, that of a young man twenty-five or twenty-six years of age ; but in neither case was the slightest benefit perceptible: — the young lady, indeed, became worse whilst taking it; "for whilst there was no diminution in the frequency or severity of the paroxysms, she became desponding in the highest degree — in this last respect the case resembling some re- ported by the English practitioners." Dr. Smith gave the extract in doses of five grains three times a day. The author has never used it. CLXXXVI. Fel Bovi'nidi, Felbovis, Felfauri, Bills taurina, Ox gall, Ox bile; French, Bile ou Fiel cle Bceuf; German, Ochsen- galle, Rindsgalle. Ox-gall is by no means of modern intro- duction. It, as well as the bile of many other animals, has been employed in medicine in all ages; 6 but as its administration appears to have been somewhat revived, it may be worthy of a passing notice. It has long entered into many officinal pharmacopoeias and 1 Medical Gazette, March 2, 1849. 2 Annuaire de Therapeutique pour 1850, p. 59. ■ Provincial Med. and Surg. Journ. May 23, 1849. ■ Page 111. * The Half- Yearly Abstract of the Medical Sciences, No. 9, from Jan. to June, 1849; Amer. edit. p. 200. B H. Cloquet, Faune des Medecins, ii. 365. Paris, 1822; and C. Clay, cited in Medico-Chirur. Rev. July, 1842, p. 279. SUPPLEMENT. — FEL BOVINUM. 709 formularies of the continent of Europe ; and has been regarded as a stomachic and anthelmintic. The Fel tauri inspissatum, Extractum Bilis seu Fellis, is referred by Jourdan 1 to no fewer than seventeen pharmacopoeias; and the Globuli carminativi seu Pilulse bilis are in the pharmacopoeias of Manheim and Wirtemberg. Ox-gall is a greenish-yellow fluid, more or less thick and viscid, of a peculiar nauseous smell, and a bitter disagreeable taste. The chemical characters of bile, respecting which, as Simon 2 has remarked, there is no subject in the whole domain of animal chemistry that is more perplexing and intricate, have been given — so far as known — in another work. 3 Its uses in the economy have been inquired into in the same.* The author has there remarked, that as to the mode in which the biliary fluid acts on the chyme, we have not much more than conjecture to guide us ; and that it is more than doubtful, whether it has the property of soliciting the peristaltic action of the intestines so as to produce the evacuation of their contents. It was natural, however, that it should be regarded as a plausible remedy for cases in which a deficiency of bile is presumed to exist, although it may be by no means easy to discriminate them ; and that therefore it should be given in cases of intestinal torpor, which have so often been hy- pothetically regarded as dependent upon a deficiency of secretion from the liver. Its bitterness, and alkalinity, too, suggested its em- ployment as a tonic, and antacid. Of late years, ox-gall has been strongly advised in various diseases, and often on very loose physiological and pathological notions. 5 Jaundice, it is known, when not owing to organic disease of the biliary apparatus, generally terminates spontaneously in health. Dr. Johnson 6 ascribes the cure of several cases to inspissated ox-gall given in the dose of five grains, gradually increased to ten, three times a day ; and he explains the action of the remedy on the principle, that ox-bile is the best substitute which can be found for the human secre- tion; as if jaundice necessarily consisted in a deficient secretion of that fluid ! Many years ago, ox-gall was employed by Dr. Copland, 7 who speaks highly of its therapeutical properties, both when given in clysters, and when combined with aloes, taraxacum, [?] soap, extract of gentian, &c, in restoring the healthy functions of the bowels, and digestive organs generally. One of the strongest advocates for its use is Dr. Charles Clay, 8 of Manchester. He was first led to test its powers to relieve pain in cancer, from noticing the fact that Dr. Pea- cock, of Darlington, had observed, when the system was impregnated with bile in cancerous affections, that the pain was remarkably re- lieved.^) In a case of cancerous ulcer, that had destroyed the greater portion of the nostrils, he ordered, as a forlorn hope, a mixture com- 1 Pharmacopee Universelle, i. 268. Paris, 1 828. 3 Animal Chemistry, Sydenham edition, i. 49. Lond. 1845. 3 Human Physiology, 7th edit. ii. 318. Philad. 1850. 4 Vol. i. p. 611. 5 Lincke, Vollstandiges Recept-Taschenbucli, i. 594. Leipz. 1840. 6 London Lancet, Dec. 19, 1840, p. 447. 7 Art, Constipation, in Diet, of Practical Medicine, 8 Op. cit., cited in Braithwaite's Retrospect, vi, 94. Lond. 1843. 710 SUPPLEMENT. — FEL BOVINUM. posed of inspissated ox-gall, two drams ; oil of caraway, ten minims ; carbonate of magnesia, enough to form a mass, — to be divided into thirty-six pills. Of these two were given three times a day. Marked relief was afforded after the pills had been taken for one day ; and in four the pain had ceased. He states, that before giving it in this case, the evacuations were peculiarly white; and the bowels very much constipated with acid eructations. Dr. Clay, likewise, refers to its beneficial influence in dyspepsia. In all the cases reported by him, he considered " deficiency in quality or quantity of bilious secretion was the prominent and prevailing accompaniment," and he regards the ox-gall to be "not a cathartic," but " a direct solvent to the accumulated hardened faecal mass, the consequence of deficiency of quality or quantity of bile in the alimentary canal!" Dr. Clay observed, also, that inspissated gall has a remarkable ten- dency to counteract the constipating effects of opium. He recom- mends it, moreover, in all cases of atrophy, w T hether of children or of adults. In acidity of the stomach in children, he says, it affords u most decided, effectual, and immediate relief." Its action on the system, is not, as before remarked, cathartic, but is a mere solvent of the material contained within the intestinal canal, producing no excite- ment to propel, but facilitating excretion by liquidizing the mass. It is also, he says, tonic; and in children, to a moderate extent, diuretic: but less so in the adult. The views of Dr. Clay are, in the main, concurred in by Dr. R. H. Allnatt, 1 especially those in regard to the use of ox-gall in constipa- tion and its effects in obviating the constipating tendency of opium. The latter gentleman 2 gave it in a case of constipation during preg- nancy, in the form of enema, which succeeded in relieving the bowels, after warm water enemata had failed. A dram of inspissated ox-gall was dissolved in about a pint of warm water. The relief was in- stantaneous : — a mass of scybala being expelled, which had evidently lain impacted in the colon. Dr. Chapman 3 also has found it benefi- cial as "a laxative" in constipation. The preparation used by Dr. Clay and Dr. Allnatt is simply the recent gall of the ox slowly evaporated to the consistence of an ex- tract — the Fel tauri inspissatum, Extraction Bilis seu Fellis ; French, Extrait de Bile ou deFiel: Germ. Eingedickteh Galle. This may be made into pills. One gall-bladder of a moderate-sized ox, according to Dr. Clay, will afford as much extract as will make one hundred four grain pills, and it is an article both cheap and easy to procure. Dr. Lane 4 desiccates the gall and makes it into pills. To desiccate it he allows it to remain at the same temperature used in forming the inspissated article, until there remains a dry, bright green, friable, pu- rulent, slightly aromatic mass, in which state the substance loses none of its medicinal virtues; its deliquescent character is nearly lost. It can be easily preserved in closely stopped bottles, and is readily made 1 London Lancet, June 7, 1845, p. 635 ; and Lond. Med. Gaz. June 20, 1S45, p. 343. 2 London Medical Gazette, Feb. (i, 1S46, p. 253. 3 Lectures on the more Important Diseases of the Thoracic and Abdominal Viscera, p. 301. Philad. 1844. * London Lancet, July 5, 1845, p. 27. \ SUPPLEMENT. — FERRI ET ALUMINA SULPHAS. 711 into pills, particularly with any spirituous fluid or essential oil. M. Blanch 1 has tried both the inspissated and the desiccated ox-gall, and very decidedly deposes in favour of the latter as the more efficacious, and less nauseous. The pills, too, he says, do not run together as when made of the inspissated article. As an addition to simple clysters it has been recommended to weak, emaciated, nervous individuals, who are subject to pains in the bowels. 2 The dose of ox-gall is gss. to gi. in the day, made into pills. CLXXXVII. Inspissated Bile of the Swine, Bilis Porcina, has been used in the same cases as the bile of the ox, by Dr. Mettauer, 3 of Virginia, who thinks its employment as a therapeutical agent original with him. It has, however, been long used in medicine ! so long ago as the time of Pliny, 4 who extolled it in diseases of the spleen. "At the present day," says M. H. Cloquet, 5 " it is, we may say, out of use, and will never probably resume any share of favour." It is said to contain neither picromel nor any nitrogenized matter; but in addition to seve- ral salts is formed principally of resin and soda. It differs, conse- quently, considerably from the bile of man, and that of the ox: yet, according to Dr. Mettauer, it seems to be adapted for cases of diseases in which the biliary secretion is defective. "We were induced to resort to it first," he says, "in the low depressing states of continued fever, with the design of acting especially on the gastro-intestinal mu- cous membrane, which, we believed, became disorganized in such cases in a great measure from the want of the biliary influences, and in these cases it always acted with decided benefit. It served to sub- stitute the action of the bile. Simply heating the bile over a sand- bath until it became dry and pulverizable was our mode of preparing it. It is a valuable agent in dyspepsia, and in many chronic affections attended with defective biliary secretion. In chlorosis, amenorrhoea, some forms of dysmenorrhoea, and constipation, we have also em- ployed it with decided advantage. Dr. Mettauer gave it with benefit in the adynamic stage of fever above referred to — two or three grains of the inspissated, or more properly desiccated, bile, being associated with one of ipecacuanha, and two of carbonate of potassa. "This compound," he says, "seemed to act with decided effect, as a sup- porting and secerning remedy upon the mucous membrane of the sto- mach and intestines, and as a diaphoretic at the same time." It was especially valuable in cases attended with a denuded raw tongue, which always becomes more healthy after its administration. In such a com- bination, however, it is obviously impracticable to test the precise agency of the bile. CLXXXVIII. Ferri et Alumina Sulphas, Sulphate of Iron and •Alumina. This salt has been introduced by Sir James Murray, 6 of * Cited in Braithwaite's Retrospect, xii. 93, Amer. edit. New York, 1846. Ann. Therap. Juin, 1848; cited in Schmidt's Jahrbucher, u. s. w. No. 5, S. 160. Jahrgang 1849. 3 American Journal of the Med. Sciences, July, 1843, p. 52. 4 Hist. Nat. xxviii. 13. 5 Faune des Medecins, ii. 377. Paris, 1822. See, also, Merat and De Lens, Diet, de Mat. Med. &c, art. Sus. 6 Dublin Medical Press, Mar. 14, 1849. 712 SUPPLEMENT. — HJCMOSPASIA. Dublin, as a valuable addition to the class of astringent remedies. The bisulphate of iron and alumina — as he terms it — is readily made by- treating bicarbonated solution of soft iron and carbonated solution of pure Washed alumina with sulphuric acid after separating the arsenic and other ingredients, which are too often found in the vitriolic acid of commerce. Sir James considers this salt to be a superior astringent in the treat- ment of chronic diarrhoea, dysentery and cholera morbus; leucorrhcea, and the colliquative diarrhoea and sweats of the consumptive. It is also a valuable anthelmintic; destroying the parasites, and correcting the morbid condition of the alimentary canal, which favours their gene- ration. Occasional cathartics are needed during its administration as an anthelmintic. Applied externally it is a powerful styptic, and may be used in epistaxis, and in hemorrhage from leech bites. It has been found, too, an excellent gargle in relaxation of the uvula and fauces, in the cynanche of scarlatina; and in diphtheritis. It forms, like- wise, a good collyrium; abates salivation, and improves the appear- ance, and corrects the fcetor of foul ox flabby ulcers. Injections of the salt are good astringents in excessive hemorrhage from outlets with which they can be made to come in contact. The dose is from five to ten grains in any aromatic water, or in molasses. CLXXXIX. ELemospa'sia ; French, Himospasie. This is a mode of revulsion which has been strongly urged of late years by M. Junod, for his essays on which he has twice received the Monthyon prize. It has been properly described as a means for producing a powerful derivation of the blood from one part of the body, by removing the atmospheric pressure from a large extent of surface, as from one or both extremities. It is, as the author has expressed it elsewhere, 1 dry cupping on a large scale. An air pump bath has been employed, in which the atmospheric pressure is diminished over a greater or less surface of the body, and the application of vapour has been associated with this, constituting the air pump vapour bath, which has been used in gout, paralysis, and other affections. In 1832, Sir James Murray, 2 gave a description of an apparatus for abstracting: part of the atmospheric pressure from almost the entire surface of the body. For the purpose of insulating the patient's body from the external air, a small oval bath of tin, zinc or copper, was employed by him, — its lip furnished with a groove to contain luting for connecting- the lid or cover. In this lid is an aper- ture to pass over the patient's head, and around this opening is fitted a margin of air-tight cloth, which applies itself so as to embrace the top of the chest, and the back of the neck. The patient sits upon a seat, with his head uncovered, the body and limbs only being enclosed. When the bath is thus adjusted it is to be partially rarefied, either by the condensation of a little hot air or steam, or by a few strokes of a suction pump. 3 1 General Therapeutics and Mat. Med. 4th edit. ii. 254. Philad. 1850. * London Medical and Surgical Journal, July 14, 1842. s Observations on the Medical and Surgical Agency of the Air-pump, p. 41 . Dub. 1836. SUPPLEMENT.— H^MOSTASIS, 713 At a meeting of the south-western branch of the Provincial Medical and Surgical Association held at Plymouth in 1844, Dr. Marsden 1 ex- hibited M. Junod's apparatus for exhausting the air over a large sur- face, or for his " System of Dry Cupping," as it has been termed. It is made of copper, in the shape of a boot, and is applied as one, hav- ing an Indian rubber tip to tie around the thigh, and render it air-tight. The air is then exhausted with a syringe. By the application of this apparatus, the leg may be distended to double its ordinary size : the pulse is at first quickened, but is gradually reduced both in frequency and strength, and even syncope may supervene. Very little pain at- tends the operation. After the removal of the apparatus, the blood gradually returns to its course, and in a couple of hours the swelling of the leg subsides. Experience has proved that sixty operations on the same leg, with one or two days' interval, may be attended with no injurious effects on the nervous system. Dr. Marsden described an establishment under the superintendence of M. Bonnard, of Paris, en- tirely devoted to the application of this instrument. He referred to the success which had attended its employment by M. Cerise, and de- tailed the histories of several cases in which he had himself wit- nessed beneficial results, — as of amaurosis, deafness, sore throat, chlorosis, amenorrhoea, croup, phthisis, &c. In 1835 M. Magendie greatly extolled it in cases in which it is important to attract the blood from the internal parts towards the surface of the body with- out causing any loss of the vital fluid; — and its effects certainly en- title it to great attention. It has been objected, that when the appa- ratus is removed, a violent reaction will ensue, and the blood be propelled with greater force than ever to the seat of the disease ; but the results of experience do not confirm this ; " for as the hsemospastic injection or plethora takes place chiefly in the capillary vessels, the turgescence induced by it is found to subside very slowly and gradu- ally." 3 The effects of haemospasia resemble those of heemostasis; the diminished pressure, induced over a greater or less surface, must not only affect the circulation, but induce a new action in the nervous system, and hence act as an energetic revellent. CXC. H^mos'tasis, French, Hemostase, Hemostasia Germ. Stockung des Blutes in den Gefdssen, has been long used to signify "stagnation of blood," and also any agency which arrests the flow of blood, but it has been applied by Dr. Thos. Buckler of Balti- more, 3 to a particular mode of arresting the flow of blood in the super- ficial vessels, which he brings forward as a novel therapeutical agency. It has been long the custom at the commencement of the cold stage of intermittents, to apply ligatures — as the tourniquet, 4 — to the extremi- ties ; and this unquestionably has appeared, in many cases, to give oc- casion to a subsequent mild hot stage, and abridged duration of the whole paroxysm. As to the mode in which the ligature of vessels acts 1 Provincial Med. and Surg. Journal, July 10, 1844, p. 224. a Gazette Medicale, cited in Med. Chir. Rev. Jan. 1844, p. 281. 3 Maryland Medical and Surgical Journal, March, 1843, p, 265. 