I! BIDDLE'S MATERIA MEDICA AND THERAPEUTICS. A New Series of Manuals FOR Medical Students. Price of each Book, Cloth, $3.00; Leather, $3.50. MIDWIFERY. By Alfred Lewis Galabin, m. a., m.d., Obstetric Physician to, and Lecturer on Midwifery and the Diseases of Women at, Guy's Hospital, London, etc 227 fine Engravings. 753 pages. PHYSIOLOGY. Third Edition. By Gerald F. Yeo, m.d., f.r.c.s., Professor of Physiology in King's College, London. Revised. 743 pages. 321 carefully printed Illustrations. MATERIA MEDICA, PHARMACY AND THERAPEUTICS, including the Physiological Action of Drugs, Special Therapeutics, Official and Extemporaneous Pharmac y, with numerous Tables, Form- ulae, Notes on Temperature, Clinical Thermometer, Poisons, Urinary Examinations and Patent Medicines. By Saml. O. L. Potter, m. a., m.d., Professor of Practice of Medicine, Cooper College, San Francisco; Late Surgeon U. S. Army. 750 pages. CHILDREN. By J. F. Goodh art, m.d., Physician to the Evelina Hospital for Children ; Assistant Physician, Guy's Hospital, London. American Edition. Revised and Edited by Louis Starr, m.d., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania; Physician to the Children's Hospital, Philadelphia. 50 Formulae, and directions for pre paring Artificial Human Milk, for the Artificial Digestion of Milk, etc. 738 pages. PRACTICAL THER APEUT ICS. Fourth Edition. With an Index of Diseases. By Ed. John Waring, m.d., f.r.c.p. Rewritten and Revised. Edited by Dudley W. Buxton, Assistant to the Professor of Medicine, University College Hospital, London. 744 pages. MEDICAL JURISPRUDENCE AND TOXICOLOGY. By John J. Reese, m.d., Professor of Medical Jurisprudence and Toxicology, University of Pennsylvania, etc. 606 pages. Second Edition. ORGANIC CHEMISTRY. By Prof. Victor von Richter, Univer- sity of Breslau. Translated from Fourth German Edition by Edgar F. Smith, m.a., ph.d., Professor of Chemistry, Wittenberg College, Spring- field, O., formerly in the Laboratories of the University of Pennsylvania, etc. Illustrated. 710 pages. WINCKEL'S DISEASES OF WOMEN. By Parvin. A new Text-Book. By Dr. F. Winckel, Professor of Gynaecology, etc., Royal University of Munich. The Translation Edited by Theopiiilus Parvin, m.d., Professor of Obstetrics and Diseases of Women and Children, Jef- ferson Medical College, Philadelphia. 132 Engravings, most of which are new. 700 pages. PRACTICAL SURGERY. A Manual for Students and Physicians. By Wm, J. Walsham, m.d., Assistant Surgeon to, and Demonstrator of • Surgery in, St. Bartholomew's Hospital; Surgeon to Metropolitan Free Hospital, London, etc. Thoroughly Illustrated. About 700 pages. *** Other Volumes in Preparation. A complete illustrated circular with sample pages sent free, upon application. Price of each Book, Cloth, $3,00; Leather, $3.50. P. BLAKISTON, SON & CO., Medical Publishers & Booksellers, 1012 Waln£rr. Street, Philadelphia. MATERIA MEDICA THERAPEUTICS, FOR PHYSICIANS AND STUDENTS. f BY JOHN B. BIDDLE, M.D., LATE PROFESSOR OF MATERIA MEDICA AND GENERAL THERAPEUTICS IN THE JEFFERSON MEDICAL COLLEGE. PHILADELPHIA. ELEVENTH EDITION, REVISED AND ENLARGED, WITH SPECIAL REFERENCE TO THERAPEUTICS AND TO THE PHYSIOLOGICAL ACTION OF MEDICINES. BY CLEMENT BIDDLE, M. D., U. S. Navy, AND HENRY MORRIS, M. D, FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; DEMONSTRATOR OF OBSTETRICS AND GYNECOLOGY IN JEFFERSON MEDICAL COLLEGE, ETC., ETC. ^VOFCO/V^ ( *P; 6 1889^1 WITH v r / A NUMEROUS ILLUSTRATIONS. PHILADELPHIA : P. BLAKISTON, SON & CO., No. 1012 Walnut Street. Entered, according to Act of Congress, in the year 1889, By P. BLAKISTON, SON & CO., In the Office of the Librarian of Congress, at Washington. Press of Wm F. Fell &. Co., 1220-24 Sansom St., PHILADELPHIA. PREFACE TO THE ELEVENTH EDITION. The exhaustion of the tenth edition of Biddle's Materia Medica has rendered necessary the preparation of a new one. In doing this the editors have carefully gone over the entire work, paying particular attention to the expurging of obsolete matter, the correction of errors, and the re-writing of various articles that it seemed to need. They desire to call attention to the following subjects as con- stituting the principal alterations made by them, viz. : The addi- tion of twenty-one new cuts, the omission of useless ones, the introduction of concise statements of the action of new drugs that have recently crept into the domain of pharmacology, as Hypnone, Urethan, Papaya, Adonidine, Strophantus, Sparteine, Iodol, Morrhuol, Lanolin, and Saccharin. An entirely new chapter has been added on Antipyretics, in which the phenyl- derivatives, as Acetanilide (anti-febrine), Resorcin, Hydroquinone, Pyrocatechin, Salol, Naphthaline and Naphthol, Pyridine, Chinoline, Kairine, Thalline, and Antipyrine have been tho- roughly considered. New articles on Mercuric Chloride and Iodide as antiseptic agents have also been introduced, and the article on Electricity re-written and enlarged. Numerous articles have been much extended, particularly quinine, opium, bella- donna, aconite, digitalis, etc., the medicinal uses of which have been more dwelt upon than in former editions. Useless botanical descriptions (notably in Rhubarb, Aloes, and Acacia) have been curtailed, while the therapeutical applica- VI PREFACE. tion of the majority of drugs has been elaborated. To increase the usefulness of the index, which is as full as that of previous editions, bolder type has been used in referring to the principal actions and uses of the various drugs. The editors wish to acknowledge their indebtedness to Dr. T. D. Reed, of Montreal, and Prof. F. B. Power, of the University of Wisconsin, for numerous valuable suggestions and corrections, as well as to the numerous kindly criticisms on the last edition. In conclusion, it affords them much pleasure to renew the dedication of the author to the gentlemen in attendance upon the various medical schools in North America. Clement Biddle. Henry Morris. Philadelphia, April I, 1889. PREFACE TO THE EIGHTH EDITION The exhaustion of the seventh edition of the Materia Medica within little more than a year since it was issued, having ren- dered necessary the publication of a new edition, it has been carefully revised, much of it has been recast and even rewritten, and many new articles have been added. The author trusts that it will be found to have kept pace with the progress of pharmacological science, and to contain all important recent contributions to the various departments of pharmacology. The illustrations of the book comprise, as in previous editions, representations of most of the important indigenous and natu- ralized plants, as well as diagrams of instruments employed in the atomization of liquids, in the new operation of pneumatic aspiration, in the transfusion of blood, and in the recently-intro- duced pneumatic method in the treatment of thoracic diseases. The author has aimed in this, as in previous editions, to present a succinct account of the articles of the Materia Medica in general use in the United States, and discussed in the courses of lectures delivered upon the subject, to which he trusts the work will be found, as heretofore, to furnish a suitable text-book. He takes pleasure in renewing his dedication of it to the gentle- men in attendance upon the various medical schools in North America. . John B. Biddle. CONTENTS PAGE Remedies — Definition of, 33 Division of, 33 PART I. MECHANICAL REMEDIES. General Bloodletting, 33 Local Bloodletting, 34 Leeches and Cups, 34 Scarifications, 35 Setons and Issues, 35 Bandages, Frictions, 35 Acupuncture, Baunscheidtismus, . . , 36 Pneumatic Aspiration, 37 PART II. IMPONDERABLE REMEDIES. Light, 38 Heat, , . . 39 Cold, 40 Electricity, 41 Massage, 45 PART III. PHARMACOLOGICAL REMEDIES, OR MEDICINES. Medicines — Definition of, 46 Modus operandi of, 48 Circumstances which modify the Effects of, 49 Forms in which they are used, 50 Solids, 50 Liquids, 52 Semi-solids, 57 Gases and Vapors, 58 Weights and Measures, 58 Effects of Age, Sex, Temperament, Idiosyncrasy, Habit, Disease, etc., upon, 61 Parts to which medicines are applied, 64 To the Skin, 64 The Hypodermic method, 65 To Mucous Membranes, 65 Atomization, • 66 To Serous Membranes, 69 ix X CONTENTS. PAGE To Ulcers, "Wounds, Abscesses, etc., • . 69 Intra-venous injection, 69 Transfusion of Blood, 69 Classification of Medicines, 70 Class I. — Neurotics, 72 Order I. Narcotics, 72 Opium, 73 Lactucarium, 84 Paraldehyd, 85 Hypnone, 87 Urethan, 87 Belladonna, 88 Stramonium, 94 Hyoscyamus, 95 Duboisia, 98 Cannabis Americana, 99 Cannabis Indica, 99 Humulus (Hops), 101 Dulcamara (Bittersweet), 102 Order II. Ethereal Anaesthetics, 102 ^Ether (Ether), 103 Chloroformum (Chloroform) 107 Methylene Bichloride, no Methylic Ether, in Nitrous Oxide Gas, in Ethyl Bromide, 112 Local Anaesthesia, 112 Order III. Antispasmodics, 113 Asafcetida (Asafetida), 1 13 Galbanum, 115 Ammoniacum, (Ammoniac), 115 Camphora (Camphor), 116 Valeriana (Valerian), '. . . . 1 19 Ammonii Valerianas (Ammonium Valerianate), 120 Cypripedium, 120 Scutellaria, 120 Thea (Tea), 121 Caffea (Coffee), 121 Caffeina (Caffeine), 122 Theobroma (Chocolate), 122 Erythroxylon (Coca), 122 Cocaine, 123 Guarana, 128 Mate, 128 Moschus (Musk), 128 Oleum Succini (Oil of Amber), 129 Oleum ^Ethereum (Ethereal Oil), 130 Spiritus ^Etheris Compositus (Compound Spirit of Ether), . . . 130 Order IV. Tonics, 131 CONTENTS. XI PAGE Vegetable Tonics, 132 Simple Bitters, 132 Quassia, 132 Gentiana (Gentian) 133 Calumba, 134 Chirata, 135 Aromatic Bitters, 136 Serpentaria, 136 Eucalyptus, 137 Anthemis, 138 Eupatorium, 139 Absinthium, 140 Magnolia, 141 Cascarilla, 141 Astringent Bitters, 141 Cinchona, 141 Quininae Sulphas (Quinine Sulphate), 150 Quininge Bisulphas (Quinine Bisulphate), 151 Quininae Valerianas (Quinine Valerianate), 151 Quininae Hydrobromas (Quinine Hydrobromate), 151 Quininae Hydrochloras (Quinine Hydrochlorate), 151 Chinoidinum (Chinoidin), 152 Cinchoninae Sulphas (Cinchonine Sulphate), 152 Quinidinae Sulphas (Quinidine Sulphate), 152 Cinchonidinae Sulphas (Cinchonidine Sulphate), 152 Cornus, 153 Salix, 154 Prunus Virginiana (Wild Cherry), 154 Digestive Ferments, 155 Pepsinum (Pepsin), 155 Pancreatinum (Pancreatin), 156 Papaya, 157 Mineral Tonics, 157 Ferri Praeparata (Preparations of Iron), 157 Mangani Praeparata (Preparations of Manganese), 168 Acida Mineralia (Mineral Acids), 169 Acidum Lacticum (Lactic Acid), 174 Phosphorus, 176 Zinci Phosphidum (Zinc Phosphide), 178 Order V. Astringents, 178 Vegetable Astringents, 179 Acidum Tannicum (Tannic Acid), 179 Acidum Gallicum (Gallic Acid), 180 Galla (Nutgall), 181 Catechu, 182 Kino, 183 Krameria, 184 Haematoxylon, 185 Quercus Alba (White Oak), 185 Xll CONTENTS. PAGE Geranium, 186 Hamamelis, 187 Rosa Gallica (Red Rose), 188 Rosa Centifolia (Pale Rose), 188 Rhus Glabra (Sumach), . 188 Rubus (Blackberry), 188 Castanea (Chestnut), 189 Mineral Astringents, : 189 Plumbi Praeparata (Preparations of Lead), 189 Cupri Praeparata (Preparations of Copper), 195 Zinci Prasparata (Preparations of Zinc), 196 Argenti Praeparata (Preparations of Silver), 198 Bismuthi Praeparata (Preparations of Bismuth), 201 Cerii Oxalas (Cerium Oxalate), 202 Alumen (Alum), . . « 203 Aluminii Sulphas (Aluminium Sulphate), 204 Order VI. Stimulants, 204 Diffusible Stimulants, , . 205 Alcohol, 205 Vinum (Wine), ' 209 Spiritus Vini Gallici (Brandy), 210 Spiritus Frumenti (Whisky), 210 Spiritus Sacchari (Rum), 21© Spiritus Juniperi (Gin), ., 210 Spiritus Myrciae (Spirit of Myrcia), 211 Malt Liquors, 21 1 Extractum Mai ti (Extract of Malt), 211 Ammonias Praeparata (Preparations of Ammonia), 211 Aromatics, 214 Capsicum, 215 Piper (Black Pepper) 216 Cinnamomum (Cinnamon), , 216 Myristica (Nutmeg), 217 Macis (Mace), 217 Caryophyllus (Cloves), 218 Pimenta, 218 Oleum Cajuputi (Cajeput Oil), 218 Zingiber (Ginger), 219 Cardamomum (Cardamom), 219 Pulvis Aromaticus (Aromatic Powder), 220 Extractum Aromaticum Fluidum (Aromatic Fluid Extract), . . . 220 Calamus, 220 Gaultheria, 220 Aurantii Amari Cortex (Bitter-orange Peel), 223 Aurantii Dulcis Cortex (Sweet-orange Peel), 223 Those belonging to Nat. Ord. Labiatae, 223 Menthol, 224 Vinum Aromaticum (Aromatic Wine), 224 Those belonging to Nat. Ord. Umbelliferae, 225 CONTENTS. Xlll PAGE Illicium (Star Anise), 226 Vanilla, 226 Order VII. Sedatives, 226 Aconitum (Aconite), 227 Veratrum Viride, 232 Veratrina (Veratrine), 236 Pulsatilla (Pasque-flower), 237 Arnica, 238 Phytolacca, 239 Staphisagria, 240 Antimonii Pneparata (Preparations of Antimony), 241 Potassii Nitras (Potassium Nitrate), 244 Sodii Nitras (Sodium Nitrate), 246 Refrigerants, 247 Potassii Citras (Potassium Citrate), 247 Liquor Ammonii Acetatis (Solution of Ammonium Acetate), . . 247 Spiritus yEtheris Nitrosi (Spirit of Nitrous Ether), 248 Acida Vegetabilia (Vegetable Acids), 248 Order VIII. Spinants, 251 Excito-motors, 251 Nux Vomica, 251 Strychnina (Strychnine), 257 Strychninae Sulphas (Strychnine Sulphate), 257 Ignatia, 257 Hydrastis, 258 Rhus Toxicodendron (Poison Oak), 259 Cocculus Indicus, 259 Picrotoxinum (Picrotoxin), 260 Ergota (Ergot), 260 Ustilago, 266 Gossypii Radicis Cortex (Bark of Cotton Root), 267 Digitalis, 268 Adonidine, 273 Strophantus, 274 Sparteine, 275 Cimicifuga, 276 Depresso-motors, 278 Conium, 278 Physostigma, 281 Chloral, 283 Croton- Chloral- Hydrate, 286 Potassii Bromidum (Potassium Bromide), 286 Ammonii Bromidum (Ammonium Bromide), 290 Sodii Bromidum (Sodium Bromide), 291 Lithii Bromidum (Lithium Bromide), 291 Calcii Bromidum (Calcium Bromide), 291 Zinci Bromidum (Zinc Bromide), 291 Acidum Hydrobromicum Dilutum (Diluted Hydrobromic Acid), 291 Tabacum (Tobacco), 292 XIV CONTENTS. PAGE Lobelia, 294 Acidum Hydrocyanicum Dilutum (Diluted Hydrocjanic Acid), 296 Potassii Cyanidum (Potassium Cyanide), 299 Oleum Amygdala? Amarae (Oil of Bitter Almonds), 299 Syrupus Amygdalae (Syrup of Almonds), t . 300 Amyl Nitris (Amyl Nitrite), 300 Nitroglycerinum (Nitroglycerin), 302 Potassium Nitrite, 303 Sodium Nitrite, 303 Gelsemium, 304 Woorara, 306 Viburnum, _ 307 Grindelia, 308 Sumbul, 309 Class II. — Eccritics, 310 Order I. Emetics, 310 Vegetable Emetics, 312 Ipecacuanha (Ipecac), 312 Sanguinaria, 317 Apomorphinae Hydrochloras (Apomorphine Hydrochlorate), . . 317 Sinapis (Mustard), 318 Tobacco, 318 Lobelia, 318 Mineral Emetics, 319 Order II. Cathartics, 319 Laxatives, 320 Tamarindus (Tamarind), 321 Manna, 321 Viola Tricolor, < 322 Cassia Fistula, 323 Oleum Olivae (Olive Oil), 323 Oleum Amygdalae Expressum (Expressed Oil of Almond), . . . 323 Oleum Ricini (Castor Oil), 323 Sulphur, 325 Potassa Sulphurata (Sulphurated Potassa), 326 Saline Cathartics, 327 Magnesia, ■ 328 Magnesia Ponderosa (Heavy Magnesia), 328 Magnesii Carbonas (Magnesium Carbonate), 330 Magnesii Sulphas (Magnesium Sulphate), 330 Liquor Magnesii Citratis (Solution of Magnesium Citrate), . . . 331 Magnesii Citras Granulatus (Granulated Magnesium Citrate), . . 331 Sodii Sulphas (Sodium Sulphate), 332 Mangani Sulphas (Manganese Sulphate), 382 Sodii Phosphas (Sodium Phosphate), 332 Potassii Sulphas (Potassium Sulphate), ^33 Potassii Bitartras (Potassium Bitartrate), 334 Potassii Tartras (Potassium Tartrate), 334 Potassii et Sodii Tartras (Potassium and Sodium Tartrate), . . . 334 CONTENTS. XV PAGE Mild Acrid Cathartics, 335 Rheum (Rhubarb), 335 Juglans, 337 Aloe (Aloes), 337 Senna, 339 Leptandra, 341 Frangula, 342 Cascara Sagrada, 342 Drastic Cathartics, 343 Jalapa (Jalap), 343 Bryonia (Bryony), 344 Podophyllum, 345 Chelidonium, 347 Iris, 348 Euonymus, 348 Scammonium (Scammony), 349 Colocynthis (Colocynth), 350 Cambogia (Gamboge), 351 Elaterinum (Elaterin), 352 Oleum Tiglii (Croton Oil), 353 Mercurial Cathartics, 354 Enemata, 355 Order III. Diaphoretics, 356 Pilocarpus, 357 Alterative Diaphoretics, 360 Sarsaparilla, 360 Guaiaci Lignum et Resina (Guaiacum Wood and Guaiac), . . . 362 Mezereum, 363 Menispermum, 364 Calendula, 364 Sassafras, 364 Stillingia, 365 Order IV. Diuretics, 365 Potassii Acetas (Potassium Acetate), 366 Sodii Acetas (Sodium Acetate), 366 Scilla (Squill), 367 Colchicum, 369 Oleum Erigerontis (Oil of Erigeron), 373 Apocynum, 374 Taraxacum, 375 Triticum (Couchgrass), 376 Juniperus (Juniper), 376 Scoparius, 377 Cantharis (Cantharides), 377 Order V. Blennorrhetics, 378 Senega, 378 Quillaia, 380 Allium (Garlic) , . 381 Scilla (Squill), 382 XVI CONTENTS. PAGE Terebinthina (Turpentine), . „ 382 Chian Turpentine, 383 Oleum Terebinthinae (Oil of Turpentine), 384 Pix Liquida (Tar), 385 Resina (Resin), 386 Copaiba, 387 Cubeba (Cubeb), 389 Oleum Santali (Oil of Santal), ■ 391 Matico, 392 Pareira, 392 Buchu, 393 Uva Ursi, • ■ 393 Chimaphila, 394 Myrrha (Myrrh), 396 Benzoinum (Benzoin), 396 Styrax (Storax), 397 Balsamum Peruvianum (Balsam of Peru), 398 Balsamum Tolutanum (Balsam of Tolu), 398 Order VI. Emmenagogues, 399 Sabina (Savine), . . , 400 Oleum Rutae (Oil of Rue), 401 Tanacetum (Tansy), 401 Apiol, 402 Polygonum Hydropiperoides (Water-Pepper), . 402 Class III. — Haematics, 403 Order I. Haematinics, 403 Order II. Alteratives, 403 Hydrargyri Praeparata (Preparations of Mercury), 404 Auri et Sodii Chloridum (Auric and Sodium Chloride), .... 423 Iodum (Iodine), 424 Potassii Iodidum (Potassium Iodide), 428 Ammonii Iodidum (Ammonium Iodide), . ; 430 Sodii Iodidum (Sodium Iodide), 431 Sulphuris Iodidum (Sulphur Iodide), 431 Iodoformum (Iodoform), . 431 Iodol, 434 Oleum Morrhuae (Cod-liver Oil), 436 Arsenii Praeparata (Preparations of Arsenic), 439 Calcii Phosphas Praecipitatus (Precipitated Calcium Phosphate), . 448 Syrupus Calcii Lactophosphatis (Syrup of Calcium Lactophos- phate), 449 Calcii Hypophosphis (Calcium Hypophosphite), 449 Potassii Hypophosphis (Potassium Hypophosphite), 449 Sodii Hypophosphis (Sodium Hypophosphite), 449 Syrupus Hypophosphitum (Syrup of Hypophosphites), 449 Syrupus Hypophosphitum cum Ferro (Syrup of Hypophosphites with Iron), 450 Calcii Chloridum (Calcium Chloride) 450 Ammonii Chloridum (Ammonium Chloride), 450 CONTENTS. XV11 PAGE Ammonii Phosphas (Ammonium Phosphate), 452 Potassii Chloras (Potassium Chlorate), 452 Sodii Chloras (Sodium Chlorate), 454 Potassii Bichromas (Potassium Bichromate), 454 Order III. Antacids, 454 Potassii Prseparata (Potassium Preparations), 456 Sodii Praeparata (Sodium Preparations), 458 Lithii Praeparata (Lithium Preparations), 461 Ammonii Praeparata (Ammonium Preparations), 462 Magnesii Praeparata (Magnesium Preparations), 462 Calcii Praeparata (Calcium Preparations), 462 Class IV. — Topical Medicines. Order I. Antiseptics and Antipyretics, 464 Potassii Permanganas (Potassium Permanganate), 466 Aqua Chlori (Chlorine Water), 467 Calx Chiorata (Chlorinated Lime), 467 Liquor Sodae Chlorataa (Solution of Chlorinated Soda), .... 468 Hydrargyri Chloridum Corrosivum (Mercuric Chloride), .... 468 Bromum (Bromine), 470 Iodum (Iodine), 470 Hydrargyri Iodidum Rubrum (Mercuric Iodide), . 470 Acidum Sulphurosum (Sulphurous Acid), 470 Sodii Sulphis (Sodium Sulphite), 470 Sodii Bisulphis (Sodium Bisulphite), 470 Sodii Hyposulphis (Sodium Hyposulphite), 471 Potassii Sulphis (Potassium Sulphite), 471 Magnesii Sulphis (Magnesium Sulphite), 471 Sulphides, 471 Calx Sulphurata (Sulphurated Lime), 471 Acidum Boricum (Boric [Boracic] Acid), 471 Sodii Boras (Sodium Borate — Borax), 473 Derivations of the organic radical, Phenyl, 473 Phenyl Hydride (Benzine — Benzol), 476 Acidum Carbolicum (Carbolic Acid), 476 Sodii Sulpho-carbolas (Sodium Sulpho-carbolate), 480 Creasotum (Creasote), 480 Nitro-benzine, 482 Aniline, 482 Acetanilide (Antifebrin), 482 Acidum Benzoicum (Benzoic Acid), 485 Sodii Benzoas (Sodium Benzoate), 486 Ammonii Benzoas (Ammonium Benzoate), 486 Resorcin, 487 Hydroquinone (Hydrochinone — Para-oxyphenol), 489 Pyrocatechin (Ortho-oxyphenol), \ . 489 Acidum Salicylicum (Salicylic Acid), 489 Sodii Salicylas (Sodium Salicylate), ..... 492 Lithii Salicylas (Lithium Salicylate), 49 2 Salol, 492 XV111 CONTENTS. PAGK Naphthaline, 495 Naphthol, 497 Pyridine, 497 Chinoline, 498 Kairine, 499 Thalline, 500 Antipyrine, 503 Antiseptic Oils, 505 Thymol, 505 Order II. Irritants, 506 Rubefacients, 506 Sinapis (Mustard), - 507 Capsicum, '. . . 510 Oleum Terebinthinse (Oil of Turpentine), 510 Linimentum Ammoniae (Liniment of Ammonia), 510 Pix Burgundica (Burgundy Pitch), 510 Pix Canadensis (Canada Pitch), 511 Epispastics, 512 Cantharis (Cantharides), 513 Cantharis Vittata (Potato Fly), 517 Aqua Ammonise (Water of Ammonia), 517 Suppurants, 518 Oleum Tiglii (Croton Oil), 518 Unguentum Antimonii (Antimonial Ointment), 518 Escharotics, 518 Argenti Nitras Fusus (Fused Silver Nitrate), 519 Potassa, 519 Potassa cum Calce (Potassa with Lime), 520 Soda, 520 Acidum Chromicum (Chromic Acid), 520 Acidum Arseniosum (Arsenious Acid) 520 Bromum (Bromine), 521 Zinci Chloridum (Zinc Chloride), 522 Liquor Hydrargyri Nitratis (Solution of Mercuric Nitrate), . . . 522 Potassii Bichromas (Potassium Bichromate), 522 Acida Mineralia (Mineral Acids), 523 Sapo Viridis (Green Soap), 523 Chrysarobinum (Chrysophanic Acid), 524 Order III. Demulcents 525 Cataplasmata (Poultices), 5 2 ^ Aqua (Water), 527 Acacia, 528 Tragacantha (Tragacanth), 530 Linum (Flaxseed), , . . . 53° Oleum Gossypii Seminis (Cotton-seed Oil), 532 Ulmus (Slippery-elm Bark), 532 Sassafras Medulla (Sassafras Pith), 533 Althaea (Marshmallow), 533 Oleum Sesami (Oil of Benne), 533. CONTENTS. XIX PAGE Cydonium (Quince Seed), 534 Glycyrrhiza (Liquorice Root), 534 Glycyrrhizinum Ammoniatum (Ammoniated Glycyrrhizin), . . . 535 Extractum Glycyrrhizse (Extract of Liquorice), 535 Lycopodium, 536 Cetraria (Iceland Moss), 536 Chondrus (Irish Moss), 537 Amylum (Starch), 538 Glyceritum Amyli (Glycerite of Starch), 540 Ichthyocolla (Isinglass), 540 Animal Fats, 540 Adeps (Lard), 540 Lanolin, 541 Serum (Suet), 541 Cetaceum (Spermaceti), 541 Cera (Wax), * 542 Acidutn 01 eicum (Oleic Acid), 542 Oleum Theobromse (Oil of Theobroma), ..*...*... 542 Glycerinum (Glycerin), 543 Petrolatum, 545 Pyroxylinum (Pyroxylin), 545 Collodium (Collodion), 546 Liquor Gutta Perchae (Solution of Gutta Percha), 546 Liquor Sodii Silicatis (Solution of Sodium Silicate), 547 Saccharum (Sugar), 547 Mel (Honey), 548 Saccharum Lactis (Sugar of Milk), 548 Saccharin, 548 Carbo Ligni (Charcoal), 549 Order IV. Coloring Agents, 550 Crocus (Saffron), 550 Santalum Rubrum (Red Saunders), 550 Coccus (Cochineal) - 550 Order V. Anthelmintics, ... 551 Spigelia, 551 Chenopodium, . . . . * 553 Santonica, 554 Santoninum (Santonin), 555 Sodii Santoninas (Sodium Santoninate), 556 Azedarach, » 556 Aspidium, 556 Granatum (Pomegranate), 557 Oleum Terebinthinae (Oil of Turpentine), 558 Calomel, 558 Bray era (Koosso), . . . 558 Kamala, 559 Pepo (Pumpkin Seed), 559 Appendix, 560 Signs and Abbreviations, 561 Index, 563 MATERIA MEDICA. The agents employed in the treatment of diseases are denom- inated Remedies, and the branch of medicine which is devoted to their consideration is termed Materia Medica. Remedies may be divided into Ffygienic, Mechanical, Imponderable, and Pharmacological agents. Hygienic Remedies are usually treated of in works specially devoted to the subject. PARTI. MECHANICAL REMEDIES. Mechanical Remedies belong chiefly to Surgery. A few agents of this class being, however, employed in the practice of medicine, are included in the Materia Medica. They are blood-letting (general and local), setons, issues, ba7idages, friction, acupuncture, and aspiration. I. General Blood-letting is performed principally by vene- section ox phlebotomy, which is usually practiced on the median- cephalic or basilic veins of the arm — sometimes also on the external jugular and other veins. From the veins at the elbow it is done by passing a ligature above the point selected, the patient being in the sitting posture, and making an incision in the most prominent vein ample enough to permit f§ij-iij of blood to escape per minute, and allowing it to flow until syn- cope approaches. To stop the flow, remove the ligature, apply a compress, and place the patient in the recumbent posture. 3 33 34 MATERIA MEDICA. Aricriotomy is occasionally resorted to, on the temporal artery, in cerebral affections. Blood-letting is employed to moderate vascular excitement, reduce inflammatory action, alter the quality of the blood (diminishing the proportion of fibrin, albumen and salts), relieve congestion, allay spasm and pain, relax the muscular system, promote absorption, arrest hemorrhage, remove stasis, and prevent cell proliferation and inflammatory effusions, and for these purposes it has long been considered a valuable thera- peutical resource. So powerful and exhausting an agent is, however, always to be resorted to with caution and discrimina- tion ; is not to be unduly repeated, even in inflammatory cases ; and is seldom or never proper in disease of a typhoid tendency, or where a tubercular diathesis is suspected, or in extreme infancy and old age. It is indicated in inflammations of sthenic type occurring in robust adults, and accompanied by a full, bounding, tense pulse, and should only be resorted to early in the case, before inflammatory effusions have taken place. 2. The Local Abstraction of Blood is practiced by means of leeches, cups, and ' scarifications. When a leech is applied between the inflamed area and the heart the blood current is accelerated, stasis removed or prevented, as is also the migration of cells and the effusion of serum. Scarifications produce the same results in a less degree and also give vent to effused fluids. The leech (liirndd) is an annulated aquatic worm, with a flattened body, tapering toward each end and terminating in circular flat- tened disks, which is found throughout Europe, America and India. The European leech (Ii. medicinalis, termed also sangui- suga officinalis) is of a blackish or grayish-green color on the back, from two to three or four inches in length, and is charac- terized by six longitudinal dorsal ferruginous stripes, the four lateral ones being interrupted or tessellated with black spots. It draws about f 5ss. The American leech (li. decora) is usually from two to three inches long, and is of a deep green color, with three longitudinal dorsal rows or square spots. Both the im- ported and indigenous leech are employed in this country, but the latter makes a smaller incision, and is preferable in infantile cases. It takes about f5j. When the discharge of blood from leech-bites is excessive, it may be arrested by pressure, com- MECHANICAL REMEDIES. 35 presses of lint, the application of alum, creasote, solution of iron subsulphate, and other styptics, or by cauterizing the wound by silver nitrate or a red-hot probe ; and if these means fail, the lips of the wound may be sutured. In the operation of cupping, cupping-glasses and a scarificator are employed. The removal of atmospheric pressure, by the application of glasses partially exhausted of air, produces a deter- mination of blood to the capillaries of a part, which is afterward readily drawn by scarification. When blood is not abstracted, the operation is termed dry cupping, and is a valuable revulsive agent. The topical abstraction of blood by leeches and cut cups combines the advantages of depletion and revulsion. Leeches are employed in external inflammations, in situations where cups are inadmissible, and in infantile cases. As leech-bites make scars, they should be cautiously applied over an exposed part, as the female face ; nor should they be used where there is much loose connective tissue, as the scrotum and eyelid ; over a superficial vessel or nerve ; over the seat of morbid action, nor in the vicinity of locally infective wounds, as venereal ulcers. Cups are generally preferable in internal inflammations, from their more decided revulsive influence. When blood is drawn by leeches, its continued flow may be promoted by the applica- tion of warm fomentations to the wounds. Scarifications are slight incisions made in inflamed parts, to relieve the engorged capillary vessels ; they are often employed with benefit in inflammation of the conjunctiva and of the ton- sils. 3. Setons (setaced) and Issues (fonticuli) were employed when a permanent counter-irritant effect was desired. They are now not much used. 4. Bandages are employed, in the practice of medicine, to promote the absorption of dropsical effusions, and solid inflam- matory exudations. For the same purpose strips of adhesive plaster may be applied to the chest, in chronic pleurisy and empyema, in the manner in which they are employed in the treatment of fractured ribs. 5. Frictions are useful as revellents and as local stimulants. They may be employed either with the dry hand or with horse- hair gloves, or with liniments. The latter, applied with a sponge, 36 MATERIA MEDICA. are serviceable in lumbago, sciatica, chronic rheumatism, and affections of the joints ; rubbed on the chest in bronchitis they often afford relief. 6. Acupuncture consists in the introduction into the body of fine, well-polished, sharp-pointed needles ; they are introduced by a rapid rotary motion. This is a useful remedy in rheuma- tism, neuralgia, and local paralysis. By the use of insulated needles a galvanic current may be conveyed to deeply-seated nerves. For purposes of counter-irritation a form of acupunc- ture is now used termed Baunscheidtismus. In this, an instru- ment is employed consisting of a heavy disk about half an inch in diameter, having inserted in it about twenty-five sharp needles, each about nine-sixteenths of an inch in length. To this disk is attached a strong wire spiral spring five and a half inches in length, and the other extremity of the spring is inserted in an elongated spindle-shaped handle, the spring and needles being contained in a cylinder, with the handle attached. In applying the instrument the open extremity of the cylinder is placed upon the skin ; the handle is drawn up, and when this is suddenly loosed the needles are driven into the skin, the punctures being afterward rubbed with diluted croton oil or other irritant. 7. Pneumatic Aspiration is the employment of an instru- ment termed an Aspirator (invented by Dieulafoy) for the removal by suction of pathological fluids. The aspirator consists of: — 1. A glass bottle or reservoir, A, mounted with a two-way stop-cock, B, and having an opening at the bottom for the insertion of the tube, C. 2. An exhausting syringe, D, with elastic connecting-tube, H. 3. A tubular needle, E, to be attached to the reservoir by an india-rubber tube, F. A syringe and stop-cock for injecting astringents or other fluid is supplied if desired. The stop-cock is, in such 'cases, fixed to the tube F at its junction with the stop-cock B. Thus the tube can be detached from the aspirator without any chance of air entering the morbid cavity. Directions for Use. — Adjust the aspirator as figured in the diagram, with the stop-cock B turned vertically, that is, open to the bottle ; close the stop-cock in the tube C, and form a vacuum MECHANICAL REMEDIES. 37 38 MATERIA MEDICA. by a few upward and downward movements of the piston of the exhausting syringe D. Insert one of the needles beyond the two eyes, attach tube F to it, turn the stop-cock B toward the needle, namely, hori- zontally, and continue the insertion of the needle until fluid is seen to flow through the short glass tube G into the reservoir. To empty the latter, turn the stop-cock B vertically, detach the syringe tube, and open the stop-cock in tube C. The presence of fluid having been established by the use of one of the fine needles, it is recommended, for more quickly emptying the cavity, to use one of the larger needles or trocars. The introduction of the needle into the tissues requires some precautions. In place of endeavoring to penetrate by pressure, as with an ordinary trocar, it is preferable to combine pressure with rotation, by taking the needle in the forefinger and thumb and rolling it between them. Such a manoeuvre is rendered necessary by the extreme fineness of the needle, which would be liable to bend or twist if driven in by direct pressure. Before using a needle it is well to be assured of its permeability. Aspiration has been employed with safety and success in the removal of intrathoracic effusions (as in chronic pleurisy, empy- ema, and pericarditis), of the fluid of hydrocephalus, ascites, cysts and abscesses of the liver, of the urine in retention, and of poisonous liquids in the stomach. It is also applicable to the diagnosis and treatment of morbid fluids and to the arrest of internal hemorrhage. Aspiration should be done under strict antiseptic precautions. PART II. IMPONDERABLE REMEDIES. Under this head are included Light, Heat, Cold, Electricity, and Massage. 1. Light (Lttx) exercises an important influence in the organ- ized world as a vivifying stimulus. It is useful as a therapeutic agent, in diseases dependent on imperfect nutrition and sangui- IMPONDERABLE REMEDIES. 39 fication ; and the exposure of the surface of the body to its action, as far as nudity is compatible with proper warmth, pro- motes the regular development and strength of the organs. On the other hand, in many diseases the action of light is injurious, and darkness is resorted to as a sedative and tranquilizing agent. 2. Heat {Calor), applied to the human system in moderate amount, acts, both locally and generally, as a stimulant ; in intense degree it destroys vitality and organization. It is em- ployed as a local excitant and revulsive, by means of hot bottles, hot bricks, the hot foot-batji, etc., and as an application to pain- ful and inflamed parts in the form of elastic bags containing hot water, and of poultices and fomentations. As a general appli- cation heat is chiefly resorted to in the form of the water-bath and vapor-bath. The warm bath, at a temperature from 92 to 98 F., is used as a relaxant in dislocations, herniae, spasm, infantile convulsions, croup, etc., and also for its action on the skin in rheumatic and chronic cutaneous affections. The hot bath has a temperature of from 98° to 11 2°, or even higher, and is a powerful excitant in cases of exhaustion, asphyxia or suffo- cation, alleviates the strangury of cystitis and gonorrhoea, and is employed also in old paralytic and rheumatic cases. Hot water, introduced with a Davidson's syringe, is an efficient styptic in uterine hemorrhage ; injected into the vagina before an operation on the perineum or cervix, or applied to wounds during a surgical operation, is a good means of avoiding bleed- ing. The hot-air bath, at a temperature of from 98 to 130 , is useful as an excitant, diaphoretic and revellent, and is employed in cases of internal congestion, to produce vicarious action from the skin, where the secretion from other organs, as the kidneys, is suspended, and in rheumatic, neuralgic, and cutaneous affec- tions. The hot-vapor bath is adapted to the same class of cases as the hot-air bath, and exerts a more marked diaphoretic and relaxing influence. The destructive agency of heat is resorted to for the purpose of vesication, as by the application to the skin of the metallic plate heated to 21 2° by immersion in boiling-water; and of cauterization, by the employment of red-hot iron, or of moxa. Hot iron (known as the actual cautery) is used chiefly as a styptic. The term moxa is applied to small masses of combus- 40 MATERIA MEDICA. tible matter (as cotton-wool), which are burnt slowly in contact with the skin, with a view to a revulsive effect in deep-seated inflammations, nervous affections, etc. 3. Cold (Frigus). — The application of cold to living- bodies produces a reduction of the temperature and volume of the parts, with contraction of the blood vessels and other tissues, and suspension of the secretions and exhalations. The applica- tion of excessive or prolonged cold is followed by the torpor and death of the parts. When it is applied in moderation and for a short period, reaction generally takes place, with a return and even increase in temperature, volume, color, and sensibility. Cold is employed therapeutically, with a view to both its pri- mary and secondary effects. The primary action of cold is used : 1. To lessen vascular and nervous excitement and preternatural heat, as by the use of cold lotions and spongings in fevers, the ice-cap in cerebral affection, the shower-bath in insanity, the bladder filled with ice to the spine in epilepsy, the ether spray to the spine in chorea, etc. 2. To constringe the tissues, pro- mote the coagulation of the blood and lessen the volume of parts ; hence the local application of ice or cold water to abate inflammation, check hemorrhage, cure aneurism, and reduce strangulated hernia. 3. To produce local anaesthesia in surgical operations, by means of a freezing mixture topically applied. The secondary effects of cold are obtained by the employment of a less intense degree of cold. They are resorted to : I. To invigorate the system, as with the cold shower-bath and plunge- bath. 2. To rouse the system, as by cold affusions in coma, asphyxia, syncope, and the narcotism from opium, chloroform, hydrocyanic acid, alcohol, etc. 3. In spasmodic diseases, as laryngismus stridulus, chorea, etc. 4. To recall the vital pro- perties to frost-bitten parts. 5. To effect local excitation, as by the application of the cold douche to rheumatic and paralyzed limbs. The cold bath, or packing in a cold wet sheet, is employed with much advantage in sunstroke, and in fevers where the tern- perature of the body is very high, as scarlet fever, typhoid fever, acute rheumatism, and, generally, to reduce excessive hyper- pyrexia. The ice-bag is sometimes applied along the spine in convul- IMPONDERABLE REMEDIES. 4 1 sive diseases, as epilepsy, tetanus, and infantile convulsions, and even in diseases of the secreting organs. Compresses, wrung out of cold water, are efficient local appli- cations in relieving pain. Cold liquids and ice are taken into the stomach as refrigerants in fevers. They are introduced into the rectum and vagina to check hemorrhage and allay irritation ; and cold water, injected into the impregnated uterus, is among the most certain means of inducing premature delivery. Baths are also useful in pro- moting the elimination of mineral poisons, as lead and mercury. Electricity {Electricitas), from yjXexrpov, amber. " Electricity is now regarded as a force co-related to the other great forces of nature — heat, light, etc. — and, like them, is simply a mode of motion — a force of vibration." (Beard and Rockwell.) The electric current acts as an excitant to the nerves, both of sensa- tion and motion. It influences also to some extent the secre- tions, through its action on the nerves distributed to the secreting organs ; it may promote the function of absorption, through an effect on the absorbents ; and it affects the circulation by induc- ing contractions of the heart and of the coats of the vessels. Faradisation of the peripheral ends of the cut pneumogastrics stops the action of the heart ; of the central ends, it causes re- tarded action and reduced blood pressure. A powerful charge of electricity produces violent and frequently fatal effects on the central nervous system. For medical purposes electricity is obtained from three sources : — i. Friction or Static electricity. 2. Galvanic electricity. 3. Faradic, Induced, Magnetic or Voltao-Magnetic elec- tricity. Friction electricity may be applied in three modes : — 1. By the electric bath, when the patient, placed upon an insu- lated stool and connected with the prime conductor of an elec- trical machine, is charged with electricity. 2. By a spark to a particular spot ; or, 3. A shock through a charged Leyden jar may be directed through the part which it is desired to affect. Galvanism is that form of electricity which is developed by 42 MATERIA MEDICA. chemical decomposition, and is known as the continuous, vol- taic, or battery current. It is characterized by relatively low intensity of action, but is developed in considerable quantity, and produces chemical and thermic results that are not reached by the friction electricity. In addition, it induces a flow of blood to a part by increasing the vermicular action of the vessels. Galvanism, no matter what the direction of the current, is a powerful agent in the relief of pain, hence its use in tic doulou- reux, but it is only palliative in this disease. Faradisation, or Induced electricity, is applied by means of electro-magnetic machines, their principle depending on the passage of a battery current through an insulated wire helix wrapped round a soft iron bar, which becomes magnetic by in- duction. Around this helix a fine insulated wire is coiled, which has no connection with the battery nor primary helix, and which receives electricity by induction from the latter. Closure of the current magnetizes the bar, which, in turn, attracts the rheotome ; on breaking the flow the bar becomes demagnetized, the rheo- tome flies back, and in this way an interrupted current is obtained. The polarity of the induced current changes with each make and break of the circuit, and of course is inconstant, because its direction is constantly alternating ; hence no chemical action is set up. If the interruptions be rapid enough, they cause appa- rently continuous muscular contractions. The primary current is taken from the inner helix ; the sec- ondary from the outer. The electrodes are the means by which the positive and negative electricity emerge from the battery; the positive pole being connected with the negative element, and the negative pole with the positive element. A stabile application is one in which the electrodes are kept in a fixed position ; in a labile, they are shifted from point to point. Before use they should be moistened to increase their conduc- tivity. Magneto-electricity is inferior in chemical and thermal influence to galvanism, but it produces more marked muscular contractions, and a more decided action on both the sensory and motor nerves. The brain substance, as shown by Erb, is readily affected by galvanism from the exterior, for when the electrodes are applied to the mastoids, flashes of light and vertigo are ex- perienced ; but, according to Althaus, the former phenomenon IMPONDERABLE REMEDIES. 