4 Kellie, Annals of Medicine, vols. i. and ii. 714 SUPPLEMENT. — HiEMOSTASIS. under such circumstances, there has been difference of sentiment. By some, as by Dr. Kellie, it has been supposed, that the obstruction to the circulation in the veins of the extremities causes an accumulation of blood in these vessels, and a consequent increase in the action of the heart; but the true modus operandi is probably that suggested by Dr. Mackintosh ;' the tourniquet or ligature, by confining the blood in the extremities, " prevents so much at least of the congestion in in- ternal organs ;" and in this manner exerts an analogous effect to the withdrawal of the same quantity of fluid from the vessels. A case de- scribed by Sir Geo. Lefevre, and referred to elsewhere, 3 — in which a disposition to syncope in the erect attitude, appeared to be owing to varicose veins of the lower extremities robbing the brain of its usual quantity of blood, and which was prevented by the application of ap- propriate bandages, — is confirmatory of this view of the subject. Dr. Buckler applies his ligatures upon one or more of the ex- tremities, according to the effect which he desires to induce. If a bandage, he remarks, be applied around a limb sufficiently tight to arrest completely the venous circulation, and at the same time allow the arteries to pulsate, the blood within the distended vein is cut off, as it were, from the general circulation ; a depletory effect is in this manner induced, and if the arrest of the venous circulation be prac- tised on all the extremities at once, the skin becomes relaxed ; the force of action of the heart and arteries is weakened ; and if the liga- tures be applied when the heart and arteries have been deprived of a portion of their ordinary amount of blood, owing either to anaemia or to bleeding, so that the vessels are partially empty, it is found, accord- ing to Dr. Buckler, that the exhalants of the skin pour out the most copious perspiration, — that the patient complains of a feeling of light- ness in the head ; of weakness and sickness of the stomach ; and if the carotids be pressed upon, they are found to be scarcely pulsating, and all the phenomena of syncope supervene. An agent possessed of such powers at once suggested itself as a valuable remedy in the phlegmasia more especially ; and it has been so urged upon the attention of the profession by Dr. Buckler. He considers it capable of exerting, under given conditions, a more power- ful control over the circulation than the lancet, antimony or digitalis, — controlling the action of the heart, without exhausting the vital forces. or giving rise to any other inconvenience. Many cases are brought forward by Dr. Buckler, in elucidation of the beneficial action of haemostasis and its power of sedation. He suggests, also, another application of it, — bandaging the extremities from the fingers to the toes, in cases where an individual has lost so much blood, that there is only enough left in his system to supply the organs essential to life — the heart, brain, and lungs,*— and to the ex- tremities of ansemic females in protracted labour, where, owing to the pressure of the uterus on the iliac veins, so much is cut off from the central circulation, as to deprive the brain of its normal supply, and thus render the pains weak, feeble, and inefficient. 1 Principles of Pathology and Practice of Physic, 2d Amer. edit, by Morton, i. 155. Philad. 1837. a The author's General Therapeutics and Mat Med. 4 th edit. ii. 177. Philad. 1850. SUPPLEMENT. — HYDRARGYRI ET QUINIA, &C. 715 . CXCI. Hura Brasilien'sis, Assacou, £ssacu or Ussacii, is a poisonous tree of Brazil, belonging to the family Euphorbiacese, the juice of which, and the decoction of its bark, cannot be employed without danger, in a high dose. The juice is anthelmintic, and at Santarem, in Brazil, the bark is given in elephantiasis, and at Para, the natives regard it as a specific in lepra. The physicians of Brazil administer the extract of assacou in pills, in the dose of a sixth of a grain to a grain in the day, gradually augmenting it still farther. They have also prescribed it as a drink in the form of infusion — a scruple of the bark to a quart (pinte) of water; and in baths. When given in too large a dose it excites vomiting. The bark — Casca cle Jissacu — is hard, thick, of a grayish colour, and inodorous: the epidermis is covered with a lichen of the genus lecanora.' It had not been subjected to investigation until recently, when having been taken by a leper to Saint-Marie-de Beleni, Para, it was examined by a commission of medical men appointed by the authorities of the country, who reported upon it favourably as a remedy in lepra. The results were communicated by Dr. Malcher, through the French consul at Saint-Marie-de Belem, to the Academie de Medecine, of Paris; to which body M. Gibert reported, that the active properties of assacou, and its marked effects on the solids and fluids, and especially on the diseased skin, and the acrid emetic and cathartic properties it possesses, prove it to be a powerful remedy, and encourage hopes that it has the remedial powers ascribed to it by the Brazilians. M. Bouchardat 2 is of opinion, that if introduced into the pharma- cies, it may render great service to therapeutics. CXCII. Hydrar'gyri et Qui'ni^e Protochlo'ridum. A combina- tion of mild chloride of mercury and quinia, has been prepared by Mr. M'Dermott, which has been found beneficial in some obstinate skin diseases that had resisted other remedies. The bichloride employed in the combination is said to perform the part of an acid, — the alka- loid quinia forms the base; hence a double salt, a protochloride of mercury and quinia, is obtained — not mechanically, but chemically combined. On subjecting it to the strictest analysis, no trace of the bichloride could be detected. 3 Several cases are reported by Mr. Hamilton, which had been treated at the Richmond Hospital, Dublin. A grain of the protochloride was given three times a day. In a case of lupus superjicialis of the arm of a labourer, aged forty, a rather pro- fuse salivation set in when twenty-one grains had been taken. A great improvement, however, had occurred in the local disease. The medicine was omitted for a few days, and then resumed in the dose of a grain night and morning. Pie was cured, — nothing but a simple dressing having been applied to the ulcers. The disease had existed twelve months before the treatment was commenced. 1 Merat and Gibert, Journal de Pharmacie, xiv. 422. a Annuaire de Therapeutique pour 1849, p. 71; and Ibid, pour 1850, p. 26. 3 Dublin Medical Press, No. 275, 716 SUPPLEMENT. — LETJKOLEINUM. CXCIIT. Ibe'ris Ama'ra, Bitter Candytuft; French, Passerage; of the /"«//?//// Crucifera?, is found plentifully in the gardens of Great Britain, where it is cultivated for its brilliant milk-white flowers. According to Dr. Silvester, 1 it was known to the ancients, and is mentioned by Pliny, Aetius, Paulus of JEgina, and Oribasius, by whom it is ex- tolled as an excellent internal and external remedy in various diseases. It may admit, however, of question, whether the chapter in Aetius, headed " De Iberide sive Cardamine quae et Lepidium vocatur," 2 refers to the plant in question. Mr. Adams regards the Lepidium of Paulus to be Lepidium Jatifolium or Peppenvort. The leaves, stem, and root of Iberis amara, appear to possess si- milar properties ; but from convenience and greater relative strength, the seeds were chiefly employed. Dr. Williams, of St. Thomas's Hospital, London, appears to have brought to light the properties of the plant, in a course of therapeutical researches at that hospital. He observed its good effects in asthma, bronchitis, dropsy, and more es- pecially in hypertrophy of the heart. It did not seem to diminish the velocity of the heart's action like digitalis, but controlled the vio- lence and sharp action of the organ, and softened the pulse: hence its great value in hypertrophy with dropsy. Dr. Silvester had prescribed it for ten years in numerous cases of the diseases above mentioned, "always with some benefit, and sometimes with almost magical effi- cacy." Its properties appeared to him to be analogous to those of digitalis and belladonna. It occasionally caused sickness, giddiness, or diarrhoea; but its control over the abnormous action of the heart was equally evinced, whether these effects were present or absent. Iberis amara was prescribed in powder in the dose of from one to three grains, generally mixed with bitartrate of potassa, which con- cealed the nauseous taste, and secured a perfect trituration and division of the tough seed. CXCIY. Leukolei/num, Chinoleinum, Leukol, Leucoleine, I^euko- leine, Leucolein, Chinoleine, Chinolein, Chinolin. This substance has not been found ready formed in nature. A. Hoffmann obtained it as the product of the dry distillation of coal, mixed with picolin,anilin, and other substances, in mineral tar. Subsequently, it was procured by Gerhardt and Bromier, by heating quinia, cinchonia, and strychnia with as concentrated a ley of potassa as could be made. In what- soever manner obtained, it is heavier than water; of an oleaginous consistence; and, in the state of purity, is completely colourless, and limpid as water. Its specific gravity is 1.081; and it is slightly soluble in water, and miscible in all proportions with alcohol, ether, and essential oils. 3 Wertheim prescribed it internally in combination with sulphuric acid — the pure leucolein being dissolved in a very small quantity of pure sulphuric acid. Externally, he applied a solution of pure leucolein in a small quantity of alcohol, diluted with a considera- 1 Provincial Medical and Surgical Journal, July 28, 1847. a The Seven Books of Paulus iEgineta, translated, &c., by Francis Adams. Sy- denham Soc edit hi. 212. Lond. 1847. 3 Fownes, Elementary Chemistry, 3d Amer. edit, by R, Bridges, p. 437. Philad. 1850. SUPPLEMENT. — LITHLZE CARBONAS. 717 ble quantity of water. The most evident effect produced by leucolein is on the pulse, which, like conia, it depresses. Wertheim affirms, however, that conia acts in this manner when the pulse is full and hard; and when the fever has a sthenic character; — leucolein on the contrary, when the pulse is feeble and accelerated, and the fever assumes an asthenic form. 1 Like conia, it has been given in intermittents as a substitute for the sulphate of quinia; but observations thus far made are inadequate to fix its therapeutical value. 3 CXCV. Lith'i^e Car'bonas, Lithium Carbonicum, Carbonate of Lithia; French, Carbonate de Lithine; German, Kohlensaures Lithon oder Lithion. This substance has been found in various mineral waters, as those of Toplitz, Franzensbad, Marienbad, Karls- bad, some of which have proved serviceable in calculous affections. This fact suggested to Mr. Ure, 3 as it had done to Lipowitz, to inves- tigate the solvent powers of carbonate of lithia with reference to lithic or uric acid and its compounds, at the ordinary temperature of the human body; and he found that its solvent power is more than double that of carbonate l of potassa or borate of soda, and about eight times that of bicarbonate of soda, which is the active ingredient in the Vichy water. An experiment was made on a human urinary cal- culus, composed of uric acid with alternate layers of oxalate of lime. It was allowed to stand for four hours in two ounces of the natural Vichy water, from the Hopital spring, which contained three grains and a half of carbonate of soda ; when it was found to have parted with two-tenths of a grain of uric acid ; whilst a portion of the same calcu- lus, placed under precisely similar circumstances, at the same time, in a solution of gr. 1.6 of carbonate of lithia to two ounces of distilled water, afforded nine-tenths of a grain of uric acid; thus demonstrating its superior solvent agency. Mr. Ure is of opinion, that of all the various menstrua hitherto recommended, none appears to promise more favourably than the carbonate of lithia, from the promptitude and energy with which, in dilute solution, it attacks calculi of the uric acid description; and he adds: "If by means of injection we can re- duce a stone at the rate of a grain or more an hour, we shall not merely diminish the positive -bulk of the calculus, but farther loosen its cohesion, disintegrate it, so to speak, causing it to crumble down and be washed away in the stream of the urine." The extreme scarcity of the carbonate of lithia has prevented it from being much employed in practice. It may be obtained by- adding a strong solution of carbonate of ammonia to a solution of either sulphate of lithia or chloride of lithium; or by decomposing sulphate of lithia by acetate of baryta, and calcining the acetate of lithia formed, which is thus converted into the carbonate. As usually met with, it is a white powder, like carbonate of mag- nesia; has a slight alkaline taste; and is soluble both in hat 1 Bouchardat, Annuaire de Therapeutique pour 1850, p. 177. 9 See Conia, p. 706. 3 Pharmaceutical Journal, iii. 2, cited in Medical Examiner, Oct. 28, 1843, p. !?50c 46 718 SUPPLEMENT. — MANGANESII SULPHAS. and cold water, but insoluble in alcohol. About 100 parts of cold water dissolve one part. It has been suggested as an internal remedy in lithuria; 1 and, ac- cording to Aschenbrenner, 2 may be given in the dose of from five to ten grains in the day. CXCVI. Lupuli'na, Lupulinum, Lupulin, Lupulinic glands; French, Lupuline; German, H o p f e n m e h 1, H o p f e n s t a u b. Of this substance, presumed to possess all the virtues ascribed to the hop, the author has spoken in another work. 3 As a bitter tonic he has made favourable mention of it, but as a hypnotic both it and hops have disappointed him. It is introduced here, however, in consequence of its having been recently brought forward in a new relation. Some years ago, Dr. Wm. Byrd Page 4 introduced it to a limited extent into the Blockley Hospital, as a preventive of nocturnal erections in dif- ferent forms of acute venereal disease. It was successful in the pre- vention of chordee ; and by preventing erection in acute gonorrhoea, it exercised a soothing influence on the inflamed urethra, and facilitated the operation of curative agents; relieved the troublesome perineal pain in chronic gonorrhoea, and during the treatment of stricture by the bougie; prevented the occurrence of erections during treatment of chancres of the male organ, which interfere so much with the process of cure ; and after the operation for phimosis had an excellent effect in the same manner. In spermatorrhoea it prevented the occurrence of nocturnal emissions so long as the patient was freely under its in- fluence. Dr. Page refers to Dr. F. G. Smith, and Dr. Edward Hartshorne, in confirmation of its antaphrodisiacal virtues. The dose he prescribes is from five to ten grains, to be repeated as occasion may require. The latter dose rarely requires a repetition during the night. It may be given in powder or pill. It causes no headach, constipation, nervousness, or any other unpleasant consequence. CXCVII. Mangane'sii Sulphas, Manganum sulphuricum oxydu- latum, Sulphas Man ganesii seuMa?iganosus, Sulphate of 'manganese; French, Sulfate de manganese; German, Schwefelsaures Man- ganoxy dul. The salts of manganese have been employed chiefly as external remedies in cutaneous diseases; but they have almost fallen into disuse. " The sulphate of manganese" — say MM. Merat and de Lens, 5 " appears to have been used externally, under the form of ointment, in the treatment of cutaneous diseases ; but on this head, as on the whole therapeutical history of the preparations of the metal in question," [manganese,] " we may say, that we have many more assertions than proofs ; many more chimerical views, based upon the large quantity of oxygen, which the oxide of manganese is supposed to be able to furnish to the living economy, than well observed facts or truly practical deductions." 1 Pereira, Elements of Mat. Med. and Therap. 3d edit. p. 571. Lond. 1849, a Die neueren Arzneimittel. u. s. w. S. 178. Erlangen, 1848. . 3 General Therapeutics and Mat. Med. 4th edit. i. 378. Philad." 1850. * Medical Examiner, May, 1849, p. 284. ■ Diet, de Mat Med. &c, art. Manganese. SUPPLEMENT. — MANGANESII SULPHAS. 719 By the Germans, this salt— which may be obtained by dissolving carbonate of manganese in diluted sulphuric acid, filtering and eva- porating the solution so as to yield crystals — has been given internally in syphilitic affections, and in chronic cutaneous diseases, in the dose of two or three grains [!] in watery solution. It has been used also externally in itch, in the form of ointment, made of a dram of the salt to an ounce of fresh unsalted butter — a piece of the size of a bean being rubbed on the affected part four times a day. 1 Dr. A. Ure, a who has proposed many articles as therapeutical agents on chemical considerations chiefly, but few of which will probably stand the test of accurate therapeutical observation, has recommended the sulphate of manganese as a cholagogue cathartic. If a dram, he says, be dis- solved in about half a pint of water, and swallowed before breakfast, it will generally occasion, after the lapse of an hour or so, one or more liquid evacuations. With the view of testing whether bile was thus discharged to any amount, a portion of loose feculent matter was di- gested with strong alcohol, in order to separate the mucus, and thrown upon a filter; a limpid olive-coloured solution was obtained, which, after evaporation in a water bath to the consistence of honey, yielded, on the addition of boiling chlorohydric acid, a notable quantity of bi- liary resin, together with a little fatty matter, — affording unequivocal proof of the excretion of bile. He does not show, however, that the quantity was greater than when other or no agents were administered ; but he infers, that the salt is "essentially cholagogue in the strict sense of the word." Its action is said to be prompt, and soon over; and it is recommended by Dr.Ure as a valuable cathartic in gout, in which, he says, there is generally a deficient action of the liver. [?] The communication of Dr. Ure attracted the attention of Dr. Gool- dens 3 to this salt, who instituted some trials to test its virtues. When taken upon an empty stomach, in the dose of one or two drams, he found it invariably induced vomiting in less than three hours, gene- rally within one hour, and the matter vomited consisted of a very large quantity of yellow bile. After a meal, the same effect took place, but not invariably. It very rarely acted as a cathartic alone ; and after it had been given for several days he was often obliged to have recourse to other cathartics. After the first dose, it seldom acts as an emetic. The evacuations, which are sometimes dark-coloured, soon become yellow and loaded with healthy bile ; but if it be con- tinued for four or five days, they become lighter, and ultimately show a total absence of bile, "appearing like jaundiced stools of the colour of parchment; but there is no jaundice either in the skin or urine. If the medicine be discontinued, the yellow colour of the stools returns." The dose, according to Dr. Thomson, 4 may be from half an ounce to an ounce as a cathartic; but Dr. Ure has always found a much smaller quantity suffice. Like other saline cathartics, it acts most efficiently when dissolved in a considerable quantity of water. ' Kapp,in Hufeland's Journal der Pract. Heilkund. Bd. xix. St. 1, S. 176; and Bd. x. St. 4, S. 178: cited by Osann, in Encyclopad. Worterb. der Medicin. Wissenschafl. xxii. 358. Berlin, 1840. tt Lond. Med. Gazette, Nov. 8, 1844, p. 190. 