43 is due to excitation of the fifth nerve. Of the cord, galvanism causes muscular contractions and pain. Electricity is employed in medicine for diagnostic and thera- peutic purposes. Thus, in the diagnosis of spinal paralysis : when a muscle is merely separated from the influence of the spinal cord by destruction of its nerve, or by destructive disease of the cord at the origin of its nerve, it loses its electric irrita- bility to all forms of electric irritation. In cerebral paralysis, on the other hand, there is no diminution in the contractility of the paralyzed muscle by the electric current, and there may be even an increase. In malingering, real may be distinguished from feigned paralysis, as, after railway accidents, faradisation, by showing a marked difference in the contractility of the two sides* establishes the fact of an actual morbid condition. In facial palsy the diagnostic value of electricity is typically evinced. Thus, the muscles respond scarcely, or not at all, to the faradic current in this condition, while the galvanic current will induce normal, or nearly normal, contractions. In recent hysterical paralysis the contractility of the muscles is unimpaired. Therapeutically \ electricity may be employed either to arouse or increase the action of a nerve or muscle, as in paralysis of sensation or of motion, to relieve the pain of the various neural- gias, and to counteract spasm, either tonic or clonic. For the latter galvanism only is used, the positive pole being connected with a large plate electrode which is placed over the spastic muscles, while the negative is applied over a neutral point in the median line of the body. It is chiefly available in cases of local or of purely functional palsy, as facial, and the paralysis pro- duced by alcohol, which are independent of central lesions ; or in lead palsy after the elimination of the lead from the system. In the treatment of facial palsy the positive pole of the gal- vanic current is to be placed over the pes anserinus, the negative on the terminal nerve filaments. Lumbago, neuralgia, chronic rheumatism and migraine are frequently benefited by a course of electricity. In migraine the current should be passed from the nape of the neck to the epigastrium. But little can be said in favor of electricity in dermal thera- peutics, though good results are claimed for it in chronic eczema 44 MATERIA MEDICA. (Rothwell) centrally and locally. It has also been used in acne, prurigo, and psoriasis. In anaemic and hysterical paralysis, as hysterical aphonia, static electricity is often very useful, and in nervous deafness and amaurosis, under many circumstances, faradisation will be of benefit. Electricity has also been prescribed as an emmenagogue, to produce uterine contraction in post-partum hemorrhage, in test- ing for life or death, to overcome constipation, and to promote the biliary secretion. In the form of galvanism, one pole in the rectum, the other over the abdominal tumor, electricity is employed to destroy the foetus in extra-uterine pregnancy, provided foetal life has not advanced too far. It has also been advantageously used to pro- mote the absorption of indurations and fibroid tumors. Electro- magnetism is a powerful excitant in the coma of narcotic poisons, and in asphyxia generally it is probably the most active remedy that can be exhibited. Electrolysis. — " This is a term applied to the process of decom- posing substances by electricity." It is used with decided suc- cess to remove superfluous hairs from the face and other parts. Pitzer recommends the following procedure : an ordinary gal- vanic battery of 10-15 cells is required, with a fine needle, which is attached to the negative pole. The needle is inserted within the hair follicle and the current closed with the positive electrode, causing a stinging sensation at the point of insertion ; the hair should then be withdrawn with forceps ; thirty to fifty hairs can be removed at one seance. Electrolysis has been used in the treatment of aneurism, but with a measure of success only. One or more needles con- nected with the positive pole are inserted within the sac in the hope of forming a clot by the ensuing electrolytic action of the current on the blood. The negative pole is to be applied to the shoulder, the current turned on slowly, and the seance should last about twenty minutes. Statistics show that the smaller the artery the greater the chance of occlusion. The chief dangers are hemorrhage and the detachment and drifting into the blood of coagula. In urethral stricture the galvanic current in a certain propor- tion of cases effects a cure. Mild currents must be employed IMPONDERABLE REMEDIES. 45 and applied to the seat of constriction per the negative pole by means of conical metal bulbs attached to bougies. Galvano-cautery. — This is a method of cauterization in which a wire-loop or other suitable cauterant is heated by the galvanic current. Experiment has shown that the heat developed in a wire by a current is proportional to the squares of the quantity of electricity flowing through it and to the resistance of the wire. Platinum, on account of its great resisting power, is the kind of wire selected. The chief advantages of the galvano-cautery are : easy application to inaccessible parts, absence of hemor- rhage, and comparatively little pain. Massage. — This is a word derived from the Greek, ijA<7, to stupefy) are medicines which impair Narcotics (from or destroy nervous action. The primary effect of narcotics is, however, of a stimulant character, and their therapeutic efficacy is in a great degree due to this action. They are often adminis- tered, too, for a true narcotic or sedative influence on the motor, sensory and intellectual functions. In diseased conditions, a marked tolerance of this class of medicines is established, and they can be exhibited in large doses without inducing narcosis. They are employed, chiefly, to remove muscular spasm, relieve pain, allay cerebral or spinal irritability and procure sleep. When employed to relieve pain, they are termed anodynes ; when employed to procure sleep, hypnotics or soporifics. When this class of medicines is resorted to for any length of time, with a view to a narcotic effect, their influence upon the system is much diminished, and constantly increased amounts are called for to maintain the same effect. NARCOTICS — OPIUM. 73 OPIUM. Opium (from Wo?, juice) is the concrete milky exudation of the unripe capsules of Papaver somniferum (Nat. Ord. Papa- veraceae). The opium-poppy is a native of Persia, but is culti- vated in various parts of Asia, in Europe, and in the United States. It is an annual plant, with a round, leafy stem, from two to four feet or more in height, and large four-petaled flowers. There are two prominent varieties of this species: the black poppy, with violet-colored or red flowers, brown or blackish seeds, and globular capsules ; and the white poppy, with white flowers and seeds, and ovate capsules ; but these varieties run into each other under cultivation. The nearly ripe capsules (papaver) are from an inch and a Fig. 5. POPPY-CAPSULE. half to two inches or more in diameter, and contain a good deal of opium. They are sometimes given to children in the form of syrup, and are applied externally as an anodyne emollient, in the form of decoction. The seeds are destitute of narcotic properties, and are used in Europe as an article of diet, and for the manu- facture of an oil. Opium is obtained from incisions in the half-ripe capsules. The juice which exudes from the incisions is allowed to evapo- rate spontaneously, and is scraped off after drying, generally with more or less of the epidermis, and is sometimes sent into the market unmixed, as a choice variety. The opium of com- merce is, however, commonly made by adding the dried juice, obtained by incision, to an extract prepared by expression, or 74 MATERIA MEDICA NEUROTICS. even from a decoction of the leaves, the whole being kneaded together, formed into cakes, and wrapped in fresh poppy-leaves. The commerce of the United States is supplied with opium almost exclusively from Asiatic Turkey. This is known in the market as Smyrna or Turkey opium, and comes in irregularly rounded or flattened cakes, covered with the capsules of a species of Rumex. A large amount of opium is produced in British India, for consumption in India and China, but it is not found in our mar- kets. The Persian opium is another variety, as is that obtained from upper Egypt, but these do not reach the United States. The best opium should have a fine chestnut color, an aromatic, strong, peculiar smell and a dense consistence — be- coming, however, harder and darker by being kept. It should be moderately ductile, break with a deeply-notched fracture, and, when drawn across white paper, should leave an interrupted stain. The taste is very bitter and somewhat acrid, and when chewed it excites irritation in the mouth and throat. It is in- flammable, and imparts its virtues to water, alcohol and diluted acids, but not to ether. Chemical Constituents. — Opium contains a great variety of chemical constituents, the most important of which is the alka- loid Morphina {morphine). Other principles found in opium are the alkaloids, narcotine, codeine, narceine, paramorphine (thebaine), papaverine, pseudomorphine (phormine) ; meconin, meconic and thebolactic acids, gum, extractive, resin, oil, etc., but no tannin or starch, and, in very minute amounts, alkaloids, termed meconi- dine, laudamine, codamine, lanthopine, rhceadine, laudanosine, protopine, hydrocotarnine, deuteropine, oxynarcotine, gnosco- pine, and cryptopine. Porphyroxin, so called by Merck, is not a proximate principle, but a complex substance, consisting of several alkaloids (Hesse). Morphine is the principle upon which the narcotic effects of opium essentially depend, and, with its salts, is officinal in all the pharmacopoeias. Morphine exists in opium chiefly in combination with me- conic acid. The morphine meconate is separated from the other constituents of the drug by successive macerations with water. Alcohol and water of ammonia are then added to the aqueous solution, by which the salt is decomposed, the ammonia precipi- NARCOTICS OPIUM. 75 tating the morphine and the alcohol seizing the coloring matter as soon as it is separated from the alkali. The crystals of morphine which are formed are afterward boiled in alcohol, and the solution is filtered through animal charcoal. Good samples of opium, when dried, should yield not less than 12 nor more than 16 per cent, of morphine. Morphina (Morphine} (Ci 7 H 19 N03.H 2 0) occurs in colorless, rhombic, prismatic crystals, without smell, but of very bitter taste. It is very slightly soluble in water and ether, nearly in-* soluble in chloroform, partially soluble in cold and more soluble in boiling alcohol. Acetic ether (ethyl acetate) is the best solvent for it. From the insolubility of the alkaloid the salts of morphine are preferred for medicinal use ; they are freely solu- ble in water and diluted alcohol, but are insoluble in ether and chloroform. Tests: 1. Concentrated 7titric acid strikes with morphine and its salts a rich orange-red color, slowly fading to yellow ; this will detect gr. 10 q 00 in the dry state (Wormley). 2. Neutral solutions of ferric chloride or sulphate color them deep blue. Other tests are recommended, but these are the best. Narcotine (C22H23NO7) exists in opium, chiefly in the free state, and, being insoluble in water, is left behind when the drug is macerated in this menstruum. It occurs in white, tasteless, inodorous, needle-like crystals, which are soluble in ether, alco- hol, and still more so in chloroform. At one time it was thought to possess a portion of the narcotic properties of opium, but it is now admitted to be inert in this respect. Its salts, which are bitter, have been used in India as stomachics, and as febrifuge tonics in the treatment of intermittent fever. Codeina {Codeine) C 18 H 2 iN0 3 .H 2 0) exists in opium combined, like morphine, with meconic acid, and is extracted in the process for obtaining the latter alkaloid, from which it may be separated by an alkaline solution, which dissolves the morphine and leaves the codeine. It occurs in colorless, octahedral crystals, of a bitter taste, soluble in water, alcohol, ether and chloroform. Narceine (C23H29NO9) is obtained from the mother liquid left after crystallizing out the salts of morphine. C. Bernard affirmed that it is the most certain hypnotic of all the opium alkaloids. Da Costa's experience shows that it has little effect y6 MATERIA MEDICA NEUROTICS. on skin or pupil, and that its hypnotic action is uncertain or inert, while Eulenberg asserts that to get its hypnotic effects it must be given in doses twice as large as morphine. Paramorphine (Tkebaine) (Ci 9 H 2l N0 3 ) is said to be a tetanizing toxic agent, analogous in its effects to strychnine. Papaverine (C 2 lH 2 iN0 4 ) is said to produce some soporific action, with a sedative influence on the pulse ; its strength is from one-eighth to one-fourth of that of morphine. Cryptopine (C21H23NO5) is thought to produce a hypnotic influence analogous to that of morphine, though a much feebler agent. The statements in regard to the action of the last four alkaloids are conflicting. Meconic acid is inert, but is interesting as affording the most delicate test for opium ; ferric chloride or sulphate produces, with even very diluted solutions of opium, the blood-red color of ferric meconate, which is not discharged by diluted acids or corrosive sublimate. Incompatibles. — Alkalies, and astringent infusions containing tannic acid, are incompatible with opium ; the former precipitate morphine from its soluble combination, while the latter form with it an insoluble compound. Many of the mineral salts are also decomposed by opium, as lead acetate (lead meconate and morphine acetate being formed). The chemical incompatibility, however, does not in all combinations interfere with the usual physiological action of opium ; for instance, lead acetate and laudanum, though incompatible, produce a local sedative effect ; in addition, lead acetate, opium or the morphine salts can be safely prescribed together in pill form. Physiological Effects. — Opium exerts a marked therapeutic action in the relief of pain, spasm, wakefulness, nervous irrita- bility, and certain forms of morbid discharge, especially from the alimentary canal, by a primary stimulant action, antecedent to any narcotic influence. In such conditions a tolerance of its effects is established, and very large amounts may be taken without inducing narcosis. Opium applied locally deadens the sensibility of the nerves of a part without influencing the brain (Trousseau et Pidoux, vol. ii). In detail its physiological action in moderate doses is as follows : Nervous system : the cerebral functions are stimulated, accompanied by an agreeable ex- NARCOTICS — OPIUM. y/ hilaration of the intellectual faculties, followed by drowsiness, consciousness being finally lost in sleep, the latter sometimes disturbed by dreams. Such sequelae as headache, nausea and constipation are common. The reflex function of the spinal cord is diminished, and in lethal doses destroyed, death taking place from paralysis of the respiratory centre. Pupil : in full doses opium contracts the pupil ; but, since the local applica- tion of morphine scarcely possesses this power, it follows that its action must be systemic, due probably to stimulation of the oculo-motor centres. Circulation : the heart's action becomes slower and fuller, from a depressing influence on the cardiac motor ganglia ; at the same time the arterial tension is raised. Respiration : this becomes slower, and the bronchial mucus is lessened. Secretions : the intestinal secretions are diminished, and, as peristaltic action is retarded, constipation results ; the urine is slightly diminished, as is also the saliva ; in one word, all the secretions are lessened except that of the skin, which is increased. According to Phillips the drug is probably elimi- nated by the skin. In regard to its elimination by the kidneys, Eliasson's * conclusions are as follows, viz., that large doses only can be found in the urine, small ones being undetectable, though there appears with the latter in the urine a supposed morphia-derivative. In some persons an itching and miliary eruption of the skin occurs. Most of the opium alkaloids in- crease the excretion of urea. To sum up, opium, in man, expends its force chiefly on the higher cerebral centres, scarcely influencing the cord at all, unless in full doses, while in the lower animals whose cerebra are un- developed, as the frog, its acts wholly on the cord, and in them, in the absence of a well-developed brain, hypnotism is unusual. According to Fothergill, opium produces sleep by causing cerebral anaemia and diminished activity of the cells ; and is analgesic by lessening the conductivity of nerve-matter. When a poisonous dose is taken, the stage of excitement is wanting ; giddiness and stupor rapidly come on, with diminu- tion in the frequency, though not in the fullness, of the pulse ; * Beitrage zur Lehre von dem Schicksal des Morphins im Lebenden Organismus. Inaug. Dissertation, Konigsberg, 1882, von W. Eliasson. yS MATERIA MEDICA NEUROTICS. and these symptoms are soon followed by an irresistible ten- dency to sleep, and finally by coma. The breathing is heavy and stertorous, the pulse slow and oppressed, and the pupils are contracted. If relief be not afforded, the pulse sinks, the mus- cular system becomes relaxed, and death ensues, preceded some- times in children by violent convulsions. In adults even gr. y^ of morphine,* hypodermically, and gr. ivss. of opium,f have caused death, but such results are rare. On the other hand, enormous amounts (laudanum J fSvij, and in the case of a girl aged nj^,§ fSxij) have been taken without fatal consequences. In cases of poisoning from opium or its preparations, the stom- ach should be immediately evacuated by the stomach pump, if possible, or by emetics. Owing to the torpor of the stomach, emetics are to be given in double the ordinary doses, and the direct emetics are to be preferred, as zinc sulphate (gr. xx-xxx) or copper sulphate (gr. v-x), in a tumbler of water. A large tablespoonful of mustard flour, or of powdered alum, answers very well as an emetic, or apomorphine hydrochlorate (gr. y^-) may be given hypodermically. Every means should be taken to arouse the patient from his lethargy ; he should be kept awake, and made to walk as long as possible ; afterward cold affusions, counter-irritation to the nape of the neck and extremi- ties, flagellation to the palms of the hands and soles of the feet, and, best of all when the coma is profound, the electro-magnetic battery should be resorted to, one electrode to be placed above the origin of the phrenic nerves, the other over the epigastrium. Artificial respiration is also to be practiced. The use of strong coffee has proved efficacious ; and stimuli may be given to sup- port the system. It has been found that atropine exercises a powerful influence as a physiological antidote to opium, these drugs acting in an opposite ma7iner on respiration, brain, skin, pupil and circulation. A hypodermic injection of atropine sul- phate, gr. -fa to -fa, should be administered when there is any sign of the failure of respiration, and repeated in fifteen to thirty minutes, the frequency and dose depending on the condition of * Chicago Med. Exam., May, 1878, p. 493. •f-A Treatise on Poisons, 4th ed., p. 713, by Christison. % Med.-Chir. Trans., Vol. I, p. 77. \ Guy's Hosp. Reports, XI, 1 865, p. 287. NARCOTICS OPIUM. 79 the respiration, not of the pupil or depth of coma. The poison- ous action of opium appears to be entirely directed to the nerv- ous system, since no local lesions are found after death. Opium is largely used as an habitual narcotic in Oriental countries, and to some extent in Europe and the United States. The effects of indulgence in this species of intoxication are of the most destructive character upon both the physical and men- tal faculties. A confirmed opium smoker can be recognized, generally, by his pallor, emaciation, and contracted pupil. In China extensive establishments are devoted to the smoking of opium, a form of dissipation that has fewer evils following in its train than those caused by the abuse of alcohol ; in fact, the " pipe " puts the smoker to sleep, and so effectually prevents the crimes so often induced by alcoholic inebriation. It is quite possible to indulge in the "pipe" and yet enjoy good health. In fact, there are many Chinamen who, smoking in moderation, experience no evil effects therefrom. In Japan, opium smoking is unknown, as the importation of the drug is rigorously prevented by law. As opium is either taken by means of the pipe, hypo- dermic injection, or in solution, the expression " opium eating " is a misnomer. Medicinal Uses. — Of all the articles of the Materia Medica, opium enjoys the widest range of therapeutic application. From its properties of assuaging pain and inducing sleep it is useful in almost all diseases, and should be given in doses sufficiently large to produce a decided effect. It is positively contra-indicated only where there is a tendency to apoplexy, coma, where asphyxia is threatened by copious secretions in the air passages, or where there exists an idiosyncrasy with respect to its effects. As an anodyne in all injuries, as sprains, railway accidents, burns, etc., to relieve pain and resist surgical shock, we have no substitute for opium ; and as an hypnotic in delirium tremens and in the insomnia and cerebral irritability of fever, mania, etc., it is equally invaluable. Prior to an operation, to avert surgical shock, gr. %~y$ of morphine may be thrown under the skin before ether- ization. In delirium tremens, when the arterial tension is high, to enhance its hypnotic effect, it is well combined with sedatives, as the bromides, chloral or aconite, as in the following : — 1^ Mor- 80 MATERIA MEDICA NEUROTICS. phinae sulphatis, gr. Y^-){ ; Chloral, gr. xv ; Syrupus tolutani, f5ss ; Aquae, ad f§ss, p. r. n. From its power of relaxing muscular spasm, it is our most efficient resource in colic, either biliary, renal, intestinal or ute- rine, and in spasm of the neck of the bladder, being preferably given hypodermically, often with atropine. In dysentery, cholera and cholera morbus, it forms the basis of every variety of treatment, partly for its diaphoretic effects, but principally for its action in arresting the intestinal secretions and peristalsis. In the collapse of cholera, Dr. Gallagher has derived great benefit from morphine subcutaneously. In dysen- tery, extract of opium gr. ss is given every two hours, continued until an impression is made, or it becomes contra-indicated ; or laudanum may be combined in the first stage, with castor oil or Rochelle Salt (see Sal Rochelle) ; again, opium is often added to astringents, vegetable or mineral, and lastly it may be introduced within the rectum, either in starch water or suppository, as a curative measure, or for the relief of tenesmus. In conjunction with the above treatment, the patient should be placed upon a stimulating fluid diet, as milk and brandy. In some cases of dysentery opium causes retention of the dejecta, which, by fer- menting, irritate the bowel.* In diarrhoea, preferably after the exhibition of a cathartic, opium is indicated with a vegetable astringent: — Tty Tincturae opii deodoratse, ^x; Tincturae kino vel catechu, f3j-ij ; Aquae cinnamomi, f§ss. M. Sig. — Every three or four hours ; or if accompanied with flatulency — 1^ Extracti opii, gr. ]/^ ; Pulveris camphorae, gr. iij ; Oleoresini capsici, gr. j{ ; M. Ft. pil. No. I. Sig. — Every three hours. In that form of diarrhoea in which the motions quickly follow after eating it is particularly serviceable by restraining peristalsis, thus allowing time for digestion. In peritonitis, in which large amounts are well borne, morphine hypodermically should be administered from the first, and the patient later kept narcotized by opium itself; while in puerperal septicaemia it has been found more successful than any other remedy. In gastric irritability, to check vomiting, in colica pictonum, to relieve the pain of * See the Med. and Surg. Hist, of Rebellion, chap, on Dysentery. NARCOTICS — OPIUM. 8 I rheumatism and gout, opium or morphine are constantly employed, and hypodermics of morphine in myalgia, lumbago, and the various neuralgiae are the best means of alleviating the pain, and not infrequently effect a cure. In cerebro-spinal fever it is of the greatest value, no other drug being comparable to opium, of which gr. ss-ij may be given hourly, so as to keep the patient thoroughly under its influence. In other convulsive dis- eases, such as uraemic convulsions (Loomis) and puerperal eclampsia, it is an efficient remedy ; moreover, an approaching paroxysm of malarial fever, pernicious or intermittent, may be prevented, if necessary, by the timely injection of morphine. For the relief of the cough of pulmonary affections, opium has no equal in the Materia Medica, but is generally contra-indi- cated before the secretions are established, except in minute doses combined with a diaphoretic, as in Dover's powder. Good formulae are : 1^ Morphinae sulphatis, gr. ij ; syrupus ipecacu- anhas fSijss ; syrupus pruni virginianae, f§iij ; aquae ad. f§vj. M. et Sig. — Tablespoonful every three hours. Ity Tincturae opii camphoratae, glycerini, et syrupus pruni virginianae aaf§j. M. et Sig. — A teaspoonful, repeated as necessary. In the first stage of pleurisy, morphine hypodermically, aconite, with a large dose of quinine per orem, and perhaps a blister, is the best means of relieving the pain and cough and hindering effusion. Morphine subcutaneously will generally relieve a paroxysm of asthma, -although without curative power, and Dr. Allbutt recommends it to alleviate cardiac dyspnoea, which statement the editors can confirm. In sunstroke, too, good results have been obtained from mor- phine injections with antipyretic and sedative treatment (Dr. Jas. Hutchinson). Opium and recently its alkaloid codeine have been highly lauded in the treatment of diabetes ; and, lastly, in all gangrenous processes its use is indicated. Caution must be enjoined in prescribing opium in chronic diseases, for fear of originating the opium habit, which may be contracted where there is much suffering, on account of the speedy relief afforded by it. Topically \ it is used in the form of ointment to relieve the pain of boils, carbuncles and hemorrhoids, either alone or with bella- 6 82 MATERIA MEDICA NEUROTICS. donna : ^ Extracti opii, extracti belladonnae aa gr. xxj ; acidi tannici gr. x ; adipis Sss. M. et Sig. — Apply to piles. In supposi- tory, it is serviceable both for its local and constitutional effects, in strangury, anal fissure, proctitis, prostatitis, uterine disorders, and to control chordee : 3^ Extracti opii, gr. j ; extracti bella- donnae, gr. ss. M. ft. supposit. no. i. As a sedative collyrium, in aqueous solution, in the form of lead water and laudanum, as an anodyne lotion, or as an addition to poultices, it is daily employed. Administration. — The ordinary dose of opium as an anodyne and hypnotic is gr. ss-ij. Much larger doses are, however, called for in many diseases ; and when it is administered for a length of time, as a narcotic, the dose must be gradually in- creased. To infants and very old persons it is to be given with great caution. Some of its disagreeable effects may be obviated by the addition of other remedies ; thus, if it constipate, by com- bining it with aloes, or if there be anorexia, with capsicum. Its hypnotic action is aided by the bromides, chloral, urethan, paraldehyde and hypnone; its analgesic, by belladonna and cocaine, but it should not be prescribed in full doses with these agents. The following are the officinal preparations of opium : — Opii Pulvis {Opium Powder). Used in making most of the opium preparations. It should contain not less than 12 nor more than 16 per cent, of morphine. This, as Dr. Squibb has pointed out, causes a great variation in their strength, depending on the percentage of morphine in the powdered opium ; thus laudanum Sj may contain from gr. 5.44 to gr. 7.25 of morphine. Opium Denarcotisatum {Denarcotised Opium). Opium freed from narcotine, etc., by means of ether, and containing 14 per cent, of morphine. Dose, gr. ss-ij. Pilule Opii {Pills of Opium). Each pill contains gr. j. Extractum Opii {Extract of Opium). Dose, gr. \. Trochisci Glycyrrhiz^e et Opii {Troches of Glycyrrhiza and Opium). Wistar's cough lozenges, are very useful to allay irrita- tive laryngeal or pharyngeal cough. Each troche contains gr. -^ of extract of opium. Emplastrum Opii {Opium Plaster). Made by mixing extract of opium with Burgundy pitch and lead plaster. Pulvis Ipecacuanha et Opii. Powder of Ipecac and Opium. NARCOTICS — OPIUM. 83 Dover s Powder is a most valuable anodyne diaphoretic, exten- sively prescribed in diarrhoea, dysentery, rheumatism, bronchitis, pneumonia, etc. Dose, gr. x, containing gr. j of opium and ipecac each. Tinctura Opii (Tincture of Opium). Laudanum. Contains 10 per cent, of powdered opium. It should be recollected that the opium from which these preparations are made contains from 2 to 6 per cent, more morphine than that formerly em- ployed. This is the most commonly used of all the officinal preparations of opium. When long kept, particularly if exposed to the air, it becomes thick from evaporation of the alcohol, and its strength is much increased. Dose, ^xij, or about 25 drops, equivalent to opium gr. j. There are 120 drops in f5j. Lauda- num is much used in the form of enema. Tinctura Ipecacuanha et Opii [Tincture of Ipecac a?id Opium). Dose, ^x-xx. Tinctura Opii Camphorata {Camphorated Tincture of Opium). Paregoric Elixir. Contains opium in diluted alcohol, with ben- zoic acid, oil of anise, glycerin and camphor. Dose, f5ss, or a tablespoonful, containing rather less than a grain of opium. A favorite preparation for children. 5 to 20 drops may be given to an infant. Tinctura Opii Deodorata [Deodorized Tincture of Opium). In preparing it, the narcotine and odorous ingredients of opium are got rid of. A valuable preparation. Dose, ^xij. Acetum Opii [Vinegar of Opium). Black Drop. Dose, ^xij. Vinum Opii [Wine of Opium). Sydenham 's Laudaitum. Dose, ^xij. Morphine Sulphas {Morphine Sulphate), Morphine Acetas (Morphine Acetate), Morphine Hydrochloras (Morphine Hy- drochlorate), are the officinal salts of morphine, made by satu- rating the alkaloid with sulphuric, acetic or hydrochloric acids. The sulphate and hydrochlorate occur in the form of snow- white, feathery crystals, the acetate (which is not very stable) as a white powder. They have a bitter taste, are all freely soluble in water and alcohol, and produce analogous medicinal effects ; the sulphate is most employed in this country. The salts of morphine possess the analgesic and hypnotic, but not the diaphoretic properties of opium, and are considered less apt to 84 MATERIA MEDICA NEUROTICS. produce headache, nausea or constipation. They are peculiarly adapted to the hypodermic and endermic methods of application. Dose, gr. \- \, equal to opium gr. j. Magendie's solution, not officinal, used hypodermically, contains gr. xvj to fSj ; but for this purpose compressed tablets, or the powder dissolved in water as required, are preferable, and its efficiency is often pro- moted by the addition of atropine. Troches of Morphine and Ipecac (Trochisci Morphinse et Ipe- cacuanhas) ; each troche contains gr. -^ of morphine sulphate and gr. -^ of ipecac. Pulvis Morphine Compositus [Compound Powder of Mor- phine) {Tullys Powder). Contains morphine sulphate (i part), mixed with camphor, liquorice and calcium carbonate (of each 20 parts). Codeina (Codeine) is officinal, and has been found to possess uncertain narcotic powers, gr. j having failed to be hypnotic, while gr. iv have caused insomnia and slight delirium ;* again, gr. v have produced no effect (S. Weir Mitchell). It may be used as an anodyne and hypnotic, and appears to possess a sedative effect on the vagus also. It has been used with success in gastrodynia, to allay troublesome cough, and is said to be of service in glycosuria. Dose, gr. ss-ij, in water, with elixir of orange. LACTUCARIUM. Lactucarium {Lettuce Opium) is the concrete milk-juice of Lactuca virosa, the garden lettuce {Nat. Ord. Composite), and is obtained from incisions in the stem of the plant, during the period of inflorescence. Two varieties are found in the market : English and German lactucarium, the latter being inferior. It occurs in small, brownish lumps, with an opiate smell. The active principle, termed lactucin, is said to possess less hypnotic power than the crude drug. Effects and Uses. — Lactucarium possesses very feebly the ano- dyne and hypnotic qualities of opium. It may be given where opium disagrees from idiosyncrasy. Dose, gr. x ; of the syrup f5ij-iv ; of the fluid extract £5j . * British Medical Journal, 1874, I, 478. NARCOTICS PARALDEHYD. 85 PARALDEHYD. This remedy, not officinal, is a polymeric modification of ethyl aldehyd (C 2 H 4 0) 3 , and is formed by treating it with a mineral acid. It is a colorless liquid, boiling at about 25 5° F. and solidify- ing into fusible crystals at 5 1° F. It has an acrid taste, a volatile odor like that of chloroform, is more soluble in cold than in hot water, and has a sp. gr. of .998. Physiological Effects. — The action of paraldehyd has been studied by Drs. Cervello,* Morselli,t AlbertoniJ S. A. Popoff,|| Andruzski,§ Carl von Noorden,Tf Berger, Langreuter,** Dana and others, all of whom agree that it is a hypnotic and sedative, lowers reflex activity, and is comparatively free from unpleasant after-effects. Locally : it is strongly antiseptic and anti-fermen- tative. Nervous System : the action of paraldehyd is exerted on the hemispheres, medulla and cord, in the order named (Coudray).ft Small doses cause a temporary increase followed by depres- sion of the excitability of the cerebral cortex, and quiet, tranquil sleep. When a large dose is taken the primary stimulation is absent. The pupils are unaffected. Paraldehyd depresses and in toxic doses paralyzes the respiratory centre of the medulla, cardiac innervation being unaffected. The reflex centres of the cord and the peripheral endings of sensory nerves are depressed, causing a diminution, and, if a toxic dose have been taken, a sub- sequent loss of sensibility, reflex action, and voluntary motion ; the excitability of motor nerves and of striated muscles remains unimpaired. Circulation : even large doses do not affect the circulation nor the arterial tension. If, however, toxic doses be administered * Archiv. Ital. de Biologie, 1884, p. 1 13. Archiv. pour le Science Med., Vol. VI. El Pisani, Disp. IV, V and VI. f Gazz. degli Ospitali, Jan. 1 883, Nos. IV, V and VI. Rev. Sper. di Fren. e di Med. Leg., 1 882. El Pisani Fasc, iii, loc. cit. \ Riv. di Chim. Med. e Farmaceu-tossico e Farmaco., Feb. and Mar., 1883. || Medilz. Obozrenie, Fasc. I, Vol. XXI, 1884, p. 69. \ Arkhiv. Psykhiatriee, etc., Vol. iv, Fasc. I, 1884, p. I. 1f Centralbl. filr Klin. Med., March 22, 1884. "** Centralbl. filr Klin. Med., loc. cit. Berlin. Klin. Wochensch., June 16, 1884. ft These de Paris, 1 886. 86 MATERIA MEDICA NEUROTICS. the cardiac frequency is at first decreased but soon increased, the individual beats being weaker than normal, and a gradual fall takes place in the blood pressure, the heart finally stopping in diastole. It is said that the cardiac arrest is only due to cessation of the respiratory act and that it may be prevented by resorting to artificial respiration. Respiration and temperature : more or less marked slowing of respiration always occurs, and if a sufficiently large dose be taken, there is final respiratory paralysis of central origin. The temperature is slightly lowered. Alimentary tract: as a rule, no gastro-enteric disturbance occurs on waking ; but if the dose be large and the medicine administered for a prolonged period, gastric catarrh and dis- turbed nutrition may result (Andruzski), though most observers have not seen these effects following its prolonged use. Secre- tion : the urine is increased in amount. Prof. Popoff found that large intravenous injections destroyed the red corpuscles and produced haematuria. Elimination takes place through the kid- neys and the lungs, the odor of paraldehyd having been detected in the breath twenty-four hours after its administration. Medicinal Uses. — Paraldehyd is chiefly used as a hypnotic in the insomnia of various mental disorders, or in insomnia from prolonged mental work, or where other hypnotics have proved insufficient or are contra-indicated. Its good effects are especially conspicuous where insomnia is not due to pain or to mechanical causes, such as dyspnoea or cough. In the insomnia of acute or chronic mania, delirium tremens, dementia paralytica, hys- teria, etc., it is useful by procuring sleep, but otherwise exerts no effect upon the disease. It has also been used with occasional benefit as an anodyne and hypnotic in neuralgic affections (Morselli). From its depress- ing influence on the reflex functions of the cord it has been given in epilepsy, and according to Riggi, is as useful in this affection as potassium bromide. Cervello found that paraldehyd was a physiological antagonist to strychnine, preventing the toxic symptoms of that alkaloid if given before their appearance or causing their subsidence if administered after their development, and acting whether used with, before or after strychnine. This action is not reciprocal, NARCOTICS URETHAN. 87 as strychnine appears to exert little or no influence over paraldehyd-narcosis. Paraldehyd is contra-indicated in severe gastric disease and in advanced phthisis with affection of the throat (Carl von Noorden). Administration. — Dose f5ss— ij. It is better given in small doses repeated every hour as required, than in a single large dose (Strahan) ; * more than gtt. lx is rarely required to produce sleep. Paraldehyd may be administered in capsule or emulsified with acacia and syrup of almonds, which disguises somewhat its unpleasant taste. It has also been exhibited in suppository. HYPNONE. This substance (unofficinal), phenyl-methylacetone, acetophe- none, or acetaphone is a recent addition to the narcotic group of remedies. It is a fluid having a sp. gr. of 1.032, crystallizing in large flakes at about 50 F. Its properties have been inves- tigated by Popoff, Dujardin-Beaumetz, Laborde,f Magmen % and others, who have ascertained that it possesses decided hypnotic properties. Injected into the vein of a dog it caused sleep, anal- gesia, absence of the ocular reflex, dilated the pupils, and killed by asphyxia (Laborde). It is eliminated in part by the lungs, its odor being perceptible upon the breath. Large doses are said to irritate the stomach. What the toxic dose is has not yet been determined, though as much as gtt. vj-viij have been taken without disagreeable effects. It is probably indicated in the same range of diseases to which paraldehyd is applicable, especially in uncomplicated insomnia. Dose gtt. ij— v or perhaps more, in capsule or with glycerin and syrup. URETHAN. Urethan (CHNO), unofficinal, is ethyl carbamate and occurs in white crystals, odorless, almost tasteless, and readily soluble in water. Its effects have been studied by Garnier,§ Hiibner and Strieker, 1 1 and others. It acts principally on the cerebrum, at first * London Lancet, Jan., 1885. f Comp. Rend, des Seances de la Soc. de Biol., t. II, Oct., 1885. % These, Lyon, 1 886. \ Revue Med. de Vest, 1886, p. 126. [| Deutsche Med. Wochensch., April, 1886, p. 236. 88 MATERIA MEDICA — NEUROTICS. stimulating but soon depressing its functions and inducing, in suitable cases, tranquil sleep, usually without unpleasant after effects. The circulation and respiration are also somewhat de- pressed, the reflexes lowered, and the temperature reduced. It is not an analgesic, and will not produce sleep when insomnia is due to pain. It is feebly toxic, causing in overdoses insensibility and coma, though 3iij have, been taken without alarming results. Large doses of urethan decrease the nitrogenous elements of the urine, by which fluid it is excreted (Gamier). As a hypnotic it is useful in simple insomnia when other remedies are contra-indicated on account of their action on the heart and respiration. It has been given also with benefit in epilepsy, chorea, and uraemic convulsions. In large doses it is antagonistic to strychnine but is not sufficiently powerful to be used as an antidote to that poison. The dose ranges from gr. ij— 5j, or more, dissolved in water and flavored with elixir of orange. Hypnotic effects can usually be produced by doses of gr. xv-xxx in suitable cases. Capsules may be used as a means of administration. BELLADONNA. Belladonnse Folia, Belladonna Leaves ; Belladonna Radix, Belladonna Root. Atropa Belladonna, or Deadly Nightshade (Nat. Ord. Solan- aceae), is a European perennial plant, with herbaceous, branched, downy stems, about three or four feet high, large ovate leaves of a dull-green color, and drooping, bell-shaped purple flowers. The whole plant possesses narcotic properties, but the leaves and root only are officinal. The root should be obtained from plants more than two years old ; the dried root is long, round, from one to seven inches in thickness, branched, of a reddish-brown color, of little odor, and a feeble sweetish taste. The physiological properties of belladonna depend on the presence of an alkaloid termed atropine, combined with malic acid, which is found in all parts of the plant. It is officinal, and is prepared from the root by exhaustion with alcohol, afterward adding sulphuric acid, precipitating with potassa, dissolving the atropine in chloroform, and then evaporating the chloroform. Atropina (Atropine) (C 17 H 2 3N0 3 ) occurs in the form of yellowish- white, silky, prismatic crystals, without smell, but of a bitter, acrid taste, soluble in alcohol, more so in ether, still more so in NARCOTICS BELLADONNA. 