3 London Medical Gazette, Feb. 14, 1845, p. 646. * Chemistry of Inorganic Bodies, ii. 587, cited by Dr. Ure. 720 SUPPLEMENT. — NAPHTHALINA, Of late, the preparations of manganese have been brought forward byM. Hannon' and M. Petrequin, either as adjuvants or succedanea to the preparations of iron. As asuccedaneum for iron the peroxide of man- ganese had been employed by M. Gendrin. It would appear, too, that a formulary, printed at Leipzig in 1847, under the title Vade- mecum Clinicum, by Dr. J. Kovasy, contains formulae for the em- ployment of the oxide of manganese in chlorosis and amenorrhcea, and according to M. Ducoux, the mineral waters of Cransac, which are well-known to be efficacious in anaemia, chlorosis, &c, contain a considerable amount of sulphate of magnesia and sulphate of iron. M. Hannon has recommended manganese most extravagantly as an almost infallible specific (?) in anaemia, whatever may be its origin. M. Ptjteequin more judiciously suggests it as a succedaneum for iron in chlorosis, where the latter fails or loses its influence ; or where the disease removed by iron returns. It; would appear, however, that in only one of the four cases published by him was the salt of manga- nese, the subcarbonate, used alone ; in the other three, the manganese was associated with iron. 3 Kapp has used it externally in the form of ointment composed of gj. of the sulphate to ^ij. of lard. CXCVIII. Naphthali'na, Naphthalinum, Naphthalan, Naph- thalin; French, Naphthaline; German, Naphthalin. In the dis- tillation of coal-tar, when the last portion of the volatile oily product is collected apart, and left to stand, a quantity of solid crystalline matter separates, which is principally composed of naphthalin. This substance forms large, colourless, transparent, brilliant, crystalline plates, which exhale a faint and peculiar odour, compared to that of the nar- cissus. It is insoluble in cold water, but soluble in it to a slight degree at a boiling temperature. Alcohol and ether dissolve it readily, 3 When applied to the tongue, naphthalin causes a peculiar hot and pricking sensation, which extends down the throat and bronchial tubes,, exciting a spasm of the latter, and ultimately inducing cough "of a kind very efficacious in clearing the air cells and canals of accumula- tions of mucus. It is, therefore, a remedy highly suitable in the asth- matic coughs of old people, and others, who, from debility, are unable to expel the matters which clog the pulmonary membrane." 4 According to M. Rossignon, 5 naphthalin possesses many of the physical and medical properties of camphor; for which it may be substituted. With weak alcohol it forms a tincture, which has all the properties of camphorated spirit at one half the price. 1 Etudes surla Manganese, &c. Bruxelles, 1849; cited in Canstatt und Eisenmann's Jahresbericht, u. s. w. im Jahre 1849. S. 163. Erlang. 1850. See, on some pharma- reutical preparations of manganese, W. Procter, Jr. in American Journal of Pharmacy, Oct. 1850, p. 297. - Gazette Medicale de Paris, Sept. 1849, and Archives Generates de Med., Janvier, 1 850, p. 97. * Bouchardat, Annuaire de Therapeutique pour 1844, p. 46. Paris, 1844. * London Lancet, July 8, 1843, p. 515. * Bouchardat, op. cit. pour 1843, p. 04. Paris, 1843. SUPPLEMENT. — OLEUM CADINUM. 721 M. Emory, 1 of the Hopital Saint Louis, Paris, had his attention directed to the different products of tar as remedial agents in skin dis- eases, from the successful employment of tar in these diseases, and its unpleasant odour. Of these the concrete naphthalin appeared to him to be the best. He employed it in 14 cases. In two, one of psoria- sis gyrata, and another of lepra vulgaris, it failed; but in 12 it proved more serviceable; of these, two were lepra vulgaris, and ten psoriasis. The dose is from 8 to 30 grains, given in emulsion or syrup, and repeated pro re natd. M. Dupasquier employs a looch, a syrup, and lozenges. The ointment of M. Emory consists of two parts of naph- thalin to 30 parts of lard. 3 CXCIX. Oleum Cadinum, Juniperi oleum empyreumaticum ; French, Huile de Cade ou de Genevrier; German, Brenzliches Wachholder-Oel, Cade-Oel. This oil is obtained by the com- bustion of the wood of Juniperus phcenicea and J. oxycedrus ; French, Cade, Oxycedre. A sort of liquid tar results, which is of a blackish colour, fetid, and has been employed in France by farriers in the itch and ulcers of horses, as well as in the itch of sheep. It would appear, however, that the oil of turpentine has been very generally substituted for it, and has received the name of huile de cade. 3 The true oil has been long employed in toothache, and M. Serres 4 states, that he has seen the most excruciating pain relieved by the introduction of a drop into the cavity of a carious tooth. It is also a popular domestic remedy in cases of worms, in the dose of from 20 drops to a dessert spoonful, accord- ing to the age of the child. It is rubbed, too, on the upper lip, the interior of the nostrils, temples and neck, in order that it may enter the lungs with the air of inspiration. It has been long prescribed by Alibert and Cartheuser as an anti- scrofulous and antiscorbutic remedy, given internally ; and was em- ployed with advantage in chronic ophthalmia by Van Wij ; and by Rosenstein in scabies and eczema. 5 Of late, M. Serres has revived its use in scabies, and now employs it altogether in that disease; three or four frictions with it being ge- nerally sufficient in recent cases. It is affirmed, too, by him, that va- rious cutaneous affections, — eczematous, papular, lichenoid, &c. — are cured by its application every other day. A pellicle appears to be formed by it, which falls off on the ninth or tenth day, leaving the diseased surface healed or in the way of cure. It is in scrofulous oph- thalmia, however, that M. Serres has observed the best effects— in those obstinate cases that had resisted other means. In infants, he applies it on the forehead, temples, or cheeks, and on the outer surface of the eyelids; and at times he adds the introduction of a drop into each nostril. He has used it too with advantage in tinea, otorrhcea, 1 Cited in London and Edinburgh Monthly Journal of Medical Science, Jan. 1843, p. 68. 3 Bouchardat, op. cit., and Nouveau Formulaire Magistral, p. 122. Paris, 1845. * Merat and De Lens, Diet. Univ. de Mat. Med. ii. 489. Bruxelles, 1838. 4 Bouchardat, Annuaire de Therapeutique pour 1847, p. 65. 1 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 162. Erlangen, 1848. 722 SUPPLEMENT. — PLUMBI CHLORIDUM. pruritus ani, &c.' It effectually destroys, according to M. Sully, the parasites which infest the hairy scalp in tinea; and he affirms, that it occasionally cures this loathsome and obstinate disease almost mi- raculously. As a remedy in chronic cutaneous diseases it has been extolled also by M. Devergie, 2 who has found it most successful, however, in ec- zema, both in the simple and impetiginous form. In squamous af- fections and in lupus he has also used it; but beyond this, he thinks, "there is uncertainty or deception." M. Sully 3 prescribes the following ointment in tinea: R. Olei cadin. ^iss. Essent. anis. gtt. v. Adipis Jij. M. CC. Piscid'ia Erythri'na, Jamaica Dogwood. Dr. Hamilton, 4 during a visit to the Antilles, was struck with the powerfully narcotic ef- fects produced on fish by the bark of the root of this tree. Inferring that it might be useful as a medicine, he prepared a tincture, made by macerating the bark of the roots, gathered during the period of inflores- cence, and before the appearance of the leaves, in four times "its weight by measure" of rectified spirit for 24 hours, and filtering. Of this mixture he took, when much afflicted with toothache, a fluidram in a tumblerful of cold water, drank it off, and watched its effects, which were anodyne and hypnotic; and on awaking from sleep, his pain had wholly disappeared. He subsequently used it as a topical applica- tion to carious teeth, introducing it on a dossil of cotton into the dis- eased cavity ; and after a single application, he never heard of a re- turn of pain in that tooth. The formula for Dr. Hamilton's tincture is one ounce of the bark to four fluidounces of alcohol. Dose, f 3j. and less, in a glass of water. CCI. Plumbi Chlo'ridtjm, Chloride of Lead; French, Chlorure de Plomb ; German, Chlorblei, Hornblei. Chloride of lead is formed when oxide of lead is digested in muriatic acid. It also falls as a white precipitate when a salt of lead is added to any soluble chloride. In the London Pharmacopoeia it is directed to be formed as follows: — Take of acetate of lead, 19 ounces; boiling distilled water, three pints, (imperial measure ;) chloride of sodium, six ounces. Dissolve separately the acetate of lead and chloride of sodium — the former in three pints of distilled water, the latter in one pint. Mix the solutions; wash the precipitate after it has become cool with dis- tilled water, and dry it. The chloride crystallizes in long, flattened acicular crystals, which are anhydrous. Its solubility in water is va- riously stated. Generally, it is said to dissolve in 135 times its weight of cold water, and to be more soluble in hot. 5 By the London Col- * Bouchardat, Annuaire de Therap. pour 1849, p. 1'22. - Ibid, pour 1850, p. 65. 3 Ibid, pour 1849, p. 122. 4 Pharmaceutical Journal. Auq. 1, 1844; cited in Med. Chir. Rev., Oct 1844. 1 Graham's Elements of Chemistry, Amer. edit. p. 409. Philad. 1843; Fownes's Ele- mentary Chemistry, American edit. p. '242. Philad. 1845. SUPPLEMENT. — PLUMBI NITRAS. 723 lege, it is said to be soluble in 30 parts of water at 60°, and in 22 parts at 212°. 1 It was admitted into the London Pharmacopoeia as one of the substances employed in the preparation of the muriate of morphia. Mr. Tuson, 2 has employed chloride of lead in cancerous ulcerations, both in the form of lotion and ointment, with some success. As a lo- tion, it is of use, he says, in producing a healthy surface of the sore, removing foetor, and relieving pain ; and when the ulcer has not been extensive, it has healed under its application. In "painful neuralgic tumours" it proved very beneficial in relieving the pain. When ap- plied to any great extent by rubbing it over the part in the form of ointment, it has produced a numbness of the arm ; and from the obser- vations which Mr. Tuson made, on watching the effect of the applica- tion, he was induced to think, that the pain was removed by paralyzing the nerves of the adjacent parts. From what he has seen of the effect of the remedy he is inclined to believe, that combined with other applications and assisted by internal treatment, it may be of very con- siderable service in certain cancerous affections. CCII. Pltjmbi Nitras, Plumbum nitricum, Nitras plumbicus, Nitrum saturninum, Nitrate of Lead; French, Nitrate de Plomb; German, Salpetersaures Bleioxyd. This salt is officinal in the Edinburgh college; and is directed to be prepared as follows: — Take of litharge, ^vss., diluted nitric acid, a pint. Dissolve the acid to saturation with the aid of a gentle heat. Filter, and set the liquid aside to crystallize. Concentrate the residual liquor to obtain more crystals. It forms beautiful tetraedral and octaedral crystals, nearly opake, white, and of adamantine lustre, which are permanent in the air, and soluble in somewhat more than four parts of water. 3 Hitherto, nitrate of lead has not been much used in Great Britain or this country, in medical practice; and it was introduced into the Edinburgh Pharmacopoeia merely as the best salt of lead from which to prepare the iodide. It has the same constitutional and local action as the other soluble salts of lead. The property, however, which it possesses, of coagulating albumen, and of decomposing the compounds of chlorine, and the sulphohydrates, renders it a valuable antibromic; and it has been prescribed as an excitant antiseptic to wounds. In 1773, it was in use as an antiepileptic, and was especially recom- mended by Osterdyk-Schacht and Gessner. 4 Dr. Pereira 5 states, that in active haemoptysis he has sometimes prescribed a pill of sugar of lead and opium, and a mixture containing nitric acid. Nitrate of lead would thus be formed in the stomach. With this combination 1 The Dispensatory of the United States of America, by Wood and Bache, 6th edit, p. 1075. Philad. 1845. a London Lancet, Jan. 13, 1844, p. 502; and The Structure and Functions of the Female Breast, p. 426. Lond. 1846. * Christison, Dispensatory, Amer. edit, by R. E. Griffith, p. 739. Philad. 1848. 4 Dierbach, Die neuesten Entdeckungen in der Mat. Med. 3er Band, lste Abtheil. S. 610. Heidelb. und Leipz. 1845. * Elements of Mat. Med. and Therap. 3d edit. i. 745. Lond. 1849. 724 SUPPLEMENT. — POTASS^E NITRAS. he has succeeded in getting the system under the influence of lead in a much shorter time than by the sugar of lead only. Its main use, until of late, has been as an application to wounds, ulcers, cancerous affections, chronic cutaneous diseases, chaps, &c. According to Volz, it is the active constituent of a secret remedy by Liebert, of Paris, for cracked nipples. 1 Volz employed it with ad- vantage in these and similar cases, in the quantity of ten grains to the ounce of water. The most recent circumstance of interest connected with the nitrate of lead, owing to which it is introduced here, is, that it is the admitted basis of " Ledoyen's disinfecting fluid" which attained so much celebrity a few years ago, that the British government directed expe- riments to be instituted with it for disinfecting the subjects of spread- ing diseases, as well as infected localities. It is a solution of one dram of nitrate of lead in a fluidounce of water; and it certainly de- stroys the unpleasant odour of animal and vegetable substances that are evolving sulphuretted hydrogen and hydro-sulphates of ammonia; but there is no evidence that it has any destructive power over the emanations that give occasion to disease. 2 Dr. Stratton 3 is of opinion, from observation of the effects of the two fluids, that the Ledoyen is inferior to the Burnett fluid.* He affirms, too, that it is liable to exert a depressing influence when applied to the body, or used in the room in cases of typhus ; and two cases of lead colic, arising from its application to ulcers, have been recorded. 5 By Lemaitre de Rabodanges the nitrate of lead has been employed both as a destroyer of putrid odours, and for the preservation of ani- mal substances, — of the dead body, for example, 6 as in embalming ; yet its antiseptic power has been denied. 7 The commission, consist- ing of Dr. Southwood Smith, Mr. Toynbee and Mr. Grainger, to whom, in connexion with the discoverer, the fluid was submitted for examination by Lord Morpeth, reported, that it does not possess any peculiar power in preserving the dead body from decomposition, whilst they admit its efficacy as an antibromic. 8 CCIII. Potass,e Nitras, Nitrate ofpotassa, Nitre; French, Nitrate depotasse; German, Salpetersaures Kali. This salt is noticed here in consequence of the revival of its use in large doses, within the last twenty years. As a general rule, nitrate of potassa is a dangerous and rapid irritant poison in the dose of an ounce; yet there are cases in which this and even a larger quantity have been borne with im- punity, 9 especially when dissolved in a large quantity of water. As long ago as the year 1764, Dr. Brocklesby, a celebrated British 1 Dierbach, op. cit. 2er Band, S. 1224. Heidelb. und Leipzig, 1843. * British Amer. Journal of Med. and Phys. Sciences, December, 1847, and the author's General Therapeutics and Mat Med., 4th edit. ii. 371. Philad. 1850. 3 Edinb, Med. and Surg. Journal, Oct 1848, p. 293. * See page 691. 5 Brit. Amer. Journal, March, 1848. 6 Pereira, op. cit. 1 Academie des Sciences, 8 Juin, 1840; cited by Pereira; and Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 230. Erlangen, 1848. 8 Amer. Journal of Pharmacy, November, 1847, p. 269. 9 Christison, Treatise on Poisons, Amer. edit p. 189. Philad. 1845. SUPPLEMENT. — POTASSiE NITRAS. 