89 chloroform, but only partially soluble in water. .The best test is bromine, in hydrobromic acid, which produces a yellow amor- phous precipitate, soon becoming crystalline, and will detect at least gr. 2 5 \ (Wormley) ; auric chloride gives with atropine solution a yellow amorphous precipitate ; the physiological test should also be applied by dilating the pupil of a rabbit or a cat by local application to the eye. It is a most energetic poison, producing analogous effects to those of belladonna, but much more powerful. Another alkaloid termed belladonnine has been isolated, which, according to Ladenburg, is isomeric with hyos- Fig 6. ATROPA BELLADONNA \ A, ROOT \ B, LEAVES. cyamine and atropine. It has, however, a lower fusing point, and yields a different salt with gold chloride. Physiological Effects of Belladonna. — The authorities consulted for this article are Meuriot,* Fraser,f Bezold and Bloebaum, % Lemattre,|| and Donders.§ Belladonna or atropine applied locally diminishes sensation and can be absorbed through the unbroken De la Method. Phys. de la Belladonne," 1868; an elaborate monograph, f Trans. Roy. Soc. Edin., 1869, p. 449. \ Wicrzburger Physiol. Unlersuchungen, 1867, p. 3. || Arch. Gen. de Med., VI, 6 ser., p. 173. I « Accom. and Refrac. of the Eye," 1864, p. 558. gO MATERIA MEDICA NEUROTICS. skin. Nervous system : in small doses it is a cerebral exhilarant, tending in larger doses to produce hallucinations and delirium. The exact quantity required to induce these effects cannot be stated, as individual susceptibility differs. Belladonna dilates the pupil, in whatever way exhibited. When dropped into the eye it brings about dilatation probably by paralysis of the end- organs of the third nerve and stimulation of the sympathetic, while internally it is also thought to cause pupillary dilatation by a local action. In large doses the excitability of the motor and sensory nerves is impaired by this drug, but the contrac- tility of striated muscles remains unaltered. It tetanizes the cord, and heightens its reflex function (Ringer, nth ed., p. 401). Circulation : it increases the heart's movements by stimulating the cardiac ganglia of the sympathetic and paralyzing the peripheral ends of the pneumogastrics, and as it stimulates the vaso-motor centre, an increase in blood pressure also takes place. Respiration: is quickened by stimulation of the respiratory centre. Temperature : in small doses it increases temperature and in large reduces it. Secretion : belladonna checks the salivary secretion by paralyzing the peripheral endings of the chorda tympani nerve in the submaxillary gland, hence the dry- ness of the mouth and throat experienced after its use. Its effect on the urinary secretion is doubtful, but it unquestionably aug- ments the solids ; it effectually checks the perspiration by a local paralyzing action on the peripheral nerve end-organs ; upon the intestinal glands its action is uncertain, but it certainly induces intestinal peristalsis. Atropine is eliminated by the kidneys. Belladonna, however used, has the power to check the secretion of the mammary glands. In larger doses it causes dilatation of the pupils, loss of vision, giddiness, constriction of the throat, difficulty of deglutition and articulation, increased heart-action, quickened respiration, elevation of temperature, nausea, with occasional vomiting and purging, and sometimes a red eruption. When excessive doses are taken the temperature of the body falls, the muscular system is relaxed, sensation is impaired, the pulse fails, and maniacal delirium sets in, followed by coma, syn- cope and death, often preceded by convulsions. The fatal dose of atropine cannot be precisely stated, as death has followed NARCOTICS BELLADONNA. 9 I gr. -^ per orem,* while recovery took place after swallowing gr. jss, and gr. xxx-xxxv of the extract of belladonna taken by a child in mistake for liquorice. f Post-mortem examinations show that the action of the poison is not confined to the cerebro- spinal system, but that it is attended with inflammation of the digestive organs. Poisoning by belladonna is treated by evacua- tion of the stomach, cathartics, and, if coma occur, by the electro-magnetic battery. Pilocarpi?te and physostigma are the physiological antidotes, or hypodermic injections of morphine may be administered. As atropine and its salt is decomposed and rendered inert by prolonged contact with caustic alkalies, the solutions of potassa and soda are recommended as antidotes for belladonna, and are medicinally incompatible with it ; lime solution is said to have the same action. Applied to the tem- poral region, belladonna causes dilatation of the pupil ; and accompanying its mydriatic action is paralysis of accommodation and a diminished intra-ocular pressure. Medicinal Uses. — Belladonna is one of our most highly es- teemed anodyne and antispasmodic remedies. It is destitute of hypnotic effect, and, on the contrary, has a tendency to occasion wakefulness. In the treatment of neuralgia (extract, gr. ss) it ranks at the head of the narcotics, and is extensively employed both alone and with quinine sulphate (gr. x) and general tonic treatment. In myalgia, lumbago and sciatica, the subcutaneous injection of atropine gives speedy relief and may be advanta- geously combined with morphine. It should be given until dry- ness of the throat, dilatation of the pupil, or some disorder of vision are produced. Its powers of allaying spasm have been found very efficacious in the treatment of whooping-cough, in which atropine sulphate gr. ^far ma y ^ e gi yen m water once daily to children one to four years of age, diminished or increased according to the severity of the paroxysms and the effect pro- duced. In asthma, a nightly dose at bedtime large enough to produce constitutional effects often prevents the paroxysm and, in some cases, cures the disease. In lead colic (see lead), and in laryngismus stridulus, belladonna ranks among the best anti- * Journ. de Chimie Med., i860, p. 529. Roux. f Cincinnati Lancet and Observer, 1861, p. 609. 92 MATERIA MEDICA NEUROTICS. spasmodic remedies. In the latter disease, combined with the bromides, and, in the absence of laryngitis, repeated sponging of the neck with cold water, it is most efficacious. Combined with opium in suppository, it is used for the relief of dysmenorrhcea, but is only palliative, as the treatment of this symptom depends upon its cause. It has been occasionally employed with advantage in epilepsy. As a stimulant to the circulatory system, it may be used wherever syncope is threat- ened from cardiac failure. By its influence in relieving irrita- bility of the bladder, it is probably the best remedy for the nocturnal incontinence of urine of children, for which purpose gtt. iij-v of the tincture may be cautiously given three or four times a day, and the child waked at midnight to pass water. In habitual constipation due to atony of the muscular fibre, after a dose of castor oil, the following is efficacious to reestab- lish peristalsis : 1^ Extracti belladonnas gr. 2V ; aloin gr. -^ J extracti nucis vomicae gr. -J-. M. ft. pil. 1. S. one pill after meals t. d. for some time. It is used, too, in cases of poisoning by opium, principally for its stimulating effect upon the respiratory centres (see p. 78). Hypodermic injections of atropine gr. -^y— •^q- are useful in checking colliquative night-sweats, especially in phthisis, and may be advantageously combined with minute doses of morphine, to relieve the cough ; the following also is a good combination : 3^ Atropinae sulphatis gr. -^ ; strychninae sul- phatis gr. j ; codeinse gr. x ; aquae f §iiss. M. S. teaspoonful morning and evening. And, lastly, from its anhydrotic action, it is useful in ptyalism. As a topical remedy, belladonna is employed as an anodyne, and also to relieve rigidity of the os uteri in labor, and in spas- modic urethral stricture, the application of the ointment to the constriction by a bougie is efficacious. A plaster, ointment or solution of atropine may be applied to the breasts of nursing women as a galactafuge ; while the plaster alone, to the back, often relieves lumbago and sacralgia. The liniment may be used to relieve muscular rheumatism, neuralgia and other local pains, and is advantageously combined with fluid extract of aconite as a topical remedy in severe neuralgia. A suppository (gr. ss-j of the extract) is sufficient for the relief of strangury ; and in cystitis this combined with a milk diet and rest in the re- NARCOTICS BELLADONNA. 93 cumbent posture, at the same time keeping the urine alkaline by liquor potassae, is one of the best plans of treatment. The local use of atropine in diseases of the eye is of the greatest import- ance ; solutions of the alkaloid or its sulphate (gr. i-ij to f gss. of water), may be dropped into the conjunctival sac, to relieve pain and photophobia, to determine the refraction of the eye from its influence on accommodation, in the diagnosis of sus- pected cataract, in operations for cataract, prolapsus iridis, and ulcers of the cornea. A good treatment for iritis is the instilla- tion of atropine solution until the pupil is widely and evenly dilated, at the same time giving mercury internally, and continu- ing all until the danger of synechia is passed. Gelatine wafers, containing gr. -^ to yj-g- of atropine, are used to dilate the pupil for ophthalmic purposes. It should be recollected that the local application of belladonna, or its alkaloid, may produce the con- stitutional effects of the drug. Homatropine. — This is made from tropine amygdalate and dilute hydrochloric acid, atropine having been split into tropine and tropic acid. It is similar in its effects to atropine, though weaker, retards the heart's action, and renders it irregular. Applied to the pupil, it quickly brings about wide dilatation, and, moreover, is unirritating, hence it is an acquisition in ocular therapeutics. Administration. — The dose of the powder of the root or leaves is gr. j, to be repeated and increased till dryness of the throat, dilatation of the pupil, and dimness of vision are produced. The abstract is twice as strong as the powdered root, from which it is prepared. The tincture (15 parts of the leaves to diluted alcohol q. s. to make 100 parts of tincture — dose, gtt. 15 to 30) and the alcoholic extract are also officinal. Of the fluid extract of bella- donna root the dose is *RJ— v. For external use, a plaster (emplastrum belladonnce), an ointment (unguentum belladonnce), and a liniment {linimentum belladonnce, containing fluid extract 95 per cent., and camphor 5 per cent.) are employed. Atropina {Atropine), or its officinal salt Atropine Sulphas {Atropine Sulphate), is generally employed medicinally instead of belladonna, as it represents the activity of the drug, because of the smallness of the dose required, and its fitness for hypodermic use. The sulphate, which is obtained by mixing the alkaloid 94 MATERIA MEDICA NEUROTICS. with water, and gradually adding diluted sulphuric acid until the alkaloid is dissolved and the solution is neutral, when the salt is obtained by evaporation, consists of a white, slightly crystalline powder, very soluble in water and alcohol, but insoluble in ether. As a medicinal agent, the salt is preferable because more soluble. Dose, gr. ^ 6 V STRAMONIUM. Stramonii Folia, Stramonium Leaves; Stramonii Semen; Stramonium Seed. Datura Stramonium, or Thorn-Apple, sometimes called James- town weed {Nat. Ord. Solanacese), is an annual indigenous plant, which grows very abundantly in waste grounds in all parts of the Fig DATURA STRAMONIUM. A, SEED. world. It has a forked, branching stem, from three to six feet high, ovate, toothed leaves, large funnel-shaped white or pur- plish flowers, which appear in midsummer, and ovate capsules, filled with numerous kidney-shaped, brownish-black seeds. The odor of the plant is strong and disagreeable, and its taste bitter and nauseous. It loses these properties very much when dried, but the process does not appear to weaken its narcotic qualities. The leaves and seeds are officinal, but the seeds are most pow- erful from containing most daturine. The active principle of Stramonium is an alkaloid termed NARCOTICS HYOSCYAMUS. 95 daturine, found combined with malic acid, which is chemically identical with atropine, and possesses analogous properties. The physiological effects of stramonium are closely allied to but weaker than those of belladonna. From its common occurrence in every part of the country, cases of poisoning from this weed are very frequent, particularly with children, who are fond of swallowing the seeds. A case is reported by Calkins * of a boy, aged four years, who swallowed a tablespoonful of the seeds, but, as he soon vomited them, no ill effects resulted. The treatment laid down for the relief of poisoning from belladonna is applicable to these cases. It is eliminated f by the urine. Medicinally ', it is sometimes prescribed internally in neuralgia ; and in spasmodic asthma, gr. xxv of the dried leaves are smoked with great relief in cigarettes or pipes, the smoke being drawn into the lungs and the inhalation frequently repeated. Topically, daturine is occasionally used by oculists to dilate the pupils when other mydriatics cannot be employed. Stramonium is an excel- lent anodyne application, in the form of cataplasm and ointment, to irritable ulcers, bed-sores and hemorrhoids. Administration. — The dose of the powdered leaves is gr. ij ; of the seeds, gr. j, to be repeated and gradually increased till effects are produced. Dose of the extract (of the seed) gr. x / 2 . The fluid extract (dose ^ij-v), the tincture (10 per cent, of the seed, dose ^v-xxx), and the ointment, made by mixing the extract with benzoinated lard, are also officinal. HYOSCYAMUS. Hyoscyami Folia, Hyoscyamus Leaves. Hyoscyamus niger, or Henbane {Nat. Ord. Solanaceae), is a native of Europe, and is naturalized in the northern parts of the United States. It grows to the height of about two feet, with large sinuated, pale-green leaves, and flowers of a straw-yellow color. The whole plant has narcotic properties ; but the leaves only are officinal. They should be gathered from plants of the second year's growth when in flower. The active properties of * Am. Med. Monthly, 1 856, p. 220. f Arch, de Physiologie A r orm. et Pathol., t. iii, 1870, 215. Oulmont et Laurent; De l'Hyoscine et de la Daturine. 9 6 MATERIA MEDICA NEUROTICS. the plant depend upon two alkaloids, one crystallizable, termed hyoscyamine (Q7H03NO3), isomeric with atropine ; the other an amorphous, brown liquid, to which Ladenburg has given the name of hyoscine, and which, though isomeric with hyoscyamine, differs from it very materially. Hyoscyamine can be split into tropic acid and tropine, hyoscine into tropic acid and pseudotro- pin P- 3 8 - X Brit - Med. J., 1885, p. 479. Smith. \ " The Influence of Cocaine on the Pupil and Cornea." By Edward Jackson, M D. Trans. Coll. of Phys., 1 887, 165. 124 MATERIA MEDICA — NEUROTICS. urethra, vagina and rectum, it allays irritation, causes a superficial and temporary anaesthesia, at the same time lowering the sensi- bility of the deeper tissues, contracting the vessels, producing anaemia of the surface (best seen in the vessels which ramify through the mucous membrane covering the turbinated bones in the nose) and lowering reflex sensibility of the part. Instilled into the external auditory meatus it causes a superficial diminution of sensibility without affecting the hearing, and lowers the tem- perature of this region. Dr. L. J. Tumas,* of St. Petersburg, found that a direct appli- cation of a few drops of yi to 4 per cent, solution, to the cerebral cortex of animals, caused a temporary fall of excitability of the portion painted ; and that if the cerebral cortex be painted during an epileptic seizure, the convulsions ceased. The dura mater was rendered insensitive in a few minutes by applying to it a solution of cocaine, and painting the femoral and sciatic nerves resulted in loss of sensation in the parts to which they were distributed. Intravejious injections, \ in dogs, caused general convulsions from irritation of the medulla, dyspnoea, reddening and swelling of the exposed brain, and diminution in the excitability of the psycho- motor. centres; the convulsive attacks were intermittent. The account here given of the internal action of cocaine is based chiefly on Mosso's J elaborate investigations upon dogs. Nervous system : in medicinal doses (in man) it stimulates the func- tional activity of the brain, the intellectual faculties becoming more active and imaginative, while the entire economy experiences a general feeling of renewed vigor. This state is succeeded by one of depression, and at the end by narcosis. Toxic amounts cause symptoms of general paralysis, abolition of sensibility, cessation of reflex action, cardiac weakness and stoppage of respiration. The irritability of the sensory nerves is destroyed, and, according to Ott, that of the motor nerves is much depressed. Skeletal muscles : it induces, in full doses, muscular contractions of the trunk and extremities by excitement of the motor tracts of the cord, the cranial ganglia not being involved. Section of the cord * Ejenedelnaia Klinitcheskaia Gazeta, Nos. 6 to 9, 1885. f Op. cit. Tumas. Also on cocaine, These pour le Doctorate en Medecine, Paris, 1887, par Y. Duchesne. \ Arch fiir experiment. Pathol, u. Pharm., xviij, 1887, p. 153- ANTISPASMODICS COCAINE. 125 between the occiput and atlas does not prevent this. A charac- teristic symptom of large doses is the production of sudden con- vulsions (not reflex) which resemble those of strychnia poisoning. On the involuntary muscles cocaine sets up also contractions, and, if the dose be large enough, the urine and faeces will be dis- charged involuntarily. According to Mosso the effects just noted are due altogether to an action on the nerve-centres, and not to one upon the muscle-substance, as is affirmed by Ott and others. Vulpian * found that cocaine caused wide pupillary dilatation. The patellar reflex is at first increased and afterward abolished. Circulation : cocaine increases the frequency and strength of the cardiac contractions, which are not dependent on paralysis of the vagi (Mosso). Anrep states, however, that the vagi are paralyzed, so that the matter cannot be considered as yet settled. A reduction of blood pressure succeeds full doses, which is fol- lowed by a rise, apparently due to a direct action on the vessels. The heart continues to beat after breathing has ceased. It stops the frog's heart in systole. Medium doses exert no influence on the vaso-motor centre or tonicity of the vessels. Respiration is increased, not by a reflex act, but by stimulation of the respiratory centre. A poisonous dose destroys life by paralysis of this centre. Temperature: grains ij injected into the jugular vein of a dog caused the rectal temperature to advance about 1°, which in toxic amounts is followed by a fall. Secretions : Vulpian (op. cit) could detect no increase in the hepatic, pancreatic, or salivary secretion, nor augmented flow through the ureters, but an increase in the sub-maxillary dis- charge was noted. As to the diuretic action of cocaine, Da Costa and C. B. Penrosef observed a decided increase in the quan- tity of urine and urates in nineteen out of twenty cases, with slight variations in sp.gr.; its influence on urea was not determined. They attributed its diuretic action to raised arterial tension. Elimination takes place, in part, by the kidneys, since it can be detected in the urine. The poisonous effects of cocaine are antagonized 'by chloroform * Compte Rendu, p. 836, 1884. f The Med. News, June, 1886. Observations on the diuretic influence of cocaine. 