725 army physician, urged the value of this salt, in large doses, in acute rheumatism, — as much as ten drams being given during the day and night. The practice was followed by others, — and, in 1833, Messrs. Gendrin and Martin Solon revived it in Paris; sixteen cases are re- corded, the average period of treatment of which was eight days. The mean quantity given in one day was an ounce in three quarts of water, — the total average quantity, eleven ounces They recommend, that it should be begun in the quantity of two drams and a half to a quart of fluid. Twelve successful cases are also recorded by M. Aran. 1 The mean dose was thirty-six grains in three pints of fluid, and the ave- rage total quantity, 374 grains. The mean duration of the disease was also eight days. 3 Dr. Henry Bennet, who was clinical clerk and house physician under M. Gendrin, at La Pitie, states, that for nearly three years, which he spent there, all the cases of acute rheumatism which came into the wards were treated with nitre, in doses varying from six to twelve, or sixteen drams in the twenty-four hours, ac- cording to the age, sex, or constitution of the patient; so that Dr. Bennet thinks he must have seen treated at La Pitie, in this manner, at least seventy or eighty persons. The salt was always administered dissolved in a large quantity of barley water, sweetened with sugar, — the proportion being about half an ounce to a pint and a half or two pints of fluid. This was the only beverage allowed the patient. The secretions of the skin and kidneys were generally augmented, and sometimes those of the intestinal canal ; but the principal action of the nitrate appeared to be sedative, the pulse generally falling rapidly, both as regarded frequency and strength — or, in other words, the salt seemed to act as a contrastimuiant. Neither M. Gendrin, nor M. Martin Solon, nor Dr. Bennet, observed any renal inflammation in- duced by it, as had been stated by some. Dr. Bennet 3 states, that he has not only administered an ounce or more of nitre in the twenty- four hours, for many days consecutively in acute rheumatism, but also in puerperal fever and other inflammatory diseases, with, he thinks, marked benefit, and without observing any toxical phenomena; and in a subsequent communication 4 he asks, whether nitre, thus ad- ministered, may not prove a valuable sedative in febrile and inflam- matory diseases. In chronic rheumatism he found it of little avail. Dr. W. R. Basham 5 gave it in acute rheumatism in the quantity of one, two and three ounces, largely diluted — in two quarts of water — in the twenty-four hours. The testimonies in favour of large doses of nitrate of potassa in acute rheumatism are certainly not few; but, as the author has re- marked elsewhere, 6 it must be borne in mind, that the disease is self- limited in many instances, or, in other words, appears to run a defi- 1 Journal des Connaissances Medico-Chirurg. 1841, or Gazette Medicale, Mars, 1841. 8 Cowan, Provincial Med. and Surg. Journal, May 20, 1843, p. 144. s London Lancet, Feb. 10, 1844, p. 638. * Ibid. June 15, 1844, p. 374. * Proceedings of the Royal Medical and Chirurgical Society, Nov. 14, 1848; cited in Amer. Journ. of the Med. Sciences, Jan. 1849, p, 184. 6 General Therapeutics and Mat, Med. 3d edit. ii. 212. Philad. 1850. 726 SUPPLEMENT. SANICULA MARLLANDICA. nite course, greatly uninfluenced by medicine. The action of seda- tion, ascribed to it, may result indirectly from its revellent operation on the stomach; but farther observations are needed to establish the fact of such action, before we attempt to explain the modus operandi. It may be proper to add, that Dr. Young, 1 of Chester, Pa., has found that nitrate of potassa, given in ten grain doses, every three hours, to the adult, had an excellent effect in incontinence of urine. It succeeded in several cases, in which the tincture of cantharides had failed. To a boy between nine and ten years of age, " who rarely in his life had escaped wetting the bed one or more nights in the week," Dr. Young ordered ten grains three times a day for a week. During this time he escaped. It was now omitted for three days, and then directed to be given four days in the week, omitting it three. It was thus continued five weeks, when it was entirely abandoned. The boy had no incontinence from the time of taking the nitre, nor whilst he was under Dr. Young's notice, for more than a year after. Dr. Young supposes, that the modus operandi of the nitre in these cases may consist in increasing the irritating properties of the urine, so as to make it more stimulating to the bladder or its sphincter. If so, he suggests, whether other preparations of potassa and soda may not succeed, in cases in which the nitrate fails. M. Delcour, however, who speaks favourably of the nitrate, as recommended by Dr. Young, thinks it acts rather by diminishing the excitation of the bladder. 3 Here, again, farther experience is desirable. The fumes produced by the deflagration of nitrate of potassa with paper have been inhaled with advantage in asthma. For this pur- pose bibulous paper may be dipped in a saturated solution of nitre, and afterwards dried ; in this way is obtained what is called touch paper. The fumes may be inhaled either by setting fire to the paper on a plate, or rolled up and placed in a candlestick, and permitting the fumes to escape into the room ; or by smoking the paper in a tobacco pipe. The beneficial effects are generally experienced in ten or fifteen minutes. 3 CCIV. Sanic'ula Mariland'ica, Sanicle, Maryland Sanicle, Black Snakeroot; French, Sanicle du Maryland. This plant — of the um- belliferous family — is indigenous, and common in woods and copses. 4 Dr. Stephen W. Williams 5 says, " it is supposed to be astringent, partially tonic and diuretic, and it has been used with success in dropsy; and in decoction in dysentery, leucorrhcea and hemorrhages. It is also pulmonary and balsamic." The Indians — it is affirmed — and, after their example, physicians of the country, employed it " in 1 American Journal of the Medical Sciences, April, 1843, p. 371. 9 Journal de Medecine de Bruxelles, cited in Medical Times, Jan. 4, 1845, p. 303. * Lond. Med. Gazette, Sept 4, 1846, p. 431 ; and Pereira, Elements of Mat. Med. and Therap. 3d edit i. 514. Philad. 1849. 4 Gray's Manual of the Botany of the Northern United States, p. 156. Boston and Cambridge, 1848. * Report on the Indigenous Medical Botany of Massachusetts, in Transactions of Amer. Med. Association, ii. 871. Philada. 1849. SUPPLEMENT. — SODiE HYPOSULPHIS. 727 syphilis and diseases of the lungs."* It is introduced here, however, in consequence of its having been highly recommended by J. B. Za- briskii 2 — [in some of the French works metamorphosed into Labriski,] — in cases of chorea. The root is fibrous, aromatic, and possesses the active matter of the plant. Dilute alcohol extracts the active principle in some degree; but the best form of administering it, according to Dr. Zabriskii, is the powder of the dried root. He regards it as highly tonic, and states, that it is used in popular prac- tice as a favourite remedy in intermittent fever. In chorea he gives it to- children eight or ten years of age in the dose of half a dram three times a day. CCV. SoDiE Hyposulph'is, Hyposulphite of Soda; French, Hyposvlfite de Sonde. There are several modes of preparing this salt, which is largely used for photographic purposes. One of the best is to form neutral sulphite of soda, by passing a stream of well washed sulphurous acid gas into a strong solution of carbonate of soda, and then to digest the solution with sulphur at a gentle heat for several days. By careful evaporation at a moderate temperature, the salt is obtained in large and regular crystals, which are very soluble in water. 3 It is said to have been administered with constant success by phy- sicians of Paris, who are the most versed in the treatment of cuta- neous diseases. It was first employed by MM. Chaussier, and Biett, under the name sulfite sulfure de sonde, but it had fallen into neglect when its use was revived by M. Quesneville, and the results have been entirely conformable to those obtained by MM. Chaussier and Biett. It is highly extolled by them in chronic cutaneous, and in scrofulous affections, and is said to be a most efficacious auxiliary to external sulphurous preparations. 4 The best mode of exhibiting it is in syrup, the formula for which i3 given below, — Hyposulphite of soda, 45 grammes, (about gxiss.;) Distilled Water, 255 grammes, (about f ^viij.;) Sugar, in coarse pow- der, 1000 grammes, (about ftij.) Dissolve the hyposulphite in the distilled water when cold; and form into a syrup at the ordinary temperature. Thirty parts of the syrup contain one part of the hyposulphite. From 30 to 125 grammes, (one ounce to four,) may be given in the twenty-four hours. R. Sodee hyposulph. gxiss. (45 grammes.) Aq. destillat. f ^viij. (255 grammes.) Sacchar. in pulv. crass. Oij. (1000 grammes.) fiat syrupus. Emile Mouchon.* 1 Merat and De Lens, Diet. Universel de Mat. Med. iv. 142. Bruxelles, 1838. 2 Amer. Journ. of the Med. Sciences, Oct. 1846, p, 374. * French Codex for 1839, and Fownes's Elementary Chemistry, p. 198. Phila. 1845. « Abeille Medicale, 1844, p. 210, and Juin, 1845, p. 151. 5 Journal de Pharmacie du Midi, cited in Abeille Medicates, Septembre, 1845, p. 237. 728 SUPPLEMENT. — SUCCUS LIMONIS. CCVI. Sod.e Phosphas, Phosphate of Soda; French, Phos- phate de Sonde; German, Phosphorsaures Natron. This salt has been long known under the name of " tasteless purging salt" and a formula for its preparation is given in the Pharmacopoeia of the United States. It has been urged as a remedy in lithuria, under similar views to those that suggested the employment of phosphate of ammonia. If sufficiently diluted, according to Dr. Golding Bird, 1 it is sure to enter the circulation, and be excreted by the kidneys, thus furnishing to the urine an energetic solvent of uric acid, as Liebig has shown it to be. It is true, he says, that this indication can gene- rally be fulfilled by the pure alkalies and their carbonates; " but they too often exert the injurious effect of materially interfering with the digestive organs, and thus directly affecting the integrity of those functions most intimately connected with the production of the mor- bid deposit." The phosphate of soda, according to Dr. Bird, may be given in doses of £)j. to ^ss. thrice a day in broth or gruel, without any other apparent effect than that of slightly relaxing the bowels, and the urine becomes charged with the salt. We may thus, he says, hope to obtain uric acid in solution, and gain time for the enjoyment of those remedies which are best adapted for the treatment of the uric acid diathesis; "for it must never be forgotten, that in merely giving a remedy to hold a urinary deposite dissolved, we are merely treat- ing an effect and not a cause." Dr. Bird states, that he has adminis- tered the salt in two very chronic cases of uric acid gravel, and in one with the effect of rapidly causing a disappearance of the deposit. The triple salt, ammonia-phosphate of soda, he thinks, might per- haps be a more active remedy than the simple phosphate, but its dis- agreeable flavour constitutes one objection to its employment. Dr. Buckler suggests the phosphate of ammonia in preference to the phosphate of soda; the urate of soda formed by the latter in the blood being insoluble; whilst, when phosphate of ammonia is given, "a double reaction and decomposition take place, and two new salts are formed, both of which are readily soluble and capable of being evolved." 2 — -(See Ammonle Phosphas.) CCVII. Succus Limo'xis, Lemon juice; French, Sue de Limon; German, Citron ens a ft. This familiar article has been brought forward by Dr. Owen Rees on chemical considerations, to swell the catalogue of undoubted cures of acute rheumatism. 2 Dr. Rees first had recourse to it in rheumatic gout, from a belief that the vegetable acids — probably owing to the excessive quantity of oxygen entering into their composition — contribute to effect the transforma- tion of the tissues generally, and because lemon juice was the most palatable form in which such class of remedies could be applied. Moreover, it appeared to him probable that the supercitrate con- tained in the juice, although in small quantity, was a form of alkaline 1 London Medical Gazette, Aug. 23, 1844, p. 669; and Urinary Deposits, &c, Amer. edit. Philad. 1845. 3 American Journal of the Medical Sciences, Jan. 1846, p. 120. * See Cimicifuga, page 214, and Colchicum, page 228. SUPPLEMENT. — SUMBULI RADIX. 729 salt likely to contribute to the alkalinity of the blood in its trans- formations; as the examination of the urine shows that such organic compounds become converted into carbonates. He seems to regard retained uric acid as the materies morbi in rheumatism ; and thinks that the citric acid of the lemon juice yields oxygen, which, with the elements of water, converts uric acid into urea and carbonic acid; — - an hypothesis which is by no means admitted. 1 In his earliest communication, Dr. Rees 3 reported several prominent cases of cure; and stated that the early relief from pain was such, that had any one unacquainted with the remedy in use watched the progress of the cases, they would almost inevitably have concluded ihat sedatives had been resorted to. Subsequently, he published a pamphlet, 3 in which he gives eight cases illustrative of the practice. The forms of rheumatic disease in which the greatest benefit was de- rived were acute rheumatism and rheumatic gout. In pure gout, with highly inflammatory symptoms, more advantage was obtained than in the chronic forms of the disease. In doses of half an ounce to an ounce, three times a day, it appeared to exert a marked sedative influence on the circulation. In the cases of rheumatism related by Dr. Rees, the urine was never rendered alkaline by the use of the lemon juice; and in one case, in which the urine was alkaline before treatment, it became acid after the juice was employed. Dr. Ranking* speaks favourably of the article; and others have afforded similar testimony. 5 Additional evidence is however needed, before this article — which every gouty individual is, from experience, afraid of — can be re- garded as an appropriate remedial agent in arthritic affections ; as Mr. Dakymple, however, has remarked, " should it stand the test of time and hospital practice, and we be able to avoid either half poi- soning our patients with colchicum, stupifying them with opium, or enervating them with mercury, a great boon will be conferred on the suffering multitudes of this variable climate," — (that of England,) CCVIII. Sitm'bttli Radtx, Sumbul root, Jatamansi; German? Sumbulwurzel, Moschuswurzel, Spicanard. A root introduced into notice of late years — the mother plant undetermined, but presumed to belong to the Umbelliferae Family, and allied to Archangelica officinalis. 6 According to Erdmann and Von Lede- bour, and the English botanist, Mr. Robert Brown, it comes from Bucharia; whilst Guibourt says it is obtained from Siberia. 7 It ap- 1 British and Foreign Medico-Ohirurgical Review, Oct. 1 849, p. 530. 3 London Medical Gazette, Jan. 26, 1849. 3 The Treatment of Rheumatic Diseases by Lemon Juice, with Illustrative Cases, from Hospital Practice. Lond. 1849. 4 The Half-yearly Abstract of the Med. Sciences, No. 1 1 , Jan. to July, 1850. Amer. edit., p. 19; and No. 12, July to Dec. 1850, p. 33; Amer. edit. Phila. 1851. 6 Lond. Med. Gaz. June 15, 1849, and Mr. D. Dalrymple, Lancet, Sept. 1850. 8 Aschenbrenner, Die neueren Arzneimittel, u. s. w. S. 256. Erlangen, 1848. 1 Dierbach, Die neuesten Entdeckungen in der Materia Medica, 3er Band, 2te Abth. S. 1153. Heidelb. und Leipz. 1847. 730 SUPPLEMENT. — SUMBULI RADIX. pears in commerce either uncut or in slices from one to four inches in diameter, and from half an inch to two inches thick; having a strong, musky odour, and a strong, bitter calamus-like taste. When examined by Reinsch, it was found to contain an odorous ethereal oil, which did not smell of musk; a colourless balsam, and two peculiar acids, (Sumbulamsaure and Sumbulolsaure;) aromatic resin, bitter principle, &c. According to Schnitzlein and A. Frickinger, 1 a soft resin oozes from the wood and concretes, which possesses the characteristic smell of the root in a high degree, and has a taste between that of musk and calamus. It is soluble in alco- hol, and is in great part thrown down in a milky form by the addi- tion of water. Sumbul is said to have been used in dropsy and atrophy; but it has recently been brought forward in Germany as a gentle excitant of the nervous system, and through it of all the organic actions. Thielmann prescribed it in the nervous stadium of typhoid fever; and in chorea, delirium tremens, flatulence of the stomach as a consequence of tonic spasms, in anaesthesia of the nerves of the bladder, enuresis, ischuria renalis spastica, diarrhoea and cholera morbus; and he sug- gests that it may be found a valuable prophylactic and curative agent in cholera. He prescribed it also in a case of violent vomiting in the convalescent stage of typhus; in diabetes insipidus; and in tubercular phthisis; and it seemed to him to improve the condition of a patient in the last period oi prof use suppuration from caries with hectic fever. It has been prescribed, indeed, in the most heterogene- ous cases; 3 and there is too much reason to believe that effects have been assigned to it to which it is little or not at all entitled. It was given by Dupuis, 3 of Mainz, in cardialgia, colic, disordered digestion in pregnancy, and in convalescence; and Von Kieter, 4 of Kasan, prescribed it generally with advantage in cholera typhus and in the later periods of cholera. Recently, it has been introduced into England, by Dr. Granville, of London, with a title to his essay on it which is sufficient to cast distrust on his testimony, — "The Sumbul; a new Asiatic remedy of great power against nervous disorders, spasms of the stomach, cramp, hysterical affections, paralysis of the limbs and epilepsy; with an account of its physical, chemical and medicinal cha- racters, and specific [f] property of checking the progress of collapse- cholera, as first ascertained in Russia!" In this, Dr. Granville gives a history of the article, and of its various applications to the treat- ment of disease. 5 " We do not find," says Dr. Ranking, 6 " that Dr. Granville's observations have been confirmed. Should there be any thing in the medicine, it will doubtless soon be known." 1 Dierbach, Die neuesten Entdeckungen in der Materia Medica, 3er Band, 2te Abth. S. 1156. a Aschenbrenner, Ibid. S. 257. 3 Schmidt's Jahrbucher, Jam-gang 1849, S. 294. 4 Ibid. * A full notice of Dr. Granville's pamphlet is contained in Edinburgh Medical and Surgical Journal, for Oct. 1850, p. 459. 8 The Half-yearly Abstract of the Medical Sciences, No. 12, July to December, 1850, Amer. edit. p. 184. Philada. 1851. SUPPLEMENT. — SUMBULI RADIX, 731 It has been given as an antispasmodic in epilepsy, by Dr. Todd; 1 but the results have not been published. It is prescribed in powder, in the dose of half a scruple and more, several times a day ; in infusion — half an ounce of the root to six. ounces of water — dose, a table-spoonful. — In decoction, in water or hock, half an ounce of the root to eight ounces of water or wine, boiled down to six ounces; dose, a table-spoonful; and in infuso- decoctum — half an ounce of the root being infused in five ounces of boiling water ; digested for a quarter of an hour in a closed vessel ; strained ; and the residue boiled for a quarter of an hour in sufficient water to leave three ounces. The strained liquors must then be mixed, and given like the infusion and decoction. A tincture of it is also prepared, like the tinctura Valerianae ; dose — fifteen to twenty- five drops ; and an extract, the dose of which is from five to ten Cited, from London Lancet, in Med. Examiner, July, 1850, p. 437, INDEX OF DISEASES AND THEIR REMEDIES. {For Index of Remedies, see the commencement of the volume.) Abdomen, inflammation of the (hy- drarg. cyanur. 416.) Abortion, hemorrhage from (ma- tico, 510.) Abrasions (collodion, 234, 235.) Abscess, mammary (compressio, 241.) Abscesses, large, (chlorin aq. 194; iodinum, 482.) Suppurating (creasoton, 265.) Absorbents, inflammation of the (iodinum, 482.) Acidity of the stomach (argilla, 102, fel bovinum, 710.) Acne (acid, hydrocyan. 33, 36; sul- phur, iodid. 674.) Indurata (sulphur, iodid. 674.) Rosacea (acid, hydrocyan. 33. creasoton, 271.) Vulgaris (collodion, 234.) Adiposis (ballota lanata, 131; iodi- num, 476.) After pains (ergota, 322; sulphuris carburetum, 671.) Air passages, diseases of the (chlo- rinum, 184.) [nflamed, (iodin, 485.) Albuminuria, (acid, gallic. 22 ; acid, tannic. 41; benzoate of ammo- nia, 19; urea, 677.) Alopecia, (glycerin, 402.) Amaurosis (acid, hydrocyan. 34; acu- punctur. 56 ; ammoniated coun- ter-irritants, 250; electro-mag- netism, 296, 298; electro-punc- tura, 304; galvanismus, 392, 396; haemospasia, 712; nux vo- mica, 541; strychnia, 658, 662.) Incomplete (electro. punct. 304.) Amblyopia (strychnia, 658.) Amenorrhoea (artemisia, 111; auri prseparat. 119; brominum, 144; caincse radix, 149; calendula, 151 ; electro-magnetism, 47 296 Amenorrhoea ergota, 323; galvanismus, 392; heemospasis, 713; ferr. proto- carbonas, 373; ferr. iodid. 354; iodinum, 469; manganes prse- par. 720; potassii bromid, 586; potassii iodohydrargyras, 594; strychnia, 661; sulphuris carburetum, 594.) Anaemia (ferripulvis, 335; ferri iodi- dum, 356; ferri subcarbonas, 379.) during parturition (Hsemostasis, 714.) Anaemic habits (ferri subcarbonas, 379.) Anaesthesia, local (nux vomica, 542; sulphuris carburetum, 671; sumbuli, 730.) Anasarca (acid, hydrocyan. 32; com- pressio, 237; acupunct.56; col- chicum, 229; ferri citras, 343; ferri iodid. 356; urea, 677.) Anchylosis spuria (iodin. 462.) Aneurism (acnpunct. 57; electro- puncture, 307.) Angiectasis (zinci chlorid. 689.) Angina pectoris (galvanism, 394 ; magnes. 499.) Anthrax (iodinum, 482.) Malignant (chlorin. aq. 192.) Aphonia (chlorin, 185; cubeb. 283; galvanism, 392; ol. tiglii, 564; strychnia, 658.) Aphthae, asthenic (chlorin. aq. 194.) Aphthous sores (liq. ferr.persesqui- nit. 363.) Ulceration (creasoton, 280.) Apncea, see Asphyxia. Apoplexy (ol. tiglii, 566.) Arsenic, poisoning by (ferri oxidum hydratum, 367.) Arthritis (brominum, 144; compres- sio, 238; morphia? acetas, 524.) 734 INDEX OF DISEASES. Arthrocace (ol. jecinor. aselli. 552.) Ascarides vermiformes (ferri ferro- cyanuretum, 348; fuligo ; 387.) Ascites (acupunct. 56; caincae radix, 148; compressio, 237; electro- punctur. 307; euphorb. ol. 334; ferri iodid. 356; ferri subcarb. 378; iodinum, 463, 479; potas- sii bromidum, 587.) Asphyxia (acupunct. 56; electro- magnetism, 302; galvano-punc- tur. 305; soda chlorinata, 645; sulphuris carburetum, 671.) Neonatorum (electro-magnetism, 302.) Asthenia, chronic (potassae chloras, 583.) Asthma (aether. 70; bignonia catal- pa, 137; chloroform, 198, 199, 203; creasoton, 278; galvanism, 392; iberis amara, 716; naph- thalin, 720; ol. tiglii, 564; po- tassae nitras, 726; quinia sul- phas, 623.) Humoral (colchicum, 229; sulphur iodid. 675.) Nervous (magnes. 499.) Pulverulentum (acid, hydrocy. 32.) Spasmodic (acid, hydrocyan. 32; iodinum, 463; ol. tiglii, 564.) Atheromatous cysts (electro-punc- tura, 307.) Atony from venereal excesses, (com- pressio, 241.) Atrophy (brucia, 146; ol. jecinor. aselli, 552; sumbul, 730.) Of children (oleum jecoris aselli, 552.) Partial (nux vomica, 540.) Bed-sores (collodion, 236; creasotum, 266.) Biles (iodinum, 482; ammoniated counter-irritants, 250; ol. jecor. aselli, 555.) Bites of serpents (cainca, 149.) Black eye (calx chlorin. 156.) Bladder, atony of the (diosma, 295.) Catarrh of the(acidnm benzoicum, 18; cort. adstring. Brazil. 253.) Diseases of the (diosma, 294.) Inflammation of the (fuligo, 386.) Irritation of the (acid, benzoic. 19.) Paralysis of the (diosma, 295.) Bleeding from leech bites (collodion. 235^ creasoton, 263.) Blennorrhagia, acute (morphia, 523.) Blennorrhea (acid, hydrocyan. 34; acidum tannicum,45; calx chlo- rin. 159; chimaphila, 180; cort. adstring. Brazil. 253; cubeba, 283, 287; diosma, 295; iodin.472; ferr. iodid. 358; monesia, 515; piperina, 575; salicina, 640; zinci chloridum, 691.) Of the bladder (diosma, 295.) Of the eye (calcis chlorid. 158.) See Gonorrhoea. Blepharitis glandulosa (hydrargyri cyanu return, 416.) Blotches, syphilitic (argent, praepa- rat.93; hydra rg. iodid. rubr.423.) Boils, see Biles. Bones, diseased (iodinum, 474.) Pains in the (zinci ferrohydrocy- anas, 696; iodin. 474.) Tumours of the (auri praepar. 1 19 ; potass, iodid. 602.) Bowel complaints (iodinum, 485.) Bowels, painful affections of the (acid, hydrocyan. 32; fel bovi- num, 710.) Irregular action of the (electro- magnetism, 298.) Brain, chronic affections of the (ammoniated counter-irritants, 250.) Breast, cancer of the (arsenic, iodid. 107.) Bronchia, dilatation of the (chlorin. 184.) Inflammation of the (ammoniated counter-irritants, 250.) Bronchial affections (colchicum, 229.) Bronchitis (acid, hydrocyan. 31; chloroform, 204; iberis amara, 716; iodinum, 460; lactucarium, 498; mannita, 504; spiritus pyro-aceticus, 648; strychnia, 661.) Chronic (aq. picea, 91; Chlorin. 184; cimicifuga, 214; colchi- cum, 229; creasoton, 274; ferri citras, 343; galeopsis, 390; ju- glans regia, 494; monesia, 513: salicina, 640; spiritus pyro- aceticus, 648; strychnia, 658.) Convalescence from( man nit. 504.) Summer (nux vomica, 542.) Bronchocele (ferr. iodid. 354.) See Goitre. Bronchorrhcea (creasoton, 275; mo- nesia, 513.) INDEX OF DISEASES. 735 Brow-ague (ammoniated counter- irritants, 250.) Bruises (glycerin, 402.) Bubo (chlorin. aq. 194; iodinum, 456, 482; veratria, 685.) Ulcerated (creasoton, 269.) Burns (calcis chlorin. 156. 163 ; col- lodion, 234; creasoton, 265, 281; fuligo, 386; iodinum, 484; glycerina, 402; sodse chlorid. 645;sulphuriscarburetum,671.) Severe (compressio, 238.) Bursse, inflammation of the (iodi- num, 485-) Enlarged (iodinum, 478.) Cachexia (acid. acet. empyr. 14; chlorin. 187; fuligo, 385; iodide of iodhydrate of quinia, 611.) Marsh (quinise sulphas, 624.) Mercurial (auri prsepar. 119; jug- lans, 494.) See Dyscrasy. Tuberculous (ol.jecor. aselli, 554.) Calculous diathesis (acidum ben- zoicum, 18.) Pains (diosma, 294.) Calculus (chimaphila, 180; lithise carbonas, 717.) Biliary (chloroform, 204.) Expulsion of fragments of (ergo- ta, 326.) Phosphatic (acid. lact. 38.) Uric acid (ammonise phosphas, 7 7-) Vesical (chimaphila, 180.) Cancer (acid. acet. empyr. 15; aur. nitrico-muriat. 127; auri prse- par. 119; calcis chlorid. 155; ca- lendula, 150; electro-punctura, 307; fel bovinum, 708; ferr. arseniat. 337; ferr. subearb. 376; ferr. iodid. 354; fuligo, 388.) Of the breast (arsenici iodidum, 107; calendnla, 1£ 268; fuligo, 385.) Of the face (calx chlorin. 155; creasoton, 268; fuligo, 385.) Of the integuments (calendula, 151.) Of the lip (creasoton, 268.) Of the nose (fuligo, 385.) Open (carbo animalis, 174: chlo- roform, 199.) Of the pylorus (chloroform, 198.) Of the skin (creasoton, 268.) Of the tongue (iodin. 471.) Of the uterus (acidum hydrocy- auri nitromurias, Cancer of the uterus 127; calendula, 150; cannabis, 171 ; creasoton, 268 ; ferri sub- earb. 376 ; morphiae acetas, 526.) Cancerous tumour (auri nitro-mu- rias, 127.) Ulcers (acid, hydrocyan. 36 ; acid, tannic. 42; calendula, 151 ; calx chlorin. 155 ; carbo animalis, 175; chloriniaq. 194; fel bovin. 708; ferri subearb. 376; plumbi chlorid. 723; potass, iodid. 601; zinci chlorid. 689, 693.) Of the face (creasoton, 268.) Cancrum oris (acid. acet. empyr. 15; calcis chlorin. 156 ; chlorin. aq. 194; creasoton, 267; potassse chloras, 583; potassii iodidum, 599.) Carbuncle, sloughing (creasoton, 267.) Carbunculus malignus (aq. chlorin. 192, 194.) Carcinoma of the face (auri chlorid. 121.) Cardialgia (argenti oxidum, 99; ar- temisia, 111; calendula, 151; creasotum, 276; nux vomica, 542; quiniae sulphas, 624; sum- bul, 730; zinci ferrohydrocy- anas, 695.) Carditis (ammoniated counter-irri- tants, 250.) Caries of bones (acid. acet. empyr. 15; juglans, 493; ol. jecor. aselli, 555.) Of the fibula, &c. (creasoton, 268.) Scrophulosa (ol. jecoris aselli, 552; creasoton, 267, 280; iodin, 457.) < Syphilitica (iodinum, 488.) Of the teeth (calcis chlorid. 157; creasotum, 279; monesia, 515.) Catalepsy (strychnia, 660.) Catamenia, obstruction of the. See Amenorrhcea. Cataract (atropia, 114.) Disintegrated (carbo animalis, 175.) Incipient (ammoniated counter- irritants, 250.) Catarrh, chronic (acid, hydrocyan. 31 ; aq. tannicum, 41; aq. picea, 90, 91; chimaphila, 180; chlo- rin. 184, 187; emetia, 390; ga- leopsis grandiflora, 390; iodin. 459.) 736 INDEX OF DISEASES. Catarrh, pulmonary (galeopsis, 312; mannitum, 504.) Catarrhus urethrae (cubebae, 284.) Vesicae (acid, benzoic, 18; aq. pi- cea, 92; caincae radix, 149 ; cu- bebae, 284; diosraa, 295; matico, 509.) Cellular membrane, sloughing of the (iodinum, 482.) Cephalalgia (acupunct. 57.) Chronic (artemisia, 111.) Intense (potassii cyanuretum, 591.) Intermittent (quinia? sulphas,629. ) Nervous (acid, hydrocyan. 33; chloroform, 203; zinci ferrocy- an. 696; zinci valerianas, 700.) Periodical (zinci ferrohydrocyan. 696.) Syphilitic (hydrarg. cyanur. 416.) See Headach. Cerumen, defective (acid. acet. em- pyr. 16; creasoton ; 273; glyce- rin, 401.) Chalkstones (acidum benzoicum, 18.) Chancre (acidum tannicum, 43; argenti preeparat. 41 6; collodion, 235; creasoton, 269', 280; hy- drarg. cyanur. 416; iodinum, 484.) Phagedenic (iodinum, 484.) Chaps (collodion, 234 ; glycerin, 402; ol. jecin. aselli, 556.) Chest, diseases of the (chlorin. 184.) Affections of the (fuligo, 387.) Neuralgic affections of the (gal- vanism, 394.) Chilblains (calx chlorin, 156, 164; creasotum, 266, 281; iodinum, 483.) Ulcerated (monesia, 515.) Chlorosis (artemisia, 111; ferri ci- tras, 343 ; ferri pulvis, 335 ; ferr. iodid. 354; ferr. protocarbonas, 373; ferr. lactas, 360; ferri tan- nas, 380; ferri valerianas, 381; haemospasia. 713; mangane- sium, 720; paullinia, 570.) Cholera (cannabis indica, 170, 172; carbonis trichloridum, 705; chloroform, 204; creasotum, 276; diosma, 295; guaco, 408; morphiae acetas, 524 ; ferri nitras, 363; iodin.468; nux vo- mica, 542 ; quiniae sulphas, 625 ; strychnia ; 660; sumbul, 730.) Cholera morbus(artemisia,l 1 1; chlo- roform, 204; carbonis trichlori- dum, 705; ferri et alumin. sulph. 712; sumbul, 730.) Infantum (argilla pura, 102 ; fu- ligo, 385; monesia, 514.) Chordee (iodinum, 485; lupulina, 718.) Chorea (acid, hydrocyan. 32; can- nabis indica, 170; chloroform, 203 ; cimicifuga, 2 13 ; ferri sub- carb. 378; ferri ferrocyanur. 346; ferri iodidum, 355; iodi- num, 467; nux vomica, 542; ol. jecor. aselli, 556; potassii cyanuretum, 592; sanicula ma- rilandica, 726; strychnia, 659; sumbul, 730; veratria, 683; zin- ci chlorid. 690; zinci ferrohy- drocyanas, 696.) Colic (fuligo, 385; sumbul, 730.) Flatulent (aether, 70; chloroform, 199, 203.) Hysterical (ol. sinapis, 561.) Nephritic (aether, 70; chloroform, 203.) Colica pictonum (aether, 70; nux vomica, 541.) Coma (strychnia, 658; ol. tiglii, 566.) Concretions, tophaceous, (nux vo- mica, 542; acid, benzoic. 18.) Condylomata (argent, praeparat. 93 ; creasoton, 269; Hydrarg. deuto- iodid. 423.) Congestions (electro-magnetism, 302 ; electro-puncture, 307.) In the head (ammoniated counter- irritants, 250.) Conjunctivitis (collodion, 236; lac- tucarium, 497; zinci valerianas, 700.) Scrofulous (hydrargyri cyanure- tum, 416; potassii iodidum, 603 ) Constipation (aq. picea, 91; colchi- cum, 230 ; electro-magnetism, 298; fel bovinum, 710; galva- nism, 399; mannit. 504; nux vomica, 542; ol. tiglii, 566; strychnia, 661 ; veratria, 685.) Consumption, see Phthisis. Contagion (calx chlorin. 160; chlo- rin, 188; plumbi nitras, 724; zinci chlorid. 691.) Contractions, muscular, (acupunct. 56.) INDEX OF DISEASES. 737 Contusions (acupunct. 57; creaso- ton, 266; iodinum, 484.) Convalescence (berberina, 137.) Tedious (paullinia, 570.) Convulsions (aether sulphuric. 69; cimicifuga, 213; ammoniated counter-irritants, 250 ; auri praspar. 116; magnes. 499; moxa, 533; compression of ar- teries, 242; potass, cyanur. 592.) During dentition (chlorin. aq. 191.) Hysterical (compressio, 242 ; electro-magnetism, 298; indi- gum, 433.) Parturient (chloroform, 205; er- gota, 322; ether, 72.) Convulsive affections (acupunct. 56.) Diseases of childhood (artemisia, 111.) Cornea, granulations on the (fuligo, 386) Inflamed (collodion, 236.) Obscurity of the (calx chlorin, 158.) Opacity of the (acid, hydrocyan. 34; hydrarg. iodid. rubr. 423; iodinum, 485; ol. jecor. aselli, 553, 556; zinci ferrocyanuret. 696.) Sparks on the (iodinum, 485.) Specks on the (cadmii sulphas, 705; fuligo, 386.) Scrofulous ulcers of the (ol. jecor. aselli, 556.) Spots on the (fuligo, 386; zinci valerianas, 700.) Ulcers of the (argenti oxidum, 100; ol. jecor. aselli, 553; zinci ferrocyanuret. 696; zinci vale- rianas, 700.) Coryza (cubebae, 283.) Cough (chloroform, 199; potassii iodidum, 603; cimicifuga, 214; lactucarium, 498.) Asthmatic (naphthalin, 720.) Nervous (acid, tannic. 41.) Spasmodic (chloroform, 198; chon- drus, 211; lactucarium, 198.) Spasmodic, dry (fucus crispus, 211.) Coxalgia (iodinum, 476.) Coxarthrocace (ol. jecor. aselli, 556.) Cramp (ammoniated counter-irri- tants, 250 ; magnes, 499 ; Sum- bul. 730.) Cramp of the stomach (mix vomica, 545; zinci ferrohydrocyanas, 695.) Writers' (electro -magnetismus, iv.) Croup (haemospasia, 713; iodinum, 485; quinise sulphas, 624.) Hysteric (creasoton, 271, 278.) Crusta lactea (creasoton. 271.) Cutaneous diseases (acid, hydro- cyan. 33; anthrakokali, 80; arsenias ammonias, 105; aqua picea. 89; arsenic, iodidum, 107 ; auri chlorid. 121 ; auri cyanidum, 125; calx chlorin. 157; chlorin. 187; chlorin. jaq. 194; creasoton, 270; ferr. car- bur. 339; fuligo, 385; fuligokali, 389; glycerina, 400; hydrarg. deuto -iodid. 422; hydrargyri- protonitras, 427; hydrarg. deuto- nitras, 428; hyd.et arsen. iodid. 431; hyd. et quinise protochlo- ridum, 715; iodidum ammoniae, 490; iodid. sulph. 674; iodinum, 468; juglans, 494 ; manganesii sulphas, 719; naphthalin, 721; oleum cadinum, 722; ol. jecor. aselli, 555; potassae chloras, 583; potassii cyanuret. 592; quinise arsenis, 607; soda chlorin. 645; sodas hyposulphis, 727; sulphur iodid. 674.) Syphilitic (hydrarg. iodid. rubr. 592.) Cynanche (chlorin. aq. 193; cort. adstring. Brazil. 253.) Tonsillaris, see Sore Throat. Of scarlatina (ferri et aluminae sulphas, 712.) Cyst, serous, &c. (electro-punctura, 307; iodinum, 478.) Dacryocystitis (iodinum, 477.) Dartrous eruption (hydrarg. iodid. rubr. 423; iodinum, 477.) Deafness (acid. acet. empyr. 15; creasoton, 273; cubeba, 283; electro-magnetism, 296; elec- tro-punctura, 296; galvanism, 392 ; glycerin, 401 ; haemospasia, 713; injections of air. &c, in, 437 ^ sulphuris carburetum, 671.) Erethitic, nervous (injections of vapour of acetic ether, 437.) Nervous, torpid (injections of va- pour of ether, 437.) 738 INDEX OF DISEASES. Debility (ferr. iodid. 356; nux vom- ica. 539; piperina, 575.) General (quiniaB et cinchonas tan- nas, 635.) Nervous Cacid. tannic, 41 ; quiniae * sulphas, 630.) Paralysis (ammoniated counter- irritants, 250.) Decubitus gangraenosus (plumb, tan- nas. 581.) Delirium tremens (aether sulphuric. 69; animal magnetism, 399; ol. tiglii, 565 ; chloroform, 203 ; sumbul, 730.) Dentition (chlorin. aq. 191.) Depositions, morbid (electro-punc- ture, 308.) Diabetes insipidus (sumbul, 730.) Mellitus (creasoton, 277; acid, tannic. 40; ferri iodidum, 355; urea, 677.) Diarrhoea (acid. acet. empyr. 15: acid, tannic. 44; aq. picea, 91; argilla, 101: artemisia, 111; carbo animalis, 174; chondrus. 211; ferri et alumini sulph. 712; fuligo, 385; indigum, 432; liq. ferr. persesquinit. 363; monesia, 514; nux vomica. 542; paulli- nia, 570; Spiritus pyroaceticus, 648; strychnia. 660; sumbul, 730; veratria, 685.) Bloody (acid, gallic, 21.) Choleric (nux vomica, 542.) Chronic (acid, tannic. 41 ; argent, chlorid. 95; argent, oxid. 100; emetia, 312; ferr. cyanuret. 347; ferri iodid. 363 : ferri et alumin. sulphas, 712; matico, 509 ; mor- phia? acetas, 526; nux vomica. 542.) Of phthisis (ferri nitras. 363; mo- nesia, 514.) Of infants (iodinum. 485.) Diathesis phthisica (chlorin. aq. 194.) Digestive function, torpor of the (cainca, 148; chimaphila, 180; gentiana chirayita, 399 ; hippo- castanum. 410; monesia, 514.) Diplopia (acupunct. 57.) Discharges from the meatus audi- torius(acid.acet.empyreum.l5.) Mucous ( cortex adstringens Brazil. 253; creasoton, 270; hippocas- tanum. 410; ferri et alumina? sulph. 712; fuligo, 385.) Discharges from the nose and ear (iodinum, 458, 472.) Offensive (acid. acet. empyr. 15.) From the vagina (fuligo, 386.) Disinfection (chlorin. 188; chlorin. aq. 194; zinci chlorid, 691.) Districhiasis (collodion, 236.) Dropsy (acid, hydrocyan. 32; acid, acet. empyr. 15; aur. chlorid. 