126 MATERIA MEDICA NEUROTICS. and ether, which tend to arrest the tetanus of the respiratory muscles. Amyl nitrite also has been used successfully to antago- nize toxic doses of cocaine. After the immediate danger is passed chloral should be given, and to restore the breathing, arti- ficial respiration should be practiced. It is aided in action by alcohol, and the cerebral stimulants. Incompatibles : the alkaline hydrates and carbonates, throw down a white precipitate with solution of cocaine hydrochlorate. When administered hypo dermic ally it causes no irritation. If the injection be made into the superficial tissues it acts as a local anaesthetic, while a deep injection produces a slight, transitory, general lowering of sensibility, a rise in temperature of from o.5°-i.5° F., lasting several hours, dilated pupils with uncertain vision, and a stronger and fuller pulse, with increased power of the cardiac systole and lowering of the arterial tension. Uses. — It has been chiefly used locally, to prevent pain in ope- rations on the eye, nose, larynx, vagina, rectum, etc. For this purpose the part is painted or sprayed with a 2-4 per cent, solu- tion, and the application is renewed whenever the effect begins to wear off. In cases of photophobia, acute myringitis, painful deglutition (from tubercular or cancerous deposits in the pharynx or larynx), in vaginismus (to relieve the pain in order that an examination may be made, or previous to the sexual act), and in spasm of the rectum or anus due to fissure, it may be used with great benefit. In acute gonorrhoea, f5ij of a 4-10 per cent, solution may be injected into the urethra, a few minutes before urination, to prevent pain during that act. In irritable stricture, or irritability with spasm of the sphincter vesicae, a small gelatine bougie, containing gr. J^ of cocaine, has been passed down to the neck of the bladder and allowed to dissolve previous to a careful exploration of the urethra and bladder. A 20 per cent, solution has afforded relief in supra-orbital neuralgia, pruritus ani, and scrotal eczema, and has been used for the relief of pain during the operation for phimosis. It has also been applied to painful ulcers, either in powder or solution. It is also recommended to produce contraction of the vessels and diminution of swelling in mucous membranes of the nose and larynx, thus allowing the operator to obtain a better view of the parts during examination, or as a means of preventing copious ANTISPASMODICS COCAINE. 127 hemorrhage during operations on the nasal mucous membrane, or to check epistaxis. Locally it has been applied, by brush or spray, to control hay fever, acute coryza, etc., and to lessen cough in laryngeal affections. Solution of cocaine hydrochlorate, 4-8 per cent, introduced within the nasal cavities by the atomizer is the best remedy to relieve temporarily the occlusion of the nasal fossae in acute and chronic rhinitis. Collections of inspissated mucus should be first washed away with Dobell's solution. In an elaborate article by Hern * on the use of cocaine in dental surgery, the following conclusions are reached, viz., that it cannot be relied on for the relief of pain after extraction, or to deaden the sensibility of dentine, and as an analgesic to exposed pulps it is of doubtful utility. As a submu- cous injection for the purpose of extraction it is inferior to nitrous oxide gas (summary of 90 cases). He considers it chiefly useful in the opening of abscesses, in the manipulation of models and instruments, and in operations on teeth with acute periostitis. Darier f states that it dilates the pupil without paralysis of accommodation, and is quite equal to atropine for the purpose of examining the fundus oculi. It has been used internally in gastro-intestinal neuroses, as gastrodynia, nervous dyspepsia, etc., in doses of gr. \-\ once or twice a day, in powder; to allay restlessness and produce sleep, in insomnia ; to check vomiting and diarrhoea in children ; in reflex vomiting gener- ally, as that due to sea- sickness or to pregnancy, and as a cardiac tonic in weak heart and nervous palpitation. Prof. Da Costa % has called attention to the successful use of cocaine hydrochlorate as a heart-sustaining agent in low fevers, especially where there is cerebral disturbance added. He gave gr. \-± 2 ever y two hours. Hypodermic ally it has been used to relieve pain in severe facial and other neuralgias, in acute pleurisy, and before the perform- ance of minor surgical operations, as the opening of abscesses, inflamed bursae, etc. When used for these purposes the needle of the syringe should not be inserted deeply, since superficial injections occasion local * Trans, of the Odontological Society of Great Britain, 1886-7, P- 218. Cocaine and its uses as a local anaesthetic in dental surgery. f Bulletin Gen, de Therapeutique, cvii. De l'emploi de cocaine en ThSrap. oculaire. % Pkila. Med. News, Feb. 5th. 1887, p. 302. 128 MATERIA MEDICA NEUROTICS. anaesthesia; when thrown in deeply there is no loss of sensation of the superficies (DaCosta *). Injected into the skin of the epi- gastrium, it has relieved nausea and vomiting. Deep injections have been especially recommended when it is desirable to obtain the stimulating effects which the drug exerts over the heart, as in collapse, the early stages of shock, weak heart and low fevers. A few cases of death from very large doses have been reported ; one from gr. xxiv (Edes). Dose, internally, gr. J^-ss ; hypodermically, gr. %-%. VI. Guarana. — This occurs in chocolate-colored cylinders, which are worked up from the fruit of Paullinia sorbilis {Nat. Ord. Sapindaceae), a plant of Brazil, where it is used to make a common and highly-esteemed beverage. It contains more caffeine than any other vegetable substance, and also a variety of tannic acid. It is recommended, medicinally, as a tonic, astrin- gent, and antispasmodic, and has been found especially useful in sick headache; dose, 5j-ij, or an alcoholic extract may be given in doses of gr. x-xx. A tincture and fluid extract can be used. The latter is officinal and can be given in doses of *% x-xx, or more. VII. Mate. — Under this name the dried leaves of Ilex Para- guaiensis, a shrub of Paraguay, are extensively used in preparing a beverage throughout that region of country. Paraguay tea, as it is termed, has a balsamic odor and bitter taste, and contains a principle identical with caffeine and theine } and also tannic acid. MOSCHUS — MUSK. Class, Mammalia ; Order, Ruminantia. Musk is a peculiar dried secretion obtained from Moschus moschiferus, the Musk Deer, an animal rather larger than the goat, and resembling the deer in its characters, which inhabits the mountainous portions of central Asia. The musk bag is found only in the male, arid lies between the umbilicus and prepuce. It is an oval pod, about two and a half inches long and one and a half broad, flat on one side and convex and hairy on the other, and in a full-grown animal contains from 5jss to 5vj of a liquid * Trans. Coll. of Physicians, 1886, 39. Hypodermic use of hydrochlorate of cocaine. ANTISPASMODICS OIL OF AMBER. I 29 secretion, which, when dried, is musk. Two kinds are known in commerce, the China and the Russia musk, the former of which is much the stronger. Musk occurs in grains or lumps concreted together, of a red- dish-brown color, and has usually some hairs of the pod mixed with it. It has a powerful, diffusive, aromatic odor and a bitterish taste. It is inflammable, leaving a light spongy charcoal. On analysis, it yields ammonia, fat, cholesterin, gelatinous and albumi- nous principles, but the odorous principle has not been isolated. It is partially soluble in water and alcohol, and completely so in ether. Owing to its high price, musk is greatly sophisticated. Some- times artificial pods are met with, which may be distinguished from the genuine by the absence of the remains of the penis, and of an aperture in the middle of the hairy coat. The musk itself is more frequently adulterated by mixture with dried blood and a variety of substances. Indeed, little if any genuine musk is found in the shops. Effects and Uses. — Musk is a powerful excitant and anti- spasmodic, without much effect on the cerebral functions. If a pure article could be obtained, it would have no superior as a direct antispasmodic in the treatment of essential nervous dis- orders — hysteria, epilepsy, chorea, and hiccough — and as a combined excitant and antispasmodic in the latter stages of typhus, and in typhoid pneumonia. But it is now little pre- scribed, owing to the difficulty of procuring it pure. Administration. — It may be given in the form of bolus or emulsion. Dose, gr. x, to be repeated every two or three hours. A tincture is officinal ; dose, f5j. An article termed Artificial Musk is made by the addition of one part of rectified oil of amber to three parts of nitric acid. It resembles musk both in sensible and medicinal properties, and it has been prescribed in its stead, in the same dose. OLEUM SUCCINI — -OIL OF AMBER. Amber, Succinum, derived from an extinct coniferous tree, Pinitis succinifer, is a fossil resin found in various parts of the world, and comes to this country from the shores of the Baltic. It is a hard, brittle substance, usually translucent, and of a pale 9 I3O MATERIA MEDICA — NEUROTICS. golden-yellow color, insipid and inodorous except when heated. By distillation it yields an oil, oil of amber {oleum succim), which, when rectified, is employed medicinally. The oil, solu- ble in alcohol, is nearly colorless at first, but gradually becomes brown, has a strong peculiar odor and a pungent acrid taste. An acid called succinic is also obtained from amber. Effects and Uses. — Topically, it is an active rubefacient. Oil of amber is excitant and antispasmodic, and has been used in hysteria, epilepsy, tetanus, pertussis, hiccough, and amenorrhcea. It is chiefly employed as an external application, and is a good remedy in pertussis and convulsions of children. Dose of the oil, gtt. v to xv, given in emulsion. For external use it may be mixed with three or four parts of olive oil and brandy, with one part of laudanum added. OLEUM iETHEREUM ETHEREAL OIL. This substance, known also as oil of wine, is made by the dis- tillation of alcohol with a large excess of sulphuric acid ; it is afterward mixed with an equal volume of stronger ether. It is a transparent, nearly colorless, volatile liquid, of a peculiar aro- matic ethereal odor and sharp bitter taste, sparingly soluble in water, but readily dissolved by alcohol or ether. Specific gravity 0.910. It has antispasmodic properties, but is used in medicine only as an ingredient of the compound spirit of ether. SPIRITUS ^THERIS COMPOSITUS COMPOUND SPIRIT OF ETHER. This preparation, known as Hoffman's Anodyne, is a solution of ethereal oil (3 parts) in stronger ether (30 parts) and alcohol (67 parts). It is a colorless, volatile, inflammable liquid, having an aromatic ethereal odor, and a burning, slightly sweetish taste. It becomes milky on being mixed with water, owing to the pre- cipitation of the ethereal oil. Effects and Uses. — Hoffman's Anodyne has the antispasmodic and stimulant effects of ether, and derives additional tranquil- lizing and anodyne properties from the ethereal oil present ; it is also an efficient carminative. It is much used in hysteria, and is often added to laudanum to prevent the nausea which the latter sometimes excites. A good fever and tranquillizing draught is 3^ Spiritus aetheris compositi, f$j ; liquoris ammonii TONICS. I3I acetatis,tincturae opii camphoratae, aa fSss ; aquae, ad fSjss. M. S. — One dose. Shake before using. Dose, f3j-ij, in sweetened water. ORDER IV. TONICS. Tonics, called also corroborants, are medicines which produce a gradual and permanent increase of nervous vigor. It is only, however, in certain conditions of disease that they manifest this invigorating influence ; as, in a state of health, they often act as irritants or even nauseants. Their local effects are similar to their general effects. They exalt the nervous functions of the parts to which they are applied, and increase their firmness and density. When taken into the stomach they produce a twofold corroborant effect, improving the digestive powers by their local action, and strengthening the system generally by their cerebro- spinal influence. When given in very large doses, they produce nausea and vomiting, and when their administration is too long continued, they over-stimulate the gastric mucous follicles, causing a pathological secretion to be poured out, thus pro- ducing gastric catarrh. The after effect of tonics in large doses, especially of quinine, is one of depression upon the nervous centres. Tonics differ from stimulants only in the more permanent character of their effects. The more powerful tonics are closely allied to the narcotics in their action, producing, in overdoses, giddiness, loss of sight and of hearing, convulsions, delirium, and even death. And this analogy is further illustrated by the curative power of tonics in the relief of painful and spasmodic diseases, as neuralgia, rheumatism, chorea, and epilepsy. The articles of this class may be divided into vegetable and mineral tonics. The vegetable tonics are characterized by bitter- ness ; and it is said that they owe their bitterness and medicinal activity to a principle which has been termed bitter extractive. It is doubtful, however, whether any such proximate principle has really been obtained. They should be given before meals. The mineral tonics unite astringent with tonic properties ; and the preparations of iron produce a further corroborant effect by increasing the red coloring matter of the blood. The therapeutic application of tonics comprises a diversified 132 MATERIA MEDICA NEUROTICS. range of diseases. They are employed as stomachics in dys- pepsia, and as general corroborants in convalescence from acute diseases, in chronic affections accompanied by marasmus and cachexia, in exhaustion and debility, in typhus and gangrene, and in typhoid conditions of the system generally. But their most striking and valuable powers are shown in their febrifuge influence upon miasmatic diseases. The modus operandi here is obscure, but the curative powers are undoubted, and have been attributed by some to their poisonous effects upon proto- plasm, thus destroying the germs on which these diseases depend ; while others believe they act by creating a powerful impression upon the central organs of the nervous system. The antineuralgic and antispasmodic properties of tonics have been already alluded to. They also enjoy considerable reputation in the treatment of chronic bowel-complaints, where they act by restoring tone to the debilitated intestinal tube ; and, on the other hand, they are often useful as laxatives in torpid conditions of the alimentary canal. VEGETABLE TONICS. The vegetable tonics may be arranged into three sections, viz.: 1. The pure bitters. 2. The aromatic bitters, which contain a stimulant volatile oil, and are aromatic as well as tonic. 3. The astringent bitters, which contain tannic and gallic acids, and are both astringent and tonic ; this group contains cinchona, the most powerful and important of the vegetable tonics. The bitter principle is also found in many medicines belonging to other classes, as rhubarb, aloes, taraxacum, etc., and imparts to them tonic properties. SIMPLE BITTERS. QUASSIA. Quassia is the wood of Picrsena excelsa (Nat. Ord. Simaru- baceae), a lofty tree of Jamaica and other West India islands. It is imported from the West Indies in billets of various sizes, which are found in the shops in the form of chips or raspings. It has no odor, but an intensely permanent bitter taste. Water and alcohol extract its virtues, which depend on a neutral principle termed quassin (C 10 H 12 O 3 ). TONICS GENTIAN. I 33 The article originally known as quassia was the root and wood of Quassia amara, a shrub of Surinam, but this does not now reach our markets. Effects and Uses. — Quassia is a mild tonic, free from irritant or astringent effects, and is employed principally in dyspepsia, want of appetite, and* other stomachic affections. It promotes the appetite and digestion and causes a rapid development of strength. Quassin, given before meals in doses of gr. ss, increases the alvine discharge, and hence is useful in constipa- tion due to feebleness of the muscular tunic. In diarrhoea from relaxation of the muscles, it is also of advantage. It increases the saliva, milk, and secretions from the mucous membranes.* It is much used to give additional bitterness to malt liquors. It has proved a useful tonic in general debility, atonic dyspepsia, anorexia, chlorosis, and lingering convalescence especially after fevers. Dose, in powder (rarely used), gr. xx to 5j ; but the best form of administration is that of infusion, in doses of fSjss to iij ; the infusion is a good remedy for ascarides, given by injection. An extract (aqueous) is given in the dose of gr. v, but it is principally used as an excipient. A fluid extract is also officinal, dose ^v-xx. Of the tincture, ioo parts contain 10 parts of the powder, the dose is foj to ij. GENTIANA GENTIAN. Gentian is the root of Gentiana lutea or Yellow Gentian {Nat. Ord. Gentianaceae), a perennial plant of the mountainous parts of central and southern Europe, growing to the height of two or three feet, with broad, ovate, opposite leaves and hand- some whorled yellow flowers. It is imported in cylindrical branched, twisted pieces, of various sizes, marked by transverse annular wrinkles and longitudinal furrows. Its odor in the fresh state is peculiar and disagreeable, but, when dried, feeble ; its taste is slightly sweetish and intensely bitter. Water and alcohol extract its virtues. It contains -a. fixed oil, an acid (geii- tisin or gentisic acid, Ci 4 H 10 O 5 ), pectin, grape-sugar, and a bitter principle termed gentiopicrin (C 20 H 30 O 12 ), a glucoside,. which is soluble in water and spirit of wine. Other species of gentian * Am. J. Phar. y 1883, p. 472. 134 MATERIA MEDICA NEUROTICS. are employed as substitutes for the yellow gentian. The root contains no tannic matters (Maisch). Effects and Uses. — Gentian is a pure bitter, without either astringency or much aroma. In full doses it is more disposed to relax the bowels than the other simple bitters ; and, like others of the vegetable tonics, in excessive doses it is capable of producing narcotic effects. It is an admirable stomachic in all kinds of dyspepsia and gastric disorders, and is also used in the various forms of constitutional debility. In gastric dyspepsia, due to deficiency in the quantity of gastric juice, gentian com- bined with an alkali will relieve the condition. 