121 ; auri et sodii chlorid, 124 ; auri praeparat. 119; ballota la- nata, 131; benzoate of ammo- nia, 19; caincee radix, 148; chimaphila, 180; chlorin. aq. 194; cimicifuga, 213; colchi- cum, 229; compressio, 237; electro-punctura. 307; ferr. iodid. 356; hippocastanum, 411 ; ibe- ris, 716 ; iodinum, 480 ; ol. sina- pis. 463; ol. tiglii, 563; potassii iodohydrargyras, 594 ; sumbuli radix. 730; urea, 677; veratria, 684, 636.) After intermiltents (quiniae sul- phas, 623; ferri iodid. 363.) Of the bursae (iodin, 465.) Encysted (acupunct. 58.) Of the joints (electro-punct. 307.) Of the ovary (compressio, 237 ; iodin. 479.) Of the pericardium (electro-punc- ture, 307.) After scarlatina (colchicum, 229 ; iodin. 464 ; potassii iodid. 597 ) Drunkenness(sulphuris carburetum. 671.) Dumbness (galvanism. 392.) Dyscrasy (ferr. iodid. 356 ; sufphu- ris carburetum, 671.) After intermittents (ferr. cyanur. 347.) See Cachexia. Dysentery (aq. brocchieri, 89; ar- genti chloridum, 95; argilla, 100; artemisia, 111 ; calx chlorinata; 154; chondrus, 211; eau hemas- tatique de Tisserand, 89: er- gota, 323; ferr. cyanur. 347; ferri et aluminae sulphas, 712; fuligo, 385; nux vomica, 542; paullinia, 570; strychnia, 660.) Camp (creasotum, 277.) Chronic (creasotum, 277.) Putrid (chlorin. aq. 193.) Dysmenorrhcea (aether. 70; chloro- form, 204; ergota,323 ; electro- magnetism, 300; potassii iodo- hydrargyras, 594; veratria, 684.) INDEX OF DISEASES. 739 Dyspepsia (acid. lact. 41 j acid, tan- nic. 41 j argil, 102; berberina, 137; carbo animalis, 174; chi- maphila, 180; diosma, 294 ; fel bovinum, 710 ; ferr. iodid. 354; fuligo, 387; gentiana chirayita, 399; hippocastanum, 410; ma- tias, 505 ; nux vomica, 542; ol. sinapis, 561 ; piperina, 574 ; po- tassii iodohydrargyras, 593; qui- nias sulphas, 618 ; salicina, 640 ; strychnia, 659; sumbul, 730.) Dysphagia (artemisia, 111.) Spasmodic (acid, hydrocyan. 32.) Dyspnoea (galvanism, 392 ; potass, cyanur. 592.) Dysuria (acidum benzoicum, 18; apis mellifica, 704 ; chimaphila, 180.) Ear affections (cadmii sulphas, 705. ) Middle, affections of the mucous membrane of the (iodinum, 477.) Pain in the (morphia, 523.) Eclampsia infantum (artemisia, 111.) Ectropion (collodion, 236.) Eczema (auri chlorid. 121; bromi- num, 144; ferri arsenias, 337; juglans, 494; ol. cadinum, 72; ol. jecoris aselli, 556; sulphur. iodid. 675.) Effused fluid (electro- magnetism, 302.) Effusions, rheumatic (electro-mag- netism, iv.) Elephantiasis (ferri arsenias, 337; iodinum, 469 ; hura Brasiliens. 715.) Emaciation (chondrus, 211.) Empyema (iodinum, 480.) Engorgements, visceral (ferr. iodid. 356.) Enlargements, glandular, scrofulous (potassii iodohydrargyras, 593.) Enteralgia (acid, hydrocyan. 32.) Enteritis (acid, hydrocyan, 31.) Chronic (monesia, 514.) Entropion (collodion, 236.) Ephelis (hydrarg. et arsen. iodid, 431.) Epilepsy (acid, hydrocyan. 32; acu- punct.57; ammoniated counter- irritants, 250; argenti chlori- dum, 95; artemisia, 108; com- pression of arteries, 242; conia, 708; creasoton, 277; ferr. cya- nur. 346; galvanism, 393; gra- Epilepsy natum, 407 ; indigum, 432 ; iodi- num, 467; magnes. 499; nux vomica, 542; monesia, 515; platinum, 577; Sumbul, 730; strychnia, 660; iodide of zinc and strychnia, 666; zinci vale- rianas, 700; zinci chlorid. 690; zinci ferrohydrocyanas, 695.) Epistaxis (argento oxidum, 100; cort. adstring. Brazil. 253; crea- soton, 263; ergota, 325; matico, 510; ferri etalumini sulph.712; monesia, 515.) Erectile tumours (collodion, 235 ; electro-punctura, 307 ; ol. tiglii, 565.) Erections, nocturnal (lupulina, 718.) Erethism, morbid (creasotum, 278; potassse chloras, 582.) Ergotism, 316. Erysipelas (argilla, 101 ; chlorin. aq. 193; colchicum, 229 ; compres- sio, 238; creasoton, 270; iodin. 481; ol. jecoris aselli, 596; zinci. chlorid. 692.) Of the face (cort. adstring. Brazil. 253.) Erythema, chronic (collodion, 234.) Eustachian tube, obstructed (injec- tions of air, &c. 437.) Exanthemata, febrile (chlorin. aq. 192.) Exanthematous diseases (cort. ad- string. Brazil. 253.) Excitability (acid, tannic. 41.) Excoriation from lying (creasoton 266.) Of the skin (oleum jecoris aselli 556.) Syphilitic (aurum metallicum 129.) Excrescences, adventitious (iodi num, 485 ) Syphilitic (aurum metallicum 129.) Exostosis (fuligo, 385.) Expectoration, excessive (acidum gallicum, 22.) Of phthisis (argenti oxidum, 100; iodin. 461.) Fetid (calx chlorinata, 154.) Eye, black (calcis chlorid. 156.) Cancer of the (morphia, 523.) Diseases of the (cadmii sulphas, 705; iodinum, 458; potass, cy- anuret. 59.) 740 INDEX OF DISEASES. Eye, painful affections of the (mor- phia, 523 ) Strumousulcerationsof the (aether sulphuric. 71.) Eyelid, inflammation of the (crea- soton, 272; ol. jecoris aselli, 553; zinci ferrocyanuret. 696 ; zinci valerianas, 700.) Granular (auri chlorid, 121; calx chlorin, 158; iodin, 485; ol. je- coris aselli, 553.) I Perverted states of the (collodion, 236.) Fainting, hysteric (sulphnris carbu- retum, 671.) Fauces, ulcerated, (iodinum, 485.) Febrile affections (chlorin. aq. 193; colchicum, 227; potass, nitras, 725.) Diseases (morphia, 520.) Feigned diseases (aether sulphuri- cus, 71; chloroform, 204.) Fetid discharges (aluminae sales, 76.) Fever, brain (compression of arte- ries, 242.) Congestive (quinise sulphas, 621.) Of Edinburgh (calx chlorinata, 154.) Gastric (artemisia, 111; chlorin. aq. 193.) Hectic (acid. hydrocyan. 31; chlorin. aq. 194.) Intermittent, see intermittent. Irritative (chlorin. aq. 191.) Masked (salicina, 640.) Malignant (quiniae sulphas, 620.) Nervous (chlorin. aq. 192.) Paroxysmal (quiniae sulphas, 620.) Pernicious, (quiniae sulphas, 620.) Petechial (aq. chlorin. 192.) Putrid (acid. acet. empyr. 15; chlorin, aq. 192.) Puerperal (potass, nitras, 725.) Remittent, see Remittent. Summer (quiniae sulphas, 630.) Typhoid, see Typhoid. Typhous (sodae chloridum, 644.) Yellow (guaco, 409 ; quin. sulphas, 621.) See Typhus. Fissures of the anus (acid, tannic. 42, 44; monesia, 515.) Of the nipple (collodion, 235.) Of the lips (glycerin, 402.) Of the skin (creasoton, 266; ol. jecor. aselli, 556.) Fistulae (acid, hydrocyan. 33; calcis chlorid. 155; galvanism, 395; ol. jecoris aselli, 559; potass. iodid. 602.) Fistulous openings (iodinum, 485.) Flatulence (creasoton, 277; juglans regia, 494; sumbul, 730.) Fluor albus, see Leucorrhcea. Fluxes (acid, gallic. 22.) Foetor oris (calx chlorin. 154, 161, 162; chlorin. aq. 194; chloro- form, 199; creasotum, 279.) Follicular affections of the skin (collodion, 234.) Fractures, ununited (acupuncture, 59; iodinum, 485. Freckles (hydrargyri deutonitras. 428.) Frost bites (calx chlorin. 157, 163.) Gangrenous, (zinci chlorid. 692.) Fungoid disease (chloroform, 198.) Fungous tumour (creasoton, 268; galvanism, 395; zinci chlorid. 689.) Fungus of the neck of the uterus (aur. nitrico. muriat. 127.) Furunculous swellings (aq. chlorin. 192.) Ganglion (acupunct. 59 ; hydrarg. iodid. rubr. 423; iodinum, 485.) Ganglionic system, disorder of the (ferr. cyanur. 348.) Gangrene (acid. acet. empyr. 14; calcis chlorid. 156; soda chlo- rinata, 645.) Hospital (calx chlorin. 154, 156, 163; creasoton, 267.) Of the lungs (chlorin. 185.) Of the scrotum (calx chlorin. 156.) Gangrenous sloughs (monesia, 515.) Gastralgia (bismulhi valerianas,704 : cinchona, 217; morphias acetas, 524; strychnia, 661; zinci iodid. 698) Gastricism (carbo animalis, 174; mannitum, 504.) Gastritis (codeia, 222.) Gastrodynia (acid, hydrocyan. 32; acupunct. 57; argenti oxidum, 99; bismuthi valerianas, 704; creasoton, 276; nux vomica, 542; ol. sinapis, 561.) Gastromalacia (acid. acet. empyr. 15; chlorin. aq. 193.) Genital organs, atony of the (cube- bae, 282; cort. adstring. Brazil. 253 ; nux vomica, 539.) INDEX OF DISEASES. 741 Genital organs, catarrh of the (cortex adstringens, 253.) Glanders, chronic (creasoton, 278.) Glands, enlarged (carbon', sesqui- iodid. 177; iodinum. 457, 459; plumbi iodid. 580. Induration of the (fuligo, 385; hydrarg. deuto-iodid. 422, 424.) Mammary, enlarged ( veratria, 685.) Meibomian,copious secretion from the (calx chlorin. 158.) Mesenteric, enlarged (iodinum, 456.) Of the neck, inflamed (hydrarg. iodid. rubr. 423.) Scrofulous swellings of the (calx chlorin. 157; chlorin. aq. 194; iodide of chloride of mercury, 492; iodinum, 457, 483.) Submaxillary, enlarged, (carbo animalis, 175; iodinum, 456.) Tumefied, strumous (hydrarg. iodid. 419 ; potassii hydrargyro- iodid. 594.) Glandular affections (auri chlorid. 121; fuligo, 385; iodinum, 455; veratria, 685.) Gleet (calx chlorin. 159; creasoton, 269; cubebse, 284; ergota, 330; nux vomica, 544; potassii iodi- dum, 599.) Old (tanninum, 144; strychnia, 661.) Goitre (brominum, 144; calcis chlo- rin. 164; electro-punctura, 307; hydrarg. deuto-iodid. 423; io- dinum, 454, 475; potassii bro- mid. 586; potass, iodid. 600.) Scirrhous (carbo animalis, 174, 176; sulphuris carburetum, 671 ; veratria, 685.) Gonorrhoea (acidum tannicum, 41; argenti preeparat. 93; auri prse- par. 118; calcis chlorin. 154, 159, 161, 162; chlorin. aq. 194; colchicum, 229; creaso- ton, 269; cubebse, 282; diosma, 295; ergota, 323; ferri iodid. 358; hydrargyri deuto-nitras. 428; iodin. 471; lupulina, 718; matico, 509; platinum, 576; zinci chlorid. 693; zinci iodid. 698.) See blennorrhcea. Gout (aconit. 49; acupunct. 56; am- nion, phosphas, 77; ammoniated counter-irritants, 250; ballota 48 Gout lanata, 131; benzoate of ammo- nia, 226, 231; colchicum, 131; compression of arteries, 242 ; creasoton, 275 ; glycerin, 402 ; hsemospasia, 712; iodinum, 475; magnes. 482; manganesii sul- phas, 719; moxa, 531; ol. tiglii, 564; ol. jecinor. aselli, 549; spiritus pyroaceticus, 648; suc- cus limonis, 729; sulphuris car- buretum, 670; veratria, 683.) Atonic (creasotum, 276, 279; hip- pocastanum, 410.) Chronic (chimaphila, 180; colchi- cum, 228; diosma, 294 ; ol. tig- lii, 564; succus limonis, 728.) Irregular (strychnia, 659.) Rheumatic: (auri chloridum. 121.) Suppressed (ammoniated counter- irritants, 250.) Gouty diathesis (acidum benzoicum, 18; veratria, 685.) Swellings of bones (iodin. 475; ol. jecoris aselli, 558; potass, iodid. 602.) Of the joints (iodinum, 475.) Gravel (diosma, 295.) Gravel, uric acid (amraon. phos- phas, 78; sodas phosphas, 728.) White (acid. lact. 38.) Growths, morbid (barii iodidum, 132; electro-magnetism, 302; galvanism, 395.) Gums, affections of the (chloroform. 199.) Sponginess of the (acid, tan- nic. 41, 44.) Gums, scorbutic ulcerations of the (creasoton, 267, 280; icdin. 476; monesia, 515.) Gutta rosacea (fuligo, 385; sulph. iodid. 674.) Hsematemesis (argent, oxid. 100; creasoton, 265; ergota, 332; matico, 510.) Hsematocele (iodinum, 479.) Heernaturia (acidum gallicum, 21; creasoton, 265 ; diosma. 294 ; ergota, 323.) Haemoptysis (acidum gallicum, 21; chondrus, 212; aq. Brocchieri, 89; argent, oxid. 100; cort. adstring. Brazil. 253; creaso- ton, 265 ; eau htmastatique de Tisserand, 89; ergota, 323; ga- leopsis, 391 ; lactucarium, 498 ; 742 INDEX OF DISEASES. Haemoptysis monesia, 513; plumbi nitras, 723; tannin, 42.) Hair, thinness of the (glycerin, 402.) Heaclach, intermittent (bebeeria, 35; quiniae sulphas, 632.) Rheumatic, (creasoton, 276.) Nervous (strychnia, 659; ammo- niated counter-irritants, 250; iodin. 467 ) See Cephalalgia. Hearing, defective, from otorrhcBa (cubebae, 233.) Heart, diseases of the, (acotiitia, 50 ; veratria, 685.) Enlargement of the (acid, hydro- cyanic, 32.) Hypertrophy of the (brominum, 144; iodin. 470 ; potass, bromid. 587; potass, iodid. 599.) Neuralgia of the (aconitia, 50.) Spasmodic affections of the. (acid, hydrocyan. 32.) Hectic fever (acid. hydroc)^an. 31; chlorin. aq. 194.) Helminthiasis (juglans, 494.) Hemicrania (acid, hydrocyan. 33; aether, sulph. 70; aconit. 51; compression of arteries, 242; ferri subcarb. 377; paullinia, 570; potassii cyanuretum,592; zinci valerianas, 699.) Hemiplegia(electro-magnetism,296; nux vomica, 540 ; strychnia, 657.) Rheumatica (electro - magnetis- mus, iy.) Hemorrhage (acid, hydrocyan. 31 ; aq. Binelli, 82; aq. Brocchieri, 89; acid, tannicum, 40, 44; argilla, 101 ; cort. adstring. Bra- zil. 253 ; creasoton, 261; ergota, 523, 332; ferr. iodid. 356; ferri etalumin. sulphas, 712; matico, 507.) After abortion (creasoton, 265.) From arteries of the lower limbs (compression of the aorta, 243) Active (acid, hydrocyan. 31 ; er- gota, 330.) Capillary (creasoton. 264; mati- co, 505.) From the ljuitis (creasoton, 264.) Intestinal (aqua Brocchieri, 89; argenti oxyd. 100; creasoton, 265; eau hemastalique de Tis- serand, 89; ferri nitras, 363; matico, 509.) Hemorrhage from leech-bites (crea- soton, 263; ferri et aluminae sul- phas, 712; matico, 508.) From the lungs. See Haemopty- sis. Passive (acid, gallic. 22.) Traumatic (creasoton, 265.) Uterine (acidum gallicum, 21; acid, tannic. 40, 43, 44; canna- bis indica, 171; creasoton, 264; argent, oxidum, 99 ; compres- sion of the aorta, 243 ; electro- magnetism, 299 ; ferr. iodid. 355; haemostasis, 714; matico, 510; monesia, 514; ergota, 322, 332; ferri citras, 343.) From the vagina, and tongue (matico, 508.) Hemorrhagic diathesis (acid. tannic. 41 ; matico, 508.) Hemorrhoids (acid, tannic. 41, 42; acid, chrom. 701; acid, nitric. 702; cotyledon umbilicus, 707; matico, 509; monesia, 515.) Hepatic diseases. See Liver Affec- tions. Hernia humoralis. See Orchitis. Incarcerated (sulphuris carbure- tum, 671.) Reducible (iodinum, 479.) Herniary sacs (acupunct. 58.) Herpes (acid, hydrocyan. 33 ; aqua picea, 89; calcis chlorin. 157; chlorin. aq. 194, 195 ; creasoton, 271; collodion. 234; ferr.carbur. 339 ; fuligo, 385 ; hydrarg. cya- nur. 416; hydrarg. deuto-iodid. 423; iodin. 468; juglans, 494 ; ol. jecinor. aselli, 555 ; potass, bromid. 587; potass, iodid. 598; sulphur, iodid. 674.) Circinnatus (ferri tannas, 380.) Exedens (creasoton, 271; potassii iodidum, 601.) Phagedenic (arsenic, iodat. 107; potassii iodidum, 603 ) Scrofulosus exedens (hydrargyri deuto-nitras, 428.) Herpetic ulcers (acid. acet. empyr. 14; creasoton, 267.) Hiccough, spasmodic (aether, 70; compressio, 243; ferri nitras, 363; man'nes. 499; quiniae sulphas. 624.) Hip-joint disease (moxa. 534.) Hoarseness (chondrus, 211; iodic acid, 491; ol. tiglii, 561.) INDEX OF DISEASES. 743 Hooping-cough (acid, hydrocyan.31 35 ; acid, tannic. 41 ; aether hy drocyan. 61; aether sulphur. 70 argent, iodid. 98; conia, 707 chloroform, 203 ; emetia, 312 ferr. carb. 376; iodin. 463; ol. tiglii, 564 ; veratria, 684.) Hordeolum (hydrarg. iodid. rubr. 424.) Hydrarthrosis ( electro - punctura, 307; iodinum, 478.) Hydrocele (acupunct. 58; electro- magnetism, 302 ; electro-punc- ture, 307; chlorin. 187; iodinum, 463, 477.) Hydrocephalus (compressio, 237; electro-punctura, 307; hydrar- gyri cyanuretum, 416; iodinum, 464.) Hydrocyanic acid, poisoning by (chlorin. 186; chlorin aq. 190.) Hydropericardium (electro punc- tura, 307; iodinum, 479-) Hydrophobia (aether sulphuric. 69; cannabis indica, 170, 172; chlo- rin. aq. 194; chloroform, 203; compression of the arteries, 244; guaco, 408; morphias acetas, 525.) Hydrothorax (acid, hydrocyan. 32; colchicum, 229; electro-punct. 307; ferri iodid. 356; iodinum, 463, 479.) Hygroma (iodinum, 465.) Hyperaemia (ammoniated counter- irritants, 251.) See Inflamma- tion. Hyperesthesia (conia, 706.) Hyperemesis (acid, tannic. 42.) Hypertrophy (barii iodidum, 132; compressio, 237; ferr. bromid. 338; ferr. iodid. 356.) Of the coats of the stomach (sulph. carburet. 671.) Of the heart (bromidum, 144; di- gitalina, 292; iberis amara, 716: iodin. 470; potass, bromid. 586; potass, iodid. 599, 600.) Of the mammas (iodinum, 456.) Of the spleen (iodin. 455; quiniae sulph. 605.) Of the thymus (iodin. 456.) Of the uterus (ergota, 325.) With dropsy (iberis, 716.) Hypochondriasis (auri pra3parat,116; chlorin. 187; quiniae sulphas, 625; strychnia, 659; veratriae, 683.) Hysteralgia (euphorb. ol. 334.) Hysteria (aether sulphuric. 70 ; cimi- cifuga, 213; creasoton, 278 ergota, 324; ferri valerianas, 381 fuligo, 387; granatum, 407; in digum, 434; lactucarium, 498 strychnia, 659; sumbul, 730 veratria, 683; zinci ferrohydro- cyanas, 695.) Hysteric croup (creasoton, 278.) Fainting (sulphuris carburetum, 672.) Convulsions (electro-magnetism, 298; indigum, 433.) Hysterics (ammoniated counter-ir- ritants, 250.) Ichthyosis (glycerina, 401.) Impetigo (acid, hydrocyan. 33, 36; arsen. iodid. 107 ; creasoton, 280 ; hydrarg. et arsen. iodid. 430; juglans regia, 494; oleum cadi- num, 722; ol. jecin.aselli,556.) Impotence (cubebae, 284; diosma, 295 : iodinum, 481 ; nux vomi- ca, 541.) Incontinence of urine (diosma, 295; ergota, 326; galvanismus, 392; iodin. 468; nux vomica, 539, 541; potassae nitras, 726.) Indigestion. See Dyspepsia. Indurations of the abdomen (arnica,. 104.) Glandular, chronic (carbo anima- lis, 174; electro-punctura, 307; fuligo, 385; hydrarg. deuto-io- did. 424.) Of the liver (iodinum, 455 ) Of the mammae (calendula, 151.) Of the pancreas (carbo animalis, 175; iodin. 456.) Of the spleen (iodinum, 455.) Of the stomach (calendula, 151.) Of the testes (iodinum, 456.) Chronic (calendula, 151.) Of the mammae (carbo animalis, 175.) Inflammation (acid, hydrocyan. 31; aconitia, 48 ; compression of ar- teries, 238; conia, 707.) Of the absorbents (iodinum, 482.) Of the air passages (iodinum, 485.) Of the bursae (iodinum, 485.) Of the bronchia. See Bronchitis. Chronic (acid, hydrocyan. 31: barii iodidum, 132; iodic acid, 491; ol. croton. 564.) 714 INDEX OK DISEASES. Inflammation, chronic, of the Eusta- chian tube (injections into the Eustachian tube, 436.) Of the lungs and stomach (ol. jecor. aselli, 554.) Of the cornea (collodion, 236.) Of the mouth and fauces (chlorin. aq. 196.) External (compressio, 238.) Of the heart. See Carditis. Internal (acid, hydrocyan. 31.) Of the joints (iodinum, 482.) Of the liver (chlorin. aq. 194.) Of the lungs (ammoniated coun- ter-irritants, 250.) See Pneu- monia. Of the mamma (iodinum, 482.) Of the pleura (ammoniated coun- ter-irritants, 250.) Scrofulous (iodinum, 488.) Synovial (compressio, 238.) Thoracic (acid, hydrocyan. 31.) Of the trachea (ammoniated coun- ter-irritants, 250.) Of the vagina (collodion, 235.) Inflammatory diseases (colchicum, 226; compressio, 238; cort. ad- string. Brazil. 