1^ Tincturae gentianae compositae, f§j ; liquoris potassae, i^xv. M. S. — In a wine-glass of water before meals. Administration. — In the form of powder, rarely given on ac- count of its bitterness, the dose is gr. x to 5ss. Compound tincture (Tinctura gentiance composita, gentian 8 parts, bitter orange-peel 4 parts, cardamom 2 parts, to diluted alcohol enough to make the tincture weigh 100 parts), in the dose of f5j to ij ; extract {aqueous), in the dose of gr. x to 5ss ; and flidd extract, in the dose of f5ss-j. CALUMBA. Columba or Columbo is now generally ascribed by botanists to Jateorrhiza Calumba {Nat. Ord. Menispermaceae), designated by some writers still under the old name of cocculus palmatus, a climbing plant of Mozambique, on the southeastern coast of Africa. The root is the officinal portion, and is known in Africa under the name of Calumb. It consists of fleshy tubers, with numerous offsets, which are the portions used, the main root being too fibrous. They are found in the shops in thin, circular disks about 2 in. in diameter, externally of a brown, wrinkled appearance, and internally yellow. The odor is slightly aromatic, and the taste persistently bitter. Owing to the starch which is found in columbo, it is liable to be worm-eaten. It contains, besides a large proportion of starch, two bitter princi- ples, colombin (C 42 H 44 14 ) and berberine (C 2 oH 17 N0 4 ), columbic acid (C22H21O7), but no tannin. Water and alcohol take up its vir- tues ; and from its liability to attract moisture from the air, it should not be kept in the form of powder. TONICS CHIRATA. I 35 Effects and Uses. — Columbo is a very agreeable demulcent tonic, particularly acceptable to the stomach, and hence well adapted to the convalescent stages of acute disorders of the bowels and of fevers. It is also a good preparation in the sick- ness of pregnant women, and is one of the best of the stom- achics in all cases where there is unusual delicacy of the stomach. In its native country it is much employed in the treatment of dysentery. Administration. — The dose of the powder is gr. x-xxx (rarely used). It may be given in the form of infusion (dose, f5j to ij), which should be used at once, as it is liable to spoil. Of the tincture (10 parts to ioo parts of tincture) foj to iv may be given. Of the fluid extract, the dose is f5ss-j. Columbo is Fig. q. JATEORRHIZA CALUMBA. often combined with aromatics, iron and alkalies, and is some- times added to purgative mixtures. Berberine (C^H^NOJ (not officinal), the alkaloid found in columbo, is widely diffused in the vegetable kingdom, and is obtained from numerous plants of the natural orders Berberacecz, MenispermacecE and Ranunculacece, as barberry, yellow-root, hydrastis, goldthread and others. It has been employed in the form of hydrochlorate and sulphate, as a tonic and febrifuge, in doses of gr. j-x. CHIRATA. Ophelia Chirata (Nat. Ord. Gentianaceae), an East Indian plant, has been introduced into European and American prac- tice under the name of Chirata, where it now ranks among the best simple bitters. The entire plant is officinal. Chirata 136 MATERIA MEDICA NEUROTICS. contains a peculiar bitter neutral substance, termed chiratin (C 26 H 48 13 ), and ophelic acid (C ls H2o0 10 ), which is amorphous ; in medicinal properties it resembles gentian, and may be used in the same way. Dose, of the fluid extract i^v-xx ; of the tincture *Kv-f5j. AROMATIC BITTERS. SERPENTARIA. The rhizome and rootlets of several species of Aristolochia are known under the name of Virginia Snakeroot. The most familiar is A. serpentaria (Nat. Ord. Aristolochiaceae), an herba- FlG. IO. SERPENTARIA. RHIZOME AND ROOTLETS. ceous, indigenous plant, with a perennial root, composed of numerous slender fibres, arising from a knotty, brown head. A. reticulata is a variety found in the southwestern States. TONICS — EUCALYPTUS. I 37 Virginia snakeroot is found in the shops in tufts of long, slender, matted fibres attached to a knotty, rugged head. They are brittle, and of a yellowish-brown color. The odor is aro- matic and camphoraceous ; the taste somewhat pungent, bitter and aromatic. Water and alcohol extract its virtues, which depend on the presence of a volatile oil, a bitter principle, resins and tannin. The roots of A. reticulata are very commonly substituted for those of A. serpentaria, from which they differ only in the larger size of their fibres. They are quite equal to the latter, and are thought even to contain a larger proportion of volatile oil. Effects and Uses. — Virginia snakeroot is a combined stimu- lant and tonic, with diuretic or diaphoretic properties, according to the mode of its administration. In full doses it irritates the alimentary canal, causing nausea, eructations and colic. It is much used in the latter stages of fevers, and in other acute dis- eases, and is frequently combined with Peruvian bark in the treatment of intermittents. It may be administered in infusion (not officinal), dose fgj to ij, repeated. Of the tincture (10 parts in iqo parts of tincture) the dose is f 5j to ij ; of the fluid extract, f5ss-j. Huxhairis Tincture contains serpentaria. EUCALYPTUS. The leaves of the Eucalyptus globulus {Nat. Ord. Myrtaceae), a lofty tree of Australia, commonly known as the Blue Gum- Tree, are classed among the aromatic bitters. The leaves should be collected from rather old trees. When fresh they are more active than when dried. They owe their activity to a volatile oil, having the odor of oil of peppermint, which contains cymol (C 10 H l4 ), two terpenes, and eucalyptol (C 10 H 18 O) ; from eucalyptus are also obtained tannin, resin (crystallizable) and cerylic alcohol. Effects and Uses. — The oil possesses a decided destructive power upon infusoria, and locally is an irritant. Nervous sys- tem : large doses in animals produce muscular weakness, loss of reflex irritability, and finally death from centric paralysis (cord and medulla). These effects are preceded by a period of excite- ment. In small doses in man it causes mental activity and a feeling of well-being. Circulation and respiration are both accelerated by eucalyptus. Secretions: the ingestion of the I38 MATERIA MEDICA NEUROTICS. drug excites the salivary secretion, promotes the appetite, causes diaphoresis, and, by stimulating the intestinal secretion, induces soft stools. It decidedly increases the elimination of urea (Gim- bert). It is eliminated by the bronchial mucous membrane, kidneys and skin. Eucalyptus has been given with contradictory results in mias- matic fevers, in doses varying from 5j— iv of the dried leaves, or less of the fresh, but it is unlikely that it will ever supersede quinine as an anti-miasmatic. The fluid extract is officinal; dose, f5j in some aromatic water. Oleum eucalypti (commonly called eucalyptot) has proved effi- cient in bronchitis and whooping-cough; dose, gtt. v-x in cap- sules or emulsion. Eucalyptus may be used as a tonic in gastric catarrh and dyspepsia, and its employment in chronic vesical catarrh is recommended. Indeed, its best effects are obtained in chronic affections of the mucous membranes, be they pulmonary, gastric, or vesical, and its beneficial influence in these diseases is due to contact of the oil during elimination with the surface. The growth of plantations of eucalyptus in miasmatic districts has been found to diminish the spread of malaria. ANTHEMIS. Anthemis nobilis, or Chamomile {Nat. Ord. Compositae), is a small herbaceous, trailing European plant, cultivated exten- sively in both Europe and this country. The flower-heads are the portions used. They consist of small spheroids, with convex yellow disks which contain the aromatic properties, and numerous white, spreading rays. Chamomile flowers have a bitter, aromatic taste, probably due to authentic acid, and a strong, peculiar odor, both of which are imparted to water and alcohol. They contain a volatile oil, bitter principle, a little tannic acid, and resin, but no alkaloid has been obtained. Effects and Uses. — Chamomile, in small doses, is a mild, agree- able, aromatic tonic, and, in large doses, acts as an emetic. The cold infusion is much employed as a stomachic, and the hot infusion is given to aid the operation of emetics. The flowers, boiled in water, form a good fomentation to inflamed parts. The usual form of administration is the infusion. Dose, TONICS EUPATORIUM. 139 as a stomachic, f§ij, two or three times a day, cold; as an emetic, hot, ad libitum. Matricaria. The flower-heads of Matricaria chamomilla or German chamomile {Nat. Ord. Compositae), an annual Euro- pean plant, possess properties very similar to those of chamo- mile. They contain volatile oil, bitter extractive, tannin, and malates. They are not much employed in this country. EUPATORIUM. Eupatorium perfoliatum, Boneset, or Thoroughwort (Nat. Ord. Compositae), is a very common indigenous plant, growing in wet grounds in every part of the United States. It has numerous herbaceous stems, with long, narrow leaves, per- FlG. II. EUPATORIUM PERFOLIATUM. FLOWERING TOPS. forated by the stems. The leaves and flowering tops are the officinal portion. They have a faint odor, a strongly bitter taste, impart their virtues to water or alcohol, and contain a bitter I4-0 MATERIA MEDICA NEUROTICS. glucoside, called eupatorin; also gum, tannic acid, and a trace of volatile oil. In the leaves are found also resin, wax, and gallic acid.* E. teucrifolium, E. aromaticum, and other native species, are almost identical in their properties with E. perfoliatum. Effects and Uses. — Thoroughwort is a stimulant tonic, dia- phoretic and expectorant, and in large doses proves emetic and laxative. It is a good stomachic in dyspepsia, and, from its combined corroborant, expectorant, and diaphoretic properties, is an excellent remedy in epidemic influenza, and in the latter stages of pneumonia and bronchitis. It is used also with good effect in rheumatism, and in intermittent, remittent, and typhoid fevers. It may be given in infusion, f§ij of which may be taken cold, as a stomachic, three or four times a day, and in freer warm draughts as a diaphoretic; but the fluid extract is to be preferred; dose, f5j. ABSINTHIUM. The tops and leaves of Artemisia Absinthium, or Worm- wood [Nat. Ord. Composite), a European plant, naturalized in New England, are ranked among the aromatic bitters, but are not now much employed. They may be given in infusion. Wormwood contains an essential oil (chiefly absinthol), a bitter principle termed absinthin (C4oH 58 9 ), tannin, etc. According to Magnan,f absinthe given to animals in small doses induces brisk muscular contractions, while large amounts provoke attacks in which the animal falls in tonic and clonic convulsions, with ster- torous respiration, and involuntary fecal and urinary evacuation. The convulsions are not prevented by depriving the animal of its cerebral lobes. He points out, too, that absinthe-epilepsy " is a kind of intoxication " to which is added the phenomenon of epilepsy. The oil possesses powerful stimulant properties, in large doses producing epileptiform convulsions, and in lethal quantities (fSj^) is capable of causing poisonous symptoms. No'fatal cases have, however, been recorded. J A liqueur termed absinthe, containing the oil in question, is much used in France, with highly pernicious effects. It enters into the composition of vinum aromaticum. * Am. Journ. of Pharmacy, F. W. Franz, Analysis of the Leaves of E. perfolia- tum, Feb., 1888, p. 77. f Compte Rendu, 1869, p. 825. % Woodman and Tidy, 1882, p. 268. TONICS — CINCHONA. I4I MAGNOLIA. The barks of Magnolia glauca, Magnolia acuminata, and Magnolia tripetala {Nat. Ord. Magnoliaceae), indigenous trees remarkable for the beauty of their foliage and the size and fragrance of their flowers, are officinal, and rank with the aro- matic bitters. The barks (quilled, thin, and inodorous) of the trunk, branches, and root are alike officinal ; but those of the last are the most active. They contain a volatile oil, tannin, resins, and a crystallizable bitter principle (Lloyd*). An extract of the fruit of M. umbrella yields magnolin. The aromatic pro- perty is impaired by drying, and is lost when the barks are long kept. They are used as gentle stimulant tonics and diaphoretics, in the low stages of fever, rheumatism, etc. An infusion may be given, but the best solvent is diluted alcohol. CASCARILLA. This is the bark of Croton Eluteria {Nat. Ord. Euphor- biaceae), a small tree of the Bahamas and other West India islands. It occurs in the form of small, thin, quilled pieces, though sometimes in fragments, having a grayish, easily detached corky layer and an inner smooth surface. Its taste is warm and bitter. It yields its properties to alcohol, and partially to water ; and contains volatile oil, resin, a bitter crystalline principle called cascarillin, and some tannin. Effects and Uses. — Cascarilla is a very pleasant aromatic bitter, causing neither vomiting nor purging, and hence agree- ing very well with the stomach. It may be given in powder in the dose of gr. xx to 5ss ; but this is a less agreeable form than the infusion; dose, f§ij. ASTRINGENT BITTERS. CINCHONA. The name Cinchona (derived from the Countess of Chinchon, wife of a viceroy of Peru) is applied to the bark of different species of Cinchona {Nat. Ord. Rubiaceae, Cinchonese), large trees which grow in the mountainous regions of the western * " Drugs and Medicines of North America," Nos. 1 and 2, 1886. 142 MATERIA MEDICA NEUROTICS. portions of South America, from the 22° of south latitude to about the io° of north latitude. Two principal varieties of cinchona- are known in commerce : Cinchona Flava ( Yellow Bark), called in commerce Calisaya Bark, derived from Cin- chona Calisaya; and Cinchona Rubra (Red Bark), derived from Cinchona succirubra. The Pharmacopoeia now recognizes, however, as officinal the barks of all species of the genus Cin- chona which contain at least three per cent, of the proper cin- chona alkaloids. It acknowledges the following species, viz. : C. officinalis, C. micrantha, C. calisaya, and C. ovata. Cinchona is brought to the United States from the Pacific ports of South America. It is obtained by stripping the trunks and branches of the Cinchona trees during the dry season, and is dried by exposure to the sun, during which process the smaller pieces usually become quilled. I. The Yellow or Calisaya Bark comes both in quilled and flat pieces. The former are from three or four inches to a foot and a half long, from a quarter of an inch to two or three inches in diameter, and of variable thickness. They have a brownish epidermis (with longitudinal wrinkles and transverse fissures), which possesses none of the virtues of the bark. The bark itself is one or two lines thick, compact, of a short, fibrous texture, and when broken presents shining points. The flat pieces, which are derived from the larger branches and trunk, are usually destitute of epidermis, are more roughly marked externally and are of a browner hue than the quilled pieces. They are also less compact, less bitter, and of less medicinal virtue. The yellow bark is distinguished from the other barks by its much more bitter taste ; its comparative freedom from astringency ; its brownish-yellow, somewhat orange color, which is still brighter in the powder ; and by containing a large propor- tion of quinine with very little cinchonine. 2. The Red Bark usually comes in large, thick, flat pieces ; sometimes also in quills from half an inch to two inches in diameter. They are covered with a reddish-brown, rugged epidermis, beneath which is a dark-red, brittle and compact layer, the interior parts being woody and fibrous and of a lively brownish-red color. The taste of red bark is bitter and astrin- gent ; its odor not different from that of the other barks ; its TONICS CINCHONA. 1 43 powder is reddish. It contains considerable quantities both of quinine and cinchonine. Pale Bark, called in commerce Loxa and Lima Bark, derived from C. condaminea and C. micrantha is no longer officinal. It comes in thin quills of a pale fawn-color. The pale barks contain a much larger proportion of cinchonine than of quinine ; and, from their yielding little of the latter alkaloid, have fallen into disuse in the United States. Under the name of Carthagena Barks, large quantities of very good bark have been imported from New Granada, and are now used in the manufacture of quinine, under the name of Colombian barks. Their percentage of alkaloids varies greatly. Within a few years, the cultivation of several varieties of cinchona trees has been successfully introduced into India, the islands of Ceylon and Java, and also into Jamaica, and the markets are now supplied with barks of very good quality from these sources. Chemical Constituents. — The most important constituents of cinchona are two alkaloid-principles, termed Quinina {Quinine) and Cinchonina (Cinchonine), which exist chiefly in combination with an acid called kinic (inert). These alkaloids are found in different proportions in the different barks, quinine being obtained from the yellow bark most abundantly, cinchonine from the pale bark, and the two principles in about equal proportions from the red bark. Two other valuable alkaloids, quinidine and cinchoni- dine, are found (also as kinates) most abundantly in the pale and Carthagena barks, but to a certain extent in all. By heat, the crystallizable alkaloids are converted into amorphous modifica- tions, as quinine into quinicine and cinchonine into cinchonicine; and other alkaloids, aricine, paricine, quinamine, and paytine, have been discovered in cinchona. Other principles found are cincho-tannic acid, coloring matter, kinovic acid, starch, fatty matter, and a trace of volatile oil. Gum is found in the pale bark, but not in the yellow or red bark. Quinine is obtained by heating the sulphate with an alkaline solution. Quinine Sulphas (Quinine" Sulphate) is prepared in the following manner : Powdered yellow bark is boiled in water acidulated with hydrochloric acid, by which the alkaloid is separated from its combination with kinic and other acids, to 144 MATERIA MEDICA NEUROTICS. form a soluble hydrochlorate. By the addition of lime, this salt is decomposed, and quinine precipitated. The precipitate is washed with distilled water, and is separated from insoluble impurities by digestion in boiling alcohol, which is afterward distilled off. To the residual brown viscid mass, mixed with distilled water and heated to the boiling point, sulphuric acid is added, in quantity sufficient to dissolve the quinine. The liquor is then boiled with animal charcoal, filtered, and set aside to crystallize. The alkaloid quinine may be obtained in the form of fine crystalline needles of a silky lustre, but usually occurs as a loose white powder ; it is inodorous, very bitter, and alkaline. It (the hydrate) is soluble in 1670 parts of cold water and in 773 parts of boiling water, in little more than its weight of absolute alcohol, in about 5 parts of chloroform, and in 25 parts of ether, and also in the fixed and volatile oils. It unites with acids to form salts, the most important of which is the officinal salt, the sulphate. Its composition is C20H24N2O2.3H2O. Quinine and its salts may be distinguished from all other vegetable alka- lies and their salts (excepting quinidine and quinicine) by forming an emerald-green precipitate when treated first with fresh chlo- rine-water and then with ammonia (Thalleioquin test, detects -5-^oT part, Fluckiger). Herapattis test is made by adding to quinine sulphate (gr. v) diluted acetic acid (f5j) with alcohol (f5ss) and tincture of iodine (8 drops), heating gently over a spirit-lamp till it forms a clear light-brown solution, when, as the liquor cools, right-angled, quadrate, rhombic crystals are deposited, which by reflected light appear of a copper-green color, resem- bling the elytra of Spanish flies. This precipitate, which is quinine iodosulphate (C^H^^C^SC^HJa), is termed Herapathite. Cinchonine is a white crystalline substance, less bitter than quinine, almost insoluble in cold water, very soluble in boiling alcohol, and slightly soluble in ether and the fixed and volatile oils. Its composition is C20H24N2O. It is distinguished from quinine by striking a white precipitate when chlorine-water and afterward ammonia are added ; with potassium ferrocyanide, a yellowish-white precipitate ensues. As cinchonine is but slightly soluble in ether, while quinine is soluble in that menstruum, the latter may by this means be readily separated from the former alkaloid. The medicinal properties of quinine and cinchonine TONICS CINCHONA. 145 are analogous, and cinchonine sulphate is now officinal. Quini- dine is isomeric with quinine, but more crystallizable and less soluble in ether ; its salts strike a white precipitate with solution of potassium iodide. Cinclwnidine is isomeric with cinchonine. It is usually found mixed with quinidine, the mixture being known as commercial quinidine. The commercial quinidine sul- phate (which is more soluble in water and alcohol than quinine sulphate) may be used as a substitute for the latter salt. Incompatibles. — The alkalies and alkaline earths precipitate the alkaloidal principles of cinchona ; tannic acid, and the tinc- ture and compound solution of iodine, form with them insoluble compounds ; the ferric salts precipitate cincho-tannic acid ; solu- tion of potassium arsenite is also incompatible with infusions and decoctions of cinchona, as it forms a precipitate with them. Physiological Effects. — Locally, cinchona and its alkaloids act as irritants, and have, besides, a marked antiseptic effect, arrest- ing putrefaction and fermentation by a destructive influence upon fungi and infusoria.* As the physiological action of cin- chona depends on its contained alkaloids (chiefly quinine), the following account relates to the latter. Nervous system : quinine in medicinal doses stimulates the cerebral functions and increases the mental activity. Full doses (gr. xv-xx) induce a hyperaemic condition of the brain, the first indications of which are upon the special senses, especially that of hearing, which undergoes sub- jective noises, as ringing and roaring in the ears (tinnitus annum), with partial deafness, the latter rarely permanent ; amblyopia is an accompaniment, though less common. Doses of this size, continued, may produce a sense of fullness of the head, frontal headache and vertigo. Very large doses augment the above symptoms, accompanied by a slow, weak pulse, dilatation of the pupils, convulsions and stupor ; death in rare cases has followed quinine-poisoning, though immense doses of it have been taken with impunity. Quinine given to frogs reduces and finally abolishes the reflex excitability of the spinal cord. Its effect in this respect, on man, is as yet sub judice. Quinine given in * Arch, de Physiol. Norm, et Pathol., v, 1873, P- 3^9- L'action de la quinine sur les vibrioniens et sur les mouvements amiboides ; par Bochefontaine. 