253; morphia, 520; ol. sinapis, 561; potass. nitras, 725.) Insanity (aether sulphuric. 69; chloro- form, 203; quiniae sulphas, 625.) Integuments, lesions of the (creaso- ton, 266.) Intermittent (adansonia digitata 703; aether, 70; argent, limat 101; bebeeria, 135; cetrarina 178; chlorin. aq. 193; chloro form, 199; cinchonia, 217; co | nia, 707 ; cubeba, 283 ; ferr. sub carb. 378 ; ferrocyanur. 347 gentiana chirayita, 399; hippo castanum, 410; indigum, 432 iodin. 465; matias, 505; nar cotina, 537; phloridzina, 572 piperina, 574; quinia, 604; qui niae arsenias, 606; quiniae arse nis, 607; quinia, iodide of iodhy drate of, 611; quiniae lactas 612; quiniae murias, 613; qui niae sulphas, 617, 623, 629 ; qui niae valerianas, 634; quiniae e cinchon. tannas, 636; quiniae sul phas impurus, 636; resina chi nae praepar. 636; salicina, 638 6anicula marilandica, 726; soda chlorin. 644; strychnia, 661.) Intertrigo of children (collodion, 234 ; creasoton, 266.) Intestines, atony of the (ferri ferro- cyanur. 347.) Ulceration of the (monesia, 514.) Iodina, 451. Iodine disease, 451. Iodine, stain from (potassii cyanu- retum, 591.) Iodism, 451. Iodkrankheit, 451. Iodosis, 451. Iralgia (quinia? sulphas, 629.) Iris, adhesion of to the lens (arte- misia, 115.) Iron, sparks of, removed from the eye (iodinum, 485.) Irritable habits (ferri subcarbonas, 379.) Ischias (oleum sinapis, 561; veratria, 682.) Ischuria (apis mellifica, 704; col- chicum, 229; sumbul, 730.) Issues, formation of (zinci chlorid. 690.) Isthmitis, atonic (chloroform, 198; ferri et aluminae sulphas, 712.) Itch (calx chlorin. 157, 163 ; chlorin. aq. 194, 195; creasoton, 271; fuligo, 385; iodinum, 469; man- ganesii sulphas, 719 ; sapo mol- lis, 641 ; oleum cadinum, 721 ; zinci chlorid. 692.) Inveterate (hydrarg. iodid. rubr. 422; ol. jecor. aselli, 555.) Itching (aquaamygdalarum concen- trata, 81.) Jaundice (fel bovinum, 709.) With liver disease (iodinum, 456.) Joints, inflamed (iodinum, 482.) Anomalous pains of the (iodinum, 482.) Chronic inflammation and En- largement of the (iodinum, 482.) False (iodinum, 476.) Rheumatic (iodin. 476; mor- phia, 521.) Swelled (ammoniated counter- irritants, 250; chimaphila, 181; calx chlorin. 157, 164; iodinum, 458; veratria, 685.) Keratitis (collodion, 236.) Kidneys, diseases of the (diosma, 295.) Bright's disease of the (acid, gal- lic. 22.) INDEX OF DISEASES. 745 Kriebelkrankheit, 317. Labia pudendi. infiltration of (crea- sotum, 267.) Offensive affections of (creasoton, 267.) Labour, premature, inducing (ergo- ta, 322, 329.) Tedious (cannabis indica, 172; electro-magnetism, 299.) Languor (acid, tannic. 41.) Laryngismus stridulus (asther, 70.) Larynx, chronic engorgements of the (iodinum, 463.) Nervous affections of the (conia, 707.) Spasmodic affections of the (vera- tria, 684.) Leech-bites, hemorrhage from (crea- soton, 263; matico, 508) Lepra (arsen. iodid. 107; auri prae- parat. 119; carbon, sesqui-iodid. 177; chlorin. 187; ferri arsenias, 337; glycerina, 401; hura Bra- siliensis, 715; hyd. et arsen. iodid. 430; iodidum ammonii, 490; naphthalin, 721; sulphur, iodid. 674.) Leucophlegmatia after intermit- tent (ferri ferrocyanu return, 347) Leucorrhoea (acidum gallicum, 22; acid. tannicum, 41; argent, oxyd. 100; chlorin. aq. 194; colchi- cum, 229; cort. adstring. Bra- zil. 253; creasoton, 269; ferri et alumin. sulph. 712; gentiana chirayita, 400; cubebee, 283; ergota, 323. 330; ferr. iodid. 355, 358; iodinum, 471; juglans re- gia, 494; liq. ferr. persesquinit. 363; matico, 509; monesia,514; platin. 576; potassii iodhydrar- gyras, 594; potassii iodidum, 5S9; salicina, 640.) Lichen (ferri arsenias, 337; glycerin. 402; potassii cyanuretum, 592.) Leproides (ferr. earbur. 340.) Urticatus (hydrarg. et arsenic, iodid. 431.) Lipomatous cysts (electro-punctura, 307.) Lips, chapped (glycerin. 402.) Litfiuria (acidum benzoicum, 18; ammon. phosphas, 78; leuco- lein, 717; lithiae carbonas, 717; sodse phosphas, 728.) Liver, affections of the (potassae chloras, 583; berberina, 137; chlorin. 187; iodin. 456.) Enlarged (iodinum, 456.) Induration of the (hydrarg. deuto- iodid. 424; iodinum, 455, 463.) Inflammation of the (chlorin. aq. 194.) Obstruction of the (hydrarg. iodid. 419.) Tubercles of the (iodinum, 463.) Lumbago (acupunct.57; ammoniated counter-irritants, 250, 251; chlo- roform, 199; emetia,311; iodin. 475; veratria, 683.) Lungs, affections of the (cimicifuga, 213; chlorinum, 184.) Gangrene of the (chlorin. 185.) And stomach, chronic inflamma- tion of the (ol. jecor. aselli, 554.) Mucous affections of the (crea- sotum, 275.) Ulceration of the (chlorinum, 184 ; creasotum, 274.) Lupus (auri chlorid. 121; collodion, 234; ferri arsenias, 337; ferri protocarb. 376; hydrarg. et ar- sen. iodid. 430 ; hydrarg. deuto- iodid. 425; hydrarg. deuto-ni- tras, 428; hydrarg. et quinise protochlorid. 715; iodin. 469, 483; oleum cadinum, 722; ol. jecoris aselli, 555; zinci chlo- rid. 690.) Nou exedens (collodion. 234; sul- phur, iodid. 674.) Of the ala nasi (ferr. carb. praec. 377.) Of the nose (creasoton, 268.) Luxations (diosma, 295.) Lymphatic glands, indurated (sul- phuris carburetum, 671.) Lymphatism (ferr. iodid. 355.) Malignant disease (ferri citras, 343.) Mammary tumour, chronic(iodinum, 456; potassii iodidum, 602; ve- ratria, 685.) Mammae, hypertrophied (iodinum, 456; potassii iodidum, 602.) Indurated {carbo animalis, 176; iodinum, 456.) Inflamed (iodinum, 482.) Painful tumours of the (potass, iodid. 602.) Mania (cannabis indica, 171.) Hydrophobic (chloroform, 203.) 746 INDEX OF DISEASES. Mastitis (collodion, 235; iodinum, 482.) Measles (chlorin. aq. 193; iodin. 467.) Melaena (matico, 509.) Melicerous cysts (electro-punctura, 307.) Membranes, false (acid, tannic. 41.) Meningitis, tubercular (iodin. 464.) Menorrhagia (acidum gallicum, 21; argent, oxid. 100; cannabis in- dica, 171; cort. adstring. Bra- zil. 253; electro -magnetism, 299 ; ferr. cyanur. 347 ; matico, 509; monesia, 514.) Mental affections (auri prseparat. 116; ol. tiglii, 505.) Mesenteric glands. See Glands, mesenteric. Metritis (acid, hydrocyan. 31.) Metrorrhagia (cort. adstring. Brazil, 253; monesia, 514.) See He- morrhage, uterine. Miasmata, destroying (calx chlorin. 157.) Milzbrandkarbunkel (chlorin. aq. 192; zinci chlorid. 689.) Mortification, mildew, 316. Mouth, inflammation of the, chronic (chlorin. aq. 196.) Offensive conditions of the (calx chlorin. 157.) Ulcers in the (calx chlorinata. 162.) Mucous membranes, irritability and tenderness of the (liquor ferri persesquinitrat. 363.) Inordinate secretion from (chima- phila, 180; ol. sinapis, 561.) Mutism, paralytic (electro-punctur. 307.) Mydriasis (ergota, 325.) Naevi (collodion, 235; creasotum. 273; ol. tiglii, 565; zinci chlo- rid. 689.) Necrosis (iodinum, 458; zinei chlo- rid. 689.) Nephralgia (chimapbila, 180; chlo- roform, 203.) Nephritis (acid, hydrocyan. 31.) Nervous coughs (tanninum, 41.) Diseases (acidum hydrocyani- cum, 32; ammoniated counter- irritants. 251; auri praeparat. 116; cort. adstring. Brazil. 253: creasoton, 277; electro-punctur. 307; ferr. carb. prsec. 377 ; ferr. Nervous diseases cyanur. 347; fuligo, 387; gal- vanism, 395; iodinum, 467; magnes. 499; morphia, 522; morphias acetas, 524; ol. sina- pis, 561 ; quiniee sulphas, 632; surnbul, 730; veratria, 682 ; zinci ferrohydrocyanas, 695.) Chronic (acid, hydrocyan. 32; liq. argent, muriat. ammoniat. 96.) Excitement (lactucarium, 497.) Neuralgia (acid, hydrocyan. 32, 33; aconitia, 49, 51; acupunctura. 56; aether sulphuric. 70; am- moniated counter-irritants, 252; atropia, 115; chloroform, 199. 203; bebeeria, 135; bismuthi valerianas, 704; cannabis indi- ca, 169; compression of arte- ries, 242; conia, 706; contra- irritatio, 249; creasoton, 277; delphinia, 289; electro-magnet. 296, 298; electro -punct. 303; ferr. carb. preec. 376; ferr. ferro- cyanur. 347; galvanism, 392; glycerin, 402; iodin. 467; mag- nes. 499; morphia, 521; mor- phiae acetas, 524; morphiae bi- meeonas, 530; moxa, 534; nux vomica, 542; ol. sinapis, 561; ol. tiglii, 564; potass, cyanur. 590; quiniee arsenis,607; strych- nia. 659; veratria, 682. 686; zinci ferrohydrocyanur. 696.) Of the abdomen (codeia, 222.) Of the arm (strychnia, 659.) Of the chest (galvanism. 394.) Faciei (acid, hydrocyan. 33; artemisia. 111; codeia, 222; compression of the arteries, 242; conia, 707; creasotum. 277; ferri ferrocyanar. 347; morphia, 522; nux vomica, 542: potassas chloras. 583; potassii eyanuretum, 590, 592.) See Tic Douloureux. Frontal (galvanism, 398; morphia, 522.) Of the head (cannabis indica. 171.) Of the heart (aconitia, 50; magnes. 499.) Of the nervns pudendus superior T (compression of the arteries, 242.) Obstinate (zinci valerianas, 700.) INDEX OF DISEASES. 747 Neuralgia of the orbitar nerves (compression of the arteries. 242.) Pulmonary (magnes. 499.) Rheumatic (electro-magnetismus, iv.) Sciatic (morphia, 523; potassii cyanuret. 590.) Neuralgic tumours (plumbi chlorid. 723.) Neuropathic diseases (iodinum, 467.) Neuroses (aether sulphuric. 68; chloroform, 202; electro-mag- netism, 297; granatum, 407; ol. tiglii, 564; iodide of zinc and strychnia, 666 ; zinci chlo- rid. 690.) Nipples, excoriated (acid. acet. empyr. 13; acid, tannic. 42; calx chlorin. 156; collodion, 234 ; creasoton, 266 ; glycerin, 402; plumbi tannas, 581.) Nodes, gouty (sulphur, carb. 672.) Noli me tangere (iodinum, 483; zinci chloridum, 690.) Noma (chlorin. aq. 194.) Obstetrics (aether, 70; chloroform, 205.) Odontalgia (chloroform, 199; am- moniated counter-irritants, 250; conia, 707; ol. sinapis, 561.) See Toothach. {Rheumatic (sulphuris carbure- tum, 672; ol. croton. 564.) Odour, offensive (calx chlorin. 157.) (Edema (creasoton, 272 ) Of the feet (acupunct. 56.) Meningum (iodin. 465.) (Esophagus, stricture of the (iodi- num, 476; sulphuris carbure- tum, 671.) Offensive evacuations, (calx chlorin. 154.) Oligaemia (ferri iodidum, 356.) Ophthalmia (acid, hydrocyan. 34; acupunct. 56, 57; aether, 70; argent, oxid. 100; creasoton, 272 ; ferri et aluminas sulphas. 712; iodin. 468.) Catarrhal (calx chlorin. 158, 163; lactucarium, 497.) Chronic (cadmii sulphas, 705 ; calx chlorin. 158; iodinum 485; matico, 516; oleum cadinum, 721.) Egyptian (acid, tannic. 42.) ' Ophthalmia, neonatorum (calx chlo- rin. 158.) Purulent (calx chlorin. 158; mo- nesia, 515.) Rheumatic (zinci ferrohydrocyan. 696.) Scrofulous (auri prseparat. 118; ami chlorid. 121; calx chlorin. 163; hydrarg. et arsen. iodid. 431; iodin. 458; oleum jecoris aselli, 553; potass, iodid. 602, 603; quinise sulphas, 631; zinci iodid. 698.) Strumous (bebeeria, 135; creaso- ton, 272; fuligo, 386; hydrarg. . et arsenic, iodid. 431 ; iodin. 485; juglans, 494; matias, 505; ol. cadinum, 721 ; potassii iodid. 601 ; ol. jecor. aselli, 553.) Tarsi (acid. acet. empyr. 15; creasoton, 272; hydrarg. deuto- iodid. 424; zinci ferrohydrocy- anas, 696 ; zinci iodidum, 698.) Orchitis (chloroform, 199; compres- sio, 238; iodinum, 485.) Os uteri, ulcerations of the(collodion, 235; creasotum, 268; iodinum, 489.) Osteocopi. syphilitic (hydrarg. et arsenic, iodid. 432; iodin. 474; strychnia, 660; strychniae ace- tas, 665; zinci ferrocyanur. 696.) Otalgia (conia, 706; ol. sinapis, 561; ol. tiglii, 564.) OtorrhoBa (cadmii sulphas, 705; creasoton, 265, 273 ; cubebse, 283 ; juglans, 494 ; oleum cadi- num, 721; potassii bromid. 586.) Otorrhoea, fetid (zinci chlorid. 693.) Ovaries, degenerated (iodin. 470.) Dropsy of the (iodin. 470.) Indurated (iodin. 470.) Inflammation of the (hydrarg. cyanur. 416.) Oz&ena (calx chlorin. 164; carbo animalis, 175; iodinum, 472.) Pain, anomalous, of hip and thigh (morphias bimeconas, 530.) Nervous and muscular (ammoni- ated counter-irritants, 249; moxa, 535.) Nocturnal, in the bones (hydrarg. et arsen. iodid. 432; iodinum, 474 ; zinci ferro-hydrocyanas, 696.) 748 INDEX OF DISEASES. Pain, rheumatic (cainca, 149 ; dios- ma, 295.) Severe (acid, hydro-cyan. 33, 34.) Pains, After (ergota, 332; sulphuris carburetum, 671.) Erratic (iodinum, 468.) Palpitations (acidum hydrocyani- cum, 32; bismuthi valerianas, 704 ; creasotum, 278 ; emetia, 307 ; magnes. 499 ; veratria, 85.) Palsy, see Paralysis. Pancreas, induration of the (carbo animalis, 175; iodin. 471.) Pannus, cellular (ol. jecoris aselli, 553.) Vascular (ol. jecoris aselli, 553.) Paralysis (acupunct. 57; arnica, 103; brucia, 146; deiphinia, 289; galvanism, 392; electro- punct. 303, 307; hsemospasia, 712; iodinum, 467; nux vo- mica, 539 ; ol. sinapis, 561 ; ol. tiglii, 564; sumbul, 730; paullinia, 570; strychnia, 657; veratria, 683 ; zinci chlorid. 690 ; zinci ferro-hydrocyanas, 695.) Of the bladder (diosma, 295 ; ergota, 326; strychnia, 658.) Of the rectum (nux vomica, 541.) Of the upper eyelid (ol. tiglii, 565; strychnia, 657.) Of the rectum (strychnia, 658.) Of the tongue (electro-puncture, 304.) Of the facial nerve (electro-mag- netismus, iv. ; strychnia, 658.) Of the portio dura (ammoniated counter-irritants, 252.) Lead (brucia, 146.) Partial (electro-magnetism, iv., 296; nux vomica, 541 ; strych- nia, 658 ; veratria, 683.) Rheumatic (electro-magnetism. 296.) Of the forearm (electro-magne- tism, iv.) Succeeding to apoplexy (brucia, 146; nux vomica, 540.) Paralytic debility (ammoniated counter-irritants, 250.) Paraplegia (ergota, 325 ; galvanism, 394; strychnia, 657; strychniae iodas, 665.; Parasites (oleum cadinum, 722.) Paroxysmal diseases (ergota, 325.) Parturient efforts, defective (can- nabis indica, 172; cimicifuga, 214; ergota, 312.) Pelvic tumours, painful (chloro- form, 199.) Pericarditis (ammoniated counter- irritants, 250.) Periodical diseases (ergota, 325 ; quiniae ferrocyanas, 609; quiniae sulphas, 620.) Periostitis (iodinum, 458.) Periosteum, diseased (iodin. 474.) Peritonitis from constipation (man- nita, 504.) Phagedena (chloroform, 198; crea- sotum, 280; iodinum, 473; zinci chloridum, 689.) Of the cheek (polassss chloras, 583.) Phagedenic tuberculous diseases (arsenic, iodid. 107.) Phimosis (lupulina, 718.) Phlebitis (compressio, 238.) Phlegmasia (compressio, 238; hae- mostasis, 714.) Phlegmon iodinum, 481.) Phosphatic depositions (acid, lactis, 38.) Photophobia (conia, 707.) Phthisis (acid, hydrocyan. 31,34; acid. acet. empyr. 15; acid, tannic. 41 ; aether, 71 ; aq. pi- cea, 89 ; argilla, 101 ; calx chlo- rin. 154; chlorin, 184; chcn- drus, 211; cimicifuga, 214; creasoton, 273; ferri iodidum, 355; fucus crispus, 211; gale- opsis, 390; haemospasis, 713; iodic acid, 491; lactucarium, 498; iodinum, 459, 462; mati- as, 505; monesia, 513; ol. tig- lii, 564; ol. jecor. aselli, 550, 554; paullinia, 570; potassee chloras, 583; sumbul, 730; spi- ritus pyro-aceticus, 647.) Cough of (codeia, 222.) Mucosa (galeopsis, 390; iodinum, 462.) Pituitosa (chimaphila, 180) Sweats of (acid, gallic. 22; bole- tus laricis, 138; acid, tannic. 42; argenti. oxid. 100; galeop- sis, 390; iodin. 461.) Threatened (galeopsis, 390.) Pica (caincae radix, 149.) Pile, bleeding (acidum nitricum, 702.) INDEX OF DISEASES. 749 Pimples (ammoniated counter-irri- tants, 250.) Pitting from smallpox (calx chlorin. 156; collodion, 236; iodin. 466.) Pityriasis (glycerina, 401 ; hydrarg. et arsen. iodid.431 ; zinci chlo- rid. 689.) Placenta praevia (aether sulphuricus, 72.) Retention of the (ergota, 322.) Plague (chlorin. aq. 194.) Prevention of (chlorin. aq. 194.) Pleuritis, see Inflammation of the Pleura. Pleurodyne (acupunct. 57.) Pneumonia (iodine, 462; mannita 504.) Chronic (hydrarg. cyanuret. 416." Convalescence from (mannit 504.) Purulent, infiltration after (moxa 534.) Poisoning, by arsenic (ferri oxyd hydrat. 367.) By arseniate of copper (ferri oxi dum hydratum, 371.) By hydrocyanic acid (chlorin. aq 194.) By opium (electro-magnetism 302.) Polypi, cartilaginous (carbo anima lis, 174.) Mucous (carbo animalis, 174.) Uterine (ergota, 323.) Porrigo (acid. acet. empyr. 14; car- bon, sesqui-iodid. 177; fuligo, 387; iodin. 468; juglans, 494; sulphur, iodid. 674; ol. jecor. aselli, 555; hydrargyri deuto- nitras, 428; hydrarg. et arsen- iodid. 431; oleum cadinum, 721.) See Tinea. Decalvans (sulphur, iodid. 674.) Favosa (creasoton, 272; hydrarg. bromid, 413; iodinum, 468; potassii bromid. 587.) Scrofulous (auri praeparat. 118; monesia, 513.) See Tinea. Profluvia (aqua Binelli, 84.) Prolapsus arii (acid, tannic. 41 ; nux vomica, 541.) Uteri (electro-magnetism, 302.) Vaginas (creasoton, 272.) Prosopalgia (ol. sinapis, 561 ; po- tassae chloras, 583; veratria, 682 ; zinci chlorid. 690.) 49 Prostate, disease of the (diosma, 295.) Enlargement of the (carbo anima- lis, 176; iodinum, 456, 474.) Prostatic discharges (cubeba, 2S4.) Prurigo (colchicum, 229; glycerin, 402; zinci chlorid. 692.) Senilis (aq. amygd. concentrata, 81 Pruritus (glycerin, 402 ; zinci chlo- rid. 692.) Pudendi muliebris (calx chlorin, 158.) Vulvae (fuligo, 385; potassii cya- nuret. 591.) Psora, see Itch. Psoriasis (chlorin, 187; creasoton, 271; ferri arsenias, 337; hy- drarg. iodid. 419; glycerina, 401; hydrarg. et arsen. iodid. 430; iodidum ammonii, 490; naphthalin, 720; sulphur, iodid. 675.) Palmaris (fuligokali, 389.) Pulmonary complaints, chronic (iodinum, 460.) Pupil, dilatation of the, caused by belladonna (ergota, 325 ) Pustular eruptions (creasoton, 272; iodinum, 474.) Pustule maligne (zinci chlorid. 689.) Putrefaction, checking (calx chlo- rin, 160.) Putrescency, tendency to (quiniae et cinchoniae tannas, 636.) Pyrosis (argenti oxidum, 99; nux vomica, 542.) Ranula (iodinum, 483.) Rectum, catarrh of the (cort. ad- string. Brazil. 253.) Paralyzed (nux vomica, 541.) Ulcerated (moxa, 534,) Varicose condition of the (matico, 510.) Remittent fever (bebeeria, 135; ferr. cyanur. 347; quiniae sulphas, 621 ; quiniae valerianas, 634.) Retention of urine (ergota, 326.) Rhagades (ol. jecor. aselli, 556.) Rheumatic gout (colchicum, 228.) Rheumatic effusions (electro-mag- netismus, iv.) Pains (cainca, 149; emetia, 311; hydrarg. deuto-iodid. 424.) Swellings of the joints (iodinum, 476, 485; potassii iodidum, 598; sulphuris carburetum, 671.) 750 INDEX OF DISEASES. Rheumatism (aconitia, 49; acu- punct. 56 ; ammoniae phosphas, 77; ammoniated counter-irri- tants, 250; anthrakokali, 80; ballota lanata, 131; caincee radix, 149 ; cannabis indica, 170; chlorin. 187; cimicifuga, 213; colchicum, 226; com- pression 238; compression of arteries, 242; creasoton, 275; delphin. 289; electro-magne- tism, 296. 300; electro-punct. 303; ergo'ta, 325; fuligo, 387; galvanism, 392; glycerin, 402; iodinum, 475; magnes. 499; morphiae acetas, 524; moxa, 534; ol. tiglii, 564; ol. jecinor. aselli. 549; ol. sinapis, 561; ol. tiglii, 565; platinum, 576; potassae chloras, 583; potass, nitras, 725; potass. cyanur. 590; quiniae sulphas, 624; sp. pyro- aceticus, 648; succus limonis, 728; sulphuris carburetum, 670; veratria, 683, 685.) Atonic (creasotum, 278.) Chronic (aconitia, 51 ; ammonias phosphas, 77, 78; anthrakokali, 80.; chimaphila, 180; colchi' cum, 231; eubebae, 283; diosma 294; electro-punctura, 307; fu ligo, 385; iodin. 475; morphia 521; ol. sinapis, 561; potassi cyanuretum, 590; veratria, 683 spiritus pyro-aceticus, 648.) Rickets (ferr. iodid. 354; fuligo, 385 ol. jecor. aselli, 549, 553.) Ringworm (ammoniated counter-ir- ritants, 250.) Roseola (chlorin. aq. 193.) Rubeolas (chlorin. aq. 193.) Rupia (iodinum, 474; hydrargyri et arsenic, iodid. 431.) Scalp, dryness of the (glycerin, 402.) St. Vitus's dance (ammoniated coun- ter-irritants, 250; liq. argent, muriat. ammon. 96; artemisia, 111; mdigum,434; nux vomica. 542; zinci chlorid. 690.) See Chorea. Salivation, mercurial (acid. acet. empyr. 15; calx chlorin. 157.) Mercurial (creasotum, 265; iodi- num, 476; potassae chloras. 534.) Profuse (auri praeparat. 116; ferri et aluminas sulphas, 712.) Sarcomatous tumour of the knee (bromin. 144.) Scabjes(acid.acet. empyr. 15; chlo- rin. 187.) Scalds (iodinum, 484.) See Itch. Scarlatina (acid. acet. empyr. 15; calx chlorin. 157; chlorin. aq. 192,195; colchicum, 229; iodin. 467; potassae chloras, 584.) Sciatica (acupunct. 57; cannabis in- dica, 170; ammoniated counter- irritants, 252; codeia, 222; io- din. 475; electro-magnetism, 296; morphia, 521; potass, cy- anur. 590.) Gouty (acid, hydrocyan. 33.) Rheumatic (acid, hydrocyan. 33.) Scirrhus (auri p:aepar. 119; calen- dula, 151 ; ferr. iodid. 354; iodi- num, 470; platinum, 576; po- tass, iodid. 598.) Of the lips (carbo animalis, 174.) Of the mammae (calendula, 151; carbo animalis, 275; ferri iodid. 354; iodin. 470.) Of the prostate (carbo animalis. 175.) Of the pylorus (acid, hydrocyan. 33; auri praeparat. 119; iodin. 471; zinci ierrohydrocyanur. 696.) Of the stomach (artemisia, 111: iodin. 471; platinum, 576.) Of the tongue (auri praeparat. 119.) Of the uterus (acid, hydrocyan. 33; auri praepar. 119; iodin. 470.) Scorbutus (acid. acet. empyr. 15; iodin. 476; monesia, 514; ol. cadinum, 721.) Scrofula (acid, pyrolign. 15; anthra- kokali, 80; auri cyanur. 125; auri praepar. 118; barii iodidum, 132; brominum, 144; carbo animalis, 175; chimaphila, 181; chlorin. 187; chondrus, 211; ferr. bromid. 335; ferr. cyanur. 347; ferr. iodid. 355; fucus crispus, 211; hydrarg. iodid. 4 IP; hydrarg. iodid. rubr. 422; iodi- num, 457; iodic acid, 491; oleum cadinum, 721; juglans regia, 494; monesia, 515; ol. jecoris aselli, 549 ; potassii bromid. 586; potass, iodid. 600.) INDEX OF DISEASES. 751 Scrofulous affections (acid. acet. empyr. 15; auri et sodii chlo- ric!. 124; carbon, sesquiiodid. 177; ferri iodid. 354; juglans, 493 ; soda chlorin. 645 ; sodae hyposulphis, 727. Caries (creasotum, 280.) Diathesis (carbo animalis, 174.) Discharges from the nose and ear (iodinum, 178.) Diseases (barium iodatum, 133.) Habit (auri et sodii chlorid. 123 ; ferr. cyanur. 347.) Inflammation (iodin. 459.) Swellings (barii iodidum, 133; brominum, 144; calx chlorin. 154; carbo animalis, 175; chlo- rin. aq. 194; conia, 707; iodid. quinise, 611; iodinum, 458, 483 ; potassii bromidum, 588; plum- bi iodid. 580, 586; potassii iodhydrargyras, 594; veratria, 685.) Of the glands (calx chlorin. 157; iodinum, 102; potassii iodhydrargyras, 594 ; potassii iodidum, 600; quinise hydriodas, 610; veratria, 685.) Of the joints (calx chlorin. 164.) Tumefaction of the testicle (po- tassii bromidum, 586.) Tumefaction of the upper lip (aur. t et sod. chlorid. 123.) Ulcers (potass, iodid. 601 ; hyd. et arsen. iodid. 430; juglans regia, 494; monesia, 515 ; zinci chlorid. 689, 692.) Scurvy (creasoton, 267.) See Scor- butus. Sea sickness (creasoton, 276.) Sebiparous organs, affections of the (collodion, 234.) Secretion, undue (argenti oxidum, "•) Sensibility, unusual, of the abdo- domen(zinci ferrohydrocyanas, 696.) Serous cysts (electro-punctura, 307; iodinum, 478.) Serpents, bites of (caincse radix, 149; guaco, 408; iodin. 485.) ' Serpigo (potass, iodid. 600.) Sibbens (hydrarg. et arsen. iodid. 431.) Skin, irritation of the (glycerin, 402.) Sleeplessness (lactucarium, 498; magnetism, animal, 499 ; mor- phias bimeconas, 530.) Sloughing of cellular membrane (acid. acet. empyreum. 16 ; iodin. 482.) Of the female organs (calx chlo- rinata, 156.) Gangrenous (monesia, 515.) Ulcers (calx chlorin. 155.) Small pox, pitting from (calx chlo- rin. 156; chlorin. aq. 193 ; io- din, 466.) Sore mouth, nurses 7 (iodin. 476.) Sore throat (ammoniated counter- irritants, 250; hsemospasia, 713.) Phagedenic (iodin. 474.) Mercurial (zinci chlorid. 692 ; creasotum, 269.) Ulcerated (chloroform, 198.) Sores, bed (collodion, 236 ; plumbi tannas, 581.) Sloughing, gangrenous (acidum pyrolign. 14; iodinum, 484.) Syphilitic (hyd. deuto-iodid. 423.) Spasmodic diseases (acid, hydro- cyan. 32 ; acupunct. 56 ; canna- bis indica, 170; colchicum, 229; conia, 707; indigum, 432; mag- nes, 499 ; zinci ferrohydrocya- nas, 695.) Erethism (creasoton, 278.) Spasms (acupunct. 57; ammoniated counter-irritants, 250; magnes, 499.) Of the muscles of the face (elec- tro-magnetismus, iv.) Specks of the cornea (fuligo, 386.) Spermatorrhoea (compressio, 241 ; cubeba, 284 ; ergota, 324 ; nux vomica, 541 ; lupulina, 718.) Sphacelus (acid. acet. empyr. 14.) Spina bifida (iodinum, 479.) Ventosa (ol. jecor. aselli, 552.) Spine, diseases of the (iodinum, 485.) Spleen, diseases of the (potass, bro- mid. 587.) Engorgement of the (quinise sul- phas, 605, 623.) Enlarged (ferri subcarb. 378; hydrarg. deuto-iodid. 424; iodin. 456; potassii hydrargyro-iodid. 594.) Indurated (iodinum, 455.) 752 INDEX OF DISEASES. Sprains (creasoton, 266; galvanism, 392; glycerin. 402; electro- punctura, 304. Violent (ammoniated counter-irri- tants, 250.) Staubasthma (acid, hydro-cyan. 32.) Steatomatous cysts (electro-punc- tnra ; 307.) Stiffness (glycerina, 402.) Stings of wasps (iodinum, 485.) Stomacace (iodinum, 476.) Stomach, coats of the, hypertrophy of the (sulph. carbur. 671.) Induration of the (calendula, 151.) Irritability of the (argenti oxi- dum, 99; nux vomica, 542; sp. pyroacet. 648.) Irritation of (codeia, 222.) Neuropathic disorders of (acid. hydrocyan. 32.) Scirrhus of the (artemisia, 111; iodin. 471.) Spasms of the (sumbul, 730.) Stomatitis (monesia, 515; potassae chloras, 583.) Strangulation, internal (strychnia, 661.) Strangury (apis mellifica, 703.) Stricture of the Eustachian tube (catheterism for, 437.) Of the oesophagus (iodin. 476.) Of the urethra (iodin. 471 ; lupu- lina, 718.) Spasmodic, of the urethra(diosma. 295.) Strophulus (glycerina, 402.) Struma varicosa (carbo animalis, 175.) Strumous habits (chimaphila, 181 ; ferri citras, 343; ferri subcar- bonas, 378.) In children (ferri ferrocyanure- tum, 347.) Suffocation, sense of, (acid, hydro- cyan. 32.) Suppuration, profuse (creasoton. 265; sumbul, 730.) Surgical operations (aether sulphu- ric. 66; chloroform, 204.) Sweating, profuse (acidum galli- cum, 22; acid, tannic. 42 ; ar- gent, oxyd. 100; boletus lari- cis, T38; ferri et alumin. sul- phas, 712.) et arsen. iodid 431.) Synovial cysts (electro -punctura 7 307.) Syphilide, tuberculous (auri chlorid. 121.) Syphilis (argenti praeparat. 94; arg. et ammon. chlorid. 96; arg. ox- idum, 99: auri cyanur. 125; auri chlorid. 121; auri praepa- rat. 116; aurum muriat. 121; chlorin. 187; hydrarg. bromid. 412; hydrarg. cyanur. 415; hy- drarg. deuto-bromid. 413; hy- drarg. deuto-iod id. 423; hydrarg. proto-nitras, 427; hydrarg. et arsen. iodid. 431 ; iodic acid, 491 ; manganesii sulphas, 719 ; platinum, 576; potassae chlo- ras, 583.) Consequences of (ferri iodidum, 355.) Of children (hydrarg. iodid. 419.) Secondary (ferr. iodid. 354; hy- drarg. et arsenic, iodid. 431 ; iodinum, 472; potassii bromi- dum, 587.) Tertiary (iodin. 473, 487; potassii bromidum, 587; potass, iodid. 597.) With scrofula (potass, iodid. 599; hydrarg. iodid. rubr. 422; sapo mollis, 642.) Syphilitic affections (potassae chlo- ras, 583.) Eruptions (arsen. iodid. 107; /err. carb. 339; hyd. et arsen. io-lid. 430.) Excoriations (aurum metallicum, 129.) Excrescences(aurum metallicum, 129; platinum, 576.) Osteocopi (hydrarg. et arsenic, iodid. 432; strychnia, 660.) Sore throat (hyd. deuto -iodid. 423) Swellings of the bones (potass, iodid. 602.) Tubercles (iodin. 473.) Ulcers (auri nitro-murias, 129, creasolum, 269.) Tabes mesenterica (ferr. iodid. 354.) Taenia (acid, hydrocyan. 34; braye- ra anthelmintica. 139; colchi- cum, 229; creasoton, 277: eu- phorb. ol. 334; filix mas, 382; granatum, 407; ol.croton. 563.) Tarsi, inflamed, chronic (creasoton, 272.) INDEX OF DISEASES. 753 Tartar of the teeth (acidum tanni- cum, 44; calx chlorin. 157.) Teeth, affections of the (chloroform, 199.) Caries of the (calx chlorin. 157; creasotum, 279; monesia, 515; piscidia erythrina, 722.) Stopping for (collodion, 236.) Tenesmus (morphia, 523.) Testes, enlarged (iodinum, 456; po- tass, iodid. 601.) Scrofulous swelling of the (potas- sii bromid. 586.) Tetanus (acid, hydrocyan. 32; acu- puncture, 57; aether sulphuric. 69; ammoniated counter-irri- tants, 250; cannabis indica, 169, 172; chloroform, 203; col- chicum, 229; galvanismus, 395.) Traumatic (cannabis indica, 169; morphiae acetas, 525; quiniae sulphas, 624; strychnia, 659.) Tetter (iodinum, 468.) See Herpes. Humid (hydrarg. cyanuret. 416.) Thoracic inflammation (hydrargyri cyanur. 416.) Throat diseases (zinci chlorid. 692.) Relaxation of the (acid, tannic. 41.) Thymus, hypertrophied (iodin. 456) Thyroid gland, swelled (iodinum, 458.) Tiz douloureux (acid, hydrocyan. ; 33; aconitia, 49; ammoniated counter-irritants, 250; delphi- nia, 289; galvanism, 394; strych- nia, 659; veratria, 682, 687; zinci valerianas, 699.) See Neuralgia. Tinea (calx chlorin. 158, 164; chlo- rin. aq. 194, 195; fuligo, 385; iodid. sulph. 674.) See Porrigo. Tinnitus aurium (electro-magne- tism, 299.) Tone, general, deficient (ferri citras, 343.) Tongue, induration of the (auri prse- parat, 119.) Malignant ulcers of the (iodinum, 483.) Paralysis of the (electro-punctura, 304.) Tonsils, enlarged (iodinum, 456, 483; zinci iodid. 108.) Malignant ulcers of the (iodinum, 485.) Toothach(acid. hydrocyan. 33; acid, acet. empyr. 14; acid, tannic. 42; acupunct. 57; collodion, 236; creasoton, 273; liq. ferr. perses- quinit. 363; magnes. 500; mor- phia, 522; oleum cadinum, 721; piscidia erythrina, 722; zinci chlorid. 692.) Rheumatic (creasoton, 273; ergota, 325; sulph. carbur. 673.) Tophi, gouty (acidum benzoicum, 18; iodinum, 475.) Tormina (artemisia, 111.) Torpor in children (ferri ferrocyanur. 347.) Tremors (magnes. 499; strychnia, 658.) From mercury (electro-punct. 303.) Trichiasis (collodion, 236.) Trismus (acupuncture, 57; ammo- niated counter-irritants, 250.) Tubercles (iodinum, 450; ol. jecor,. aselli, 554.) Of the lungs (chlorin. 184; conia, 707; iodinum, 459.) Mesenteric (iodinum, 459.) Softening of (moxa, 534.) Syphilitic (iodin. 473.) Tuberculous eruptions (brominum, 144.) Tumefactions, indolent (electro- punctura, 307.) Tumours of the bones (auri praepa- rat. 119.) Erectile (ol. tiglii, 565.) Hemorrhoidal (acid, tannic. 41.) Indolent (plumbi iodid. 580.) Of the mammae (ol. jecor. aselli, 556.) Scrofulous (iodid. quinisB, 610; iodinum, 483; veratria, 685.) Vascular (acid, nitric. 702.) Typhoid fever (aq. chlor. 192; iodi- num, 465; quiniae sulph. 622.) Typhus (calx chlorin. 154; chloro- form, 203; codeia, 223 ; chlorin. aq. 193; iodin. 465; potassee chloras, 583; quiniae et cincho- nise tannas, 635; sodae chlori- dum, 644; sumbul, 730.) Abdominalis (chlorin. aq. 193.) Bilious (calx chlorin. 154.) Convalescence from (sumbul, 730.) Ulceration of the mouth (calx chlo- rin. 155.) 754 INDEX OF DISEASES. Ulceration of the rectum (moxa, 534.) Ulcerative process (iodinum, 481.) Ulcers (acid. acet. empyr. 16; calx chlorin. 155; chlorin. aq. 194; collodion, 234; cortex adstrin- gens, 254; creasoton, 266; iodi- num, 484; matico, 507; mone- sia, 515; ol. jecor. aselli, 559; soda chlorin. 645.) Atonic (creasoton, 266; ferri iodid. 355; iodinum, 481; ol. jecoris aselli, 553; sulph. iodid. 675; zinci chloridum, 688.) Ulcers, cancerous (acid, tannic. 42 ; calx chlorin. 155; carbo anima- lis, 175; creasotum, 266; ca- lendula, 151; chlorin. aq. 195; fel bovinum, 708; ferr.subcarb. 376; hydrarg. deuto-iodid. 423; hydrargyri deuto-nitras, 428; potassii iodid. 601; zinci chlorid. 689.) Of the face (creasoton, 268; plumbi chlorid. 722; fel bovinum, 709; soda chlorin. 645.) Carious (creasoton, 266.) Erosive (zinci chlorid. 689.) Fistulous (creasoton, 266.) Flabby (acid. acet. empyr. 14 chlorin. aq. 194; ferri et alu min. sulph. 712.) Foul (acid. acet. empyr. 16; alu minae sales, 76; carbon, trichlo rid. 706 ; ferri et alumin. sulph 712; fuligo, 388; zinci chlorid 689.) Fungous (acid. acet. empyr. 14 creasotum, 268.) Gangrenous (calx chlorin. 154 creasoton, 267.) Herpetic, &c. (acid. acet. empyr 14; calx chlorin. 155; creasoton 268; fuligo, 388.) Ill-conditioned (ferri ferrocyanur 348.) Indolent (creasoton, 266; platin 577.) Irritable (argent, oxid. 100; iodin 484. Interciliary (ol. jecoris aselli 553.) Malignant (conia, 707; creasoton 267; iodinum, 484; monesia 515; zinci chlorid. 689.) Obstinate (creasotum, 266; plumb iodid. 580.) Ulcers of the mouth, after salivation (calx chlorin. 162; hydrarg. iodid. rubr. 423; iodin. 481; potassaechloras, 583 ; sodachlo- rinata. 645.) Offensive (chlorini aqua, 194.) Old (iodinum, 484.) Phagedenic (calx chlorin. 155; creasotum, 280; hydrargyri io- didum, 420; monesia, 515; zinci chlorid. 689.) Psoric (fuligo, 388.) Putrid (chlorini aqua, 194.) Sanious (creasoton, 266.) Scorbutic (creasoton, 267.) Scrofulo-venereal (hydrargyri io- didum rubrum, 422.) Scrofulous (brominum, 144; calx chlorin. 155; creasoton, 266; hyd. et arsen. iodid. 430; hy- drarg. iodid. 419, 421; hy- drarg. iodid. rubr. 423; juglans regia, 494; iodinum, 488; mo- nesia, 515; zinci chlorid, 688.) Serpiginous (monesia, 515.) Sinuous (zinci chlorid. 688.) Sloughing (acid. acet. empyr. 14; chloroform, 199; creasoton, 267; zinci chloridum, 689.) Sloughing, from lying (plumb, tan- nas. 581.) Specific (brominum, 144.) Superficial (creasotum, 266.) Syphilitic (argent, prsepar. 93; aurum metallicum, 129; b >f- minum, 144; calx chlorin. 15o; creasoton, 266, 269; ferr. iodid. 354; fuligo, 388; galvanismus, 396; hydrarg. cyanuret. 416; hydrarg. iodid. 419; hydrarg. iodid. rubr. 423, 426; iodinum 5 473 ; iodide of chloride of mer- cury, 492; monesia, 515.) Syphilitic, old (zinci chlorid. 689.) Torpid, foul, &c. (calx chlorin. 155; ferr. cyanur. 348.) Varicose (creasoton, 266.) Ulceration of os uteri (collodion, 235; hydrargyri deuto-nitras. 428; iodin. 471.) Urethra, diseases of the (diosma, 295.) Inflamed (iodin. 485.) Mucous membrane of the, tume- fied (carb. anim. 176.) Urethritis (cubeba, 284; ergota, 331.) INDEX OF DISEASES. 755 Uric acid calculus (ammonia? phos- phas, 77; sodae phosphas, 728.) Diathesis (acidum benzoicum, 18.) Urinary organs, diseased (cainca, 148; chimaphila, 180.) Urine, incontinence of (diosma, 295; ergota, 326; iodin. 468; potass, nitras, 726; sumbul, 730.) Retention of (apis mellifica, 704; ergota, 326; strychnia, 660.) Urticaria (cort. adstring. Brazil. 253; ferri nitras, 363.) Uterine contractions, excitant of the, 322, 329. Irritation, (chloroform, 198.) Uterus, cancer of the (cortex ad- stringens, 254; ferr. subcarb. 376.) Diseases of the (argenti oxidum, 99; hydrarg. et arsen. iodid. 431.) Engorgement of the (ergota, 330.) Hard tumours of the (iodidum, 470.) Hypertrophy of the (ergota, 325; ferri bromidum, 338.) Induration of the glands of the, (calendula, 151.) Inertia of the (ergotin, 332, 333.) Neck of the, fungus of the (aur. nitricomuriat. 127.) Neuralgiaof the (chloroform, 198.) Pain of the (acid, hydrocyan. 32.) Spasmodic pains of the (acid, hy- drocyan. 32.) Ulcerated (iodin. 471.) Uvula, relaxed (ferri et aluminae sulphas, 712.) Vagina, discharges of blood from the, 509.) Inflammation of the (collodion, 235; fuligo. 386; monesia, 514; zinci chlorid. 691.) Fetid discharges from the (alumi- na? sales, 76.) Vaginitis (cubeba, 284; ergota, 331.) Varicose condition of the rectum (matico, 510.) Varicose veins (acupunct. 58; elec- tro-punctura, 307.) Variola, see Small-pox. Venereal, see Syphilitic. Infection, prevention of (chlorin. aq. 194.) Vomica (chlorinum, 184.) Vomiting (acid, hydrocyan. 33; aq. picea, 91; argilla, 102; creaso- ton, 276; strychnia, 650; sum- bul, 730.) Chronic (artemisia, 111; calendu- la, 151.) Obstinate (calendula, 151; chlo- roform, 198.) Of infancy (argilla, 102.) Of pregnancy (creasotum, 276 ; nux vomica, 542.J Wakefulness (bimeconate of mor- phia, 530.) Warts, malignant (iodinum, 485.) White swelling (chimaphila, 181; iodinum, 458; ol. jecor. aselli, 555; potassii cyanuret. 590; potassii iodidum, 601.) White tissues, thickening of the (ammoniae phosphas, 77.) Whitlow (iodinum. 483.) Womb, inertia of the (ergotin, 332, 333.) Worms (caincae radix, 149; corylus rostrata, 255; ferri et alumin. sulphas, 712; filix mas, 382; granatum, 407; juglans, 494; ol. tiglii, 563 ; zinci ferrohy- drocyanas, 695.) Wounds (calx chlorin. 156.) Contused (calx chlorin. 156; di- osma, 295; iodinum, 483.) From dissection (calx chlor. 155 ; iodinum, 483, 485.) From gunpowder (calx chlorin. 156.) Lacerated (iodinum, 483; calx chlorin. 156.) Painful (acid, hydrocyan. 33.) Poisoned (argilla, 101.) Punctured (iodinum, 483.) Zymotic diseases (chlorinum, 188.) THE END. -> £ ^K •tt. A N - ++ V \ st> cv c- ** v "* ^ ( ^ v A<^ ■w v 1 - ^ A i* ^ A3 0° x .0 \ 4 X ^% W "A A v? x c> "W ^ «P x 00 ^. ; ' * ' c- •\^ V cy ^ AC ^ A^ sa **+ C- , oA c£- /- AA^t/' A rC - , %> ^A ».M* A ' , V # * ^<£- ° A V v l B ' V- y ' J * > * -s° e: ^ c£- < c S •\ o A ■ | ft , ""7* > •A5? * ,0o «£• v