10 I46 MATERIA MEDICA NEUROTICS. doses of gr. x-xx, during labor, energizes the uterine contrac- tions. Circulation : in small doses quinine slightly accelerates the action of the heart; while large amounts (gr. xl-lx) decidedly retard its beats and force, and sometimes cause it to intermit, especially in children. This slowing occurs after section of the vagi, indicating a direct influence on its motor ganglia ; applied in solution to the cut-out heart it quickly stops its movements. The cinchona alkaloids are readily dissolved from the bark by contact with the gastric juice, and being diffusible and crystal- line, quickly osmose into the blood ; if, however, they pass into the small intestines from any cause, contact there with the alka- line fluids of that tube will precipitate them, and they will be discharged with the faeces. Upon the blood, quinine has several marked actions, as follows : both in health and inflammation it diminishes the number of white corpuscles, and retards their amoeboid movements (Binz) ; Schwalbe's investigations, how- ever, do not confirm those of Binz ; it hinders the carrying of oxygen to the tissues, and increases the proportion of red to white corpuscles (Cutler and Bradford). The absorption of quinine by the blood is aided by the carbon dioxide gas of that fluid. How it exists there is unknown. The production of acid in freshly-drawn blood is diminished by the addition of quinine-solution (Binz). Temperature : in small doses in health no influence upon the animal heat has been noted ; but in large amounts a moderate fall takes place (about y 2 ° F.). No complete explanation has as yet been given of this action, but it seems to be due to an interference with the oxidation processes in every part of the body. Secretions : cinchona stimulates the peptic glands, increasing their secretion and consequently the appetite and digestion, and, from the tannic acid which it contains, pro- duces a slightly astringent effect not belonging to the salts of its alkaloids. If given too long, or if the stomach and bowels are in an irritable condition, it is apt soon to produce nausea, vomiting, and even diarrhoea. Occasionally quinine causes a cutaneous eruption, as erythema, herpes, etc. A rare effect is renal and cystic irritation. Quinine, it is said, causes contrac- tion of the spleen (Piorry) ; this, however, has been denied. Large doses of quinine (gr. xxv-xl) decidedly diminish the amount of urea and uric acid in the urine, also the phosphoric TONICS CINCHONA. 1 47 acid. Elimination * : quinine is eliminated chiefly by the kid- neys, and it has been found in the urine twenty minutes after the injection of a large dose. According to Thau from }4 to % escapes in the first six hours. It is discharged partly as quinine and partly as isomeric modifications (quinicine). Medicinal Uses. — Though the medicinal value of cinchona, or its alkaloid, quinine, can scarcely be over-estimated in the treat- ment of various diseases, yet its chief therapeutic applications can be divided into three classes, in the following order of merit : 1. Antiperiodic; 2. Antipyretic; 3. Tonic. The most import- ant therapeutic employment of cinchona is as an antiperiodic in the treatment of fevers of a miasmatic origin. Its efficacy in these diseases was first made known to the world by the Jesuit missionaries in Peru, from whom it was called Jesuit's powder. As cinchona itself is now rarely administered internally, the fol- lowing remarks apply especially to its alkaloids, on which its powers depend. The type of miasmatic fever in which the effects of quinine are most strikingly displayed is intermittent, the non-pernicious and uncomplicated forms of which it rarely, if ever, fails to control. It may be given in these cases from the very onset of the attack ; and if, owing to gastric irritability, it is rejected by the stomach, it should be introduced by the rectum or by hypodermic injection. In remittent fevers, quinine is scarcely less useful than in intermittents ; and most physicians who practice in miasmatic districts now concur in recommending its early exhibition in these fevers, without waiting for a remis- sion. In either disease the best time, however, for its adminis- tration, since the major portion is eliminated in the first six hours, is from four to six hours preceding the paroxysm, and should it be desirable to get its effects quickly, on an empty stomach and in solution. In the pernicious or congestive forms of intermittent and remittent fevers, the early administration of large doses of quinine or cinchonine, in combination with stimu- lants, is imperatively demanded; and the hypodermic injections of quinine sulphate (gr. iij-v) may here be necessary. As a prophylactic against miasmatic fever, the use of the preparations of cinchona is very efficacious. We now seem to be approach- * Bull. Gen. de Thirap., t. xci. Rienzi. I48 MATERIA MEDICA NEUROTICS. ing an explanation as to the exciting cause of miasmatic fevers and the specific action of quinine against them, due to the researches of Marchiafava* and Celli on the plasmodium mala- riae; of Laveran,f on the microbes found by him in the blood; of Councilman and Abbott,J on certain hyaline bodies discov- ered by them also in the blood, and, lastly, to Osler,§ on the haematomonas malariae. These observers, with singular una- nimity, have found certain microbes in the blood of persons suf- fering with miasmatic fever, the vitality of which was destroyed by quinine. But it is yet too soon to formulate a positive theory which will surely connect the presence of these microbes with an attack of ague and the destructive action of quinine upon them. The antipyretic power which the quinine salts possess renders their use extremely valuable in conditions of pyrexia. In such states quinine is best given in a single large dose (5ss to 5j), and since the elimination of the major portion of it takes place in the first six hours, it may be necessary to repeat this dose at the expiration of that time, if it be desirable to sustain its antipyretic effect. In Germany, the treatment of typhoid fever with large doses of quinine, gr. xx to xl, given in the even- ing, is in vogue. On account of the cardiac weakness, anorexia, and nervous depression produced by the salts of quinine, they should not be given in large doses in pneumonia.|| In erysipelas, the author has found quinine sulphate scarcely, if at all, less efficient than in miasmatic fevers, and it should be given gr. iij-v, t. d., frequently combined with large doses of iron (q. v.). In puerperal septicaemia, quinine may be given as an antipyretic in addition to antiseptic, uterine and vaginal injections, with digi- talis, as indicated, opium, stimulants and easily assimilated food. In all conditions of hyperpyrexia, as in acute rheumatism, the exanthemata and pyaemia, it is still employed, although the phenol-derivatives (e. g., antipyrin) are superseding it to reduce * Bull. d. r. Accad. Med. di Roma, 1886, xii, 19-22. Marchiafava E. Richerche sull'. infezione malaria. f Traite des Fievres Palustres, par A. Laveran, 1884, p. 448. % Am. J. M. S., April, 1884, p. 416. \ Brit. Med. Jour., March 1 2th, 1 887, p. 556. || N. Y. Med. Rec, Jan. 29th, 1887. Discussion on the use of quinine in pneu- monia, N. V. Academy of Medicine. TONICS CINCHONA. 1 49 temperature. As a general tonic and stomachic, cinchona and its alkaloids are also much used, but where gastric susceptibility exists, some of the simple bitters are preferable. In convales- cence from acute diseases, as the continued and eruptive fevers, in the hectic of phthisis, and in typhoid conditions generally, it is constantly prescribed. In the various neuralgise, a large dose of quinine combined with morphine or belladonna, or smaller doses with arsenic and iron, form an effective plan of treatment. By its contracting action on the gravid uterus, quinine sulphate exerts an influence in promoting normal labor, and will often prove useful in counteracting inertia of the uterus in parturition. A full dose of quinine will sometimes abort an impending par- oxysm of asthma. In surgical shock, as after grave operations, the administration of quinine is of the greatest utility. In acute inflammations, if the researches of Binz be correct, quinine in the first stage is the remedy to be employed in order to prevent the exudation of leucocytes, and for this object about gr. J^ to each pound of the patient's weight will be needed. The systemic effects of quinine may be obtained by introducing it within the rectum in suppository or enema ; but it is advisable only to so use it when its administration by the mouth is contra-indicated. Topically, cinchona is employed as an astringent and antiseptic. Administration. — The use of cinchona in powder has been almost abandoned, owing to its bulk and disagreeable taste. When exhibited in this form 5ss to jss is the dose as an anti- periodic given usually in divided amounts; as a tonic, 5j. The following officinal preparations are employed : infusion (6 parts of the powder to water ioo parts, to which aromatic sulphuric acid i part is added), dose, f5ij, repeated ; extract' (of yellow bark), dose, gr. x-xxx, equivalent to 5j of bark ; fluid extract (yellow), dose, f5j, equal to 5j of bark; tincture (20 parts yellow bark to a mixture of 10 parts of glycerin with sufficient alcohol and water to make 100 parts of the tincture), dose, f5j-iv; com- pound tincture \_Huxham y s~\ (containing red bark 10, bitter orange- peel 8, serpentaria 2, glycerin 10, alcohol and water to make 100 parts of tincture), dose, f5j-iv. In prescribing bark, opium or port wine is often given with it, when it acts on the bowels. It is also occasionally combined with serpentaria, and when the stomach will not retain it, it may be administered by the rectum, 150 MATERIA MEDICA NEUROTICS. or even the hypodermic exhibition of the quinine sulphate may be resorted to. When administered subcutaneously the danger of the formation of a small abscess at the seat of introduction must not be lost sight of, and a salt soluble in water should be selected, as the bisulphate, the solubility of which may be in- creased by the addition of tartaric acid. Quinine Sulphas {Quinine Sulphate). This salt is prepared by the process described at p. 143. It occurs in fine, silky, rather flexible needle-shaped crystals (interlaced among one another, or grouped in small star-like tufts), which are odorless, very bitter, and slightly efflorescent. It is soluble in 740 parts of cold and 30 parts of boiling water, readily soluble in alcohol, but insoluble in ether. Quinine is a ternary base, and forms, with sulphuric acid, a basic, normal and acid sirtpJiate. Basic quinine sidphate, 2(C 2 oH24N202)S0 4 H 2 + 7 aq., is the salt in com- mon use. By the addition of dilute sulphuric acid to the basic salt normal quinine sulphate (C^H^^C^.SO^Hg -f- 7 aq.) is ob- tained in four-sided prisms, which are soluble in 1 1 parts of cold water. Acid quinine sulphate (C^H^NaC^SC^Hg -f- 7 aq.) occurs as white prisms, freely soluble in water. Solutions of quinine and its salts possess the property of fluorescence and left rotatory power on polarized light. Quinine sulphate is decomposed by the alkalies, their carbonates and the alkaline earths. In solution it forms white precipitates with liquor potassae, sodse, and ammonise. The tannic acid of astringent infusions throws down a white compound, and the soluble lead salts, oxalic, tartaric and gallic acids yield a precipitate with it ; with compound solutions of iodine, quinine iodide is formed. Various substances are mixed as adulterations with quinine sul- phate. They may be detected by adverting to their relative solubility in different menstrua, as compared with the sulphate, or by chemical tests. Thus, gum and starch are left behind by alcohol ; salicin becomes red on contact with sulphuric acid, etc. Effects and Uses. — The effects of quinine sulphate on the sys- tem are the same as those of cinchona, and, from its being less apt to disagree with the stomach, it has almost superseded the use of the latter. See pp. 147, 149. TONICS CINCHONA. I 5 I Administration. — The ordinary dose of the quinine sulphate* as an antipyretic gr. x-xx, repeated as indicated, as an antipe- riodic, gr. xvj, equal to about §j °f bark, but as much as gr. xx, and even more, are often required ; as a general tonic, gr. j-vj. It may be given dissolved in some aromatic water, by the aid of aromatic sulphuric acid, also as an enema, or hypodermi- cally. (Glycerin is a good excipient for pills of quinine sulphate.) Saccharin will partly disguise the bitterness of quinine. 3^ Qui- ninse sulphatis, gr. j ; saccharin, gr. v ; aquae, fgj j£. M. S. — Shake. Quinine Bisulphas (Quinine Bisulphate\ the normal quinine sulphate, is preferred only on account of its greater solubility (i part to II of water), as it contains about one-third less of anhy- drous quinine than the basic sulphate. (See foot-note.) It may be given in the same doses as the ordinary sulphate. Many other salts of quinine have been introduced into practice, but few possess any advantage over the sulphate and bisulphate. Quininze Valerianas (Quinine Valerianate) is obtained by dis- solving freshly precipitated quinine in diluted valerianic acid. It occurs in transparent or white rhomboidal tables, of the peculiar repulsive odor of valerianic acid, and an acrid, bitter taste, soluble in alcohol and ether, and soluble in water (i to 100). It fulfills the indications of quinine and valerianic acid, and is therefore especially useful in nervous disorders. Dose, gr. j to xx. Quinine liydrobr ornate is officinal, and being soluble in 1 6 parts of water, is recommended also for hypodermic use (Gubler). Quinine hydrochlorate is also officinal ; it is soluble in water I to 34 parts. Quinine sulphovinate, from its ready solubility, dissolving in twice its weight of water, is well adapted to hypodermic injection. Quinine carbolate, citrate, phosphate, salicylate, and sulpho- carbolate have all been used of late. * Therapeutical equivalents of the salts of quinine, by M. Boymond. Bull. Gen. de Therap., April 15th, 1887, p. 311. 1.34 gramme of the basic sulphate = I gramme of anhydrous quinine. 1.3 1 " " valerianate = " " " 1.22 " " hydrochlorate = " " " I.30 " " hydrobromate = " " " 1.69 " " bisulphate == " " " Others also are given. 152 MATERIA MEDICA NEUROTICS. Crude quinine is the impure quinine obtained from the manu- facturer before separation from the insoluble impurities. It is a soft solid of resinous aspect, nearly free from bitterness, and may be given to children in the same doses as the sulphate. Chinoidinum (Chinoidin, qninoidiii) is a "mixture of alkaloids, mostly amorphous, obtained as a by-product in the manufacture of the crystallizable alkaloids from cinchona." (U. S. P.) It appears as a resinous mass, variable in quality, faintly bitter, of a brownish color, soluble in dilute sulphuric acid and alcohol, and, according to Liebig, bears the same relation to ordinary quinine that uncrystallizable sugar bears to the crystallizable. It is considered equally efficacious with quinine, but requires doses rather larger than quinine sulphate, than which it is much more economical. Cinchoxin.e Sulphas (Cinchonine Sulphate) is made from the mother-water remaining after the crystallization of quinine sul- phate. Being the most soluble of the sulphates of the four alka- loids found in bark, it remains in solution after the quinine sulphate and the mixed cinchonidine and quinidine sulphate have crystallized out. From the mother-water it is precipitated by solution of soda, then washed with alcohol, next re-converted into a sulphate, and boiled with animal charcoal to decolorize it. It occurs in short, oblique, shining prisms with dihedral summits, of a very bitter taste, more soluble in water (54 parts) than quinine sulphate, readily soluble by alcohol, and sparingly so by ether. It rotates polarized light to the right. By the addition of sulphuric acid it is converted into the more soluble neutral sulphate. It is now admitted to have the same remedial properties as quinine sulphate, but requires about one-third larger doses. Quinidine sulpliate and cinchonidine sidpliate * are now officinal ; both are soluble in water 1 to 100 parts. Their effects and uses are similar to those of quinine, as a substi- tute for which they are much used, but the dose is somewhat larger. * In an able article by J. Marty, entitled, " Contribution a l'etude du sulphate de cinchonidine envisage au point de vue physiologique et therapeutique," Bull. Gen. de Therap., cvi, pp. 395, 445, 1884, the following conclusions are drawn, viz., that its action varies greatly; that occasionally therapeutic doses may prove toxic; and that it should be used only in mild cases, and in doses double those of quinine. TONICS CORNUS. 153 CORNUS. Cornus florida, or Dogwood (Nat. Ord. Cornaceae), is an indigenous tree found in most parts of the United States, and growing in the Middle States to the height of from fifteen to twenty feet. Its flowers are remarkable for large four-leaved white or pinkish involucres, which appear with us in May. The officinal portion is the bark of the root. It occurs in pieces of various sizes, more or less rolled, and of a reddish-gray color. Fig. 12. CORNUS FLORIDA. INVOLUCRE. Its taste is bitter, astringent, and slightly aromatic. It yields its virtues to water and alcohol, and contains cornin (cornic acid), resin, tannic and gallic acids, etc. The barks of Cornus sericea, or swamp dogwood, and of Cornus circinata, or round-leaved dogwood, possess analogous properties. Effects and Uses. — Dogwood is deservedly esteemed the best substitute for cinchona among the native astringent bitters. It 154 MATERIA MEDICA NEUROTICS. is somewhat irritant, and not unfrequently disorders the stomach. Dose, in powder, gr. xx to 5j ; of the fluid extract f5j or more. SALIX. The bark of Salix alba, the White Willow, and other spe- cies of Salix (Nat. Ord. Salicacese), is ranked among the astrin- gent bitters. It is little employed, however, except in the form of salicinum {salicin, C 13 H 18 7 , a glucoside) a neutral principle prepared from the bark of Salix' Helix and other species of Salix, consisting of white, slender, silky crystals, inodorous but very bitter, soluble in water and alcohol, but not in ether. Salicin produces effects similar to those of salicylic acid (q. v.), and is employed in the same therapeutic range, especially in acute rheumatism. It renders the sweat alkaline. Dose, gr. x-xx, frequently repeated. It has antiseptic and antifermentative properties ; it is not toxic. PRUNUS VIRGINIANA WILD-CHERRY. The Wild-cherry has long been known under the name of Prunus Virginiana, which is still retained by the Pharmaco- poeia. This name, however, belongs to another tree, the. choke- cherry ; and the wild-cherry is now properly distinguished as Prunus serotina {Nat. Ord. Rosaceae). The medicinal portion is the bark of the root and trunk, the former of which is the more active. It is found in the shops in pieces of various lengths and sizes, deprived of the epidermis and slightly curved, of a reddish-brown color and a bitter, slightly astringent, aro- matic taste. It contains a bitter, amorphous principle * (not isolated), resin, starch, tannic and gallic acids, a ferment-principle not identical with emulsin, and yields on distillation a volatile oil, containing hydrocyanic acid, which does not pre-exist in the bark, but is formed by the reaction in water of the bitter principle and the ferment. The leaves also yield this oil. Boiling water impairs the virtues of the bark. Effects and Uses. — Wild-cherry bark is tonic, with some astrin- * Pharma. Rundschau, Sept., 1887, p. 203, "On the Constituents of Wild Cherry Bark." Power and Weimar. TONICS PEPSIN. 155 gency, and at the same time exercises a sedative influence on the nervous and circulatory systems, owing to the hydrocyanic acid which is developed in it. It is used with excellent effect as a sedative corroborant in the various forms of pulmonary irrita- tion, particularly in the latter stages of pneumonia and in the hectic of phthisis. It is also a useful stomachic and tonic in a variety of cases. The infusion (4 parts to cold water enough to make the infusion weigh 100 parts), is given in the dose of f§ij, twice or thrice daily. Of the fluid extract the dose is f 3j — Ij. Of the syrup, an agreeable preparation, the dose is fgss. DIGESTIVE FERMENTS. PEPSINUM PEPSIN. In connection with the subject of stomachic tonics, this article is entitled to brief mention. It is prepared from the rennets either of the calf, sheep or pig, taken from the animal as soon as killed, the best process being Scheffer's. The mucous mem- brane of well-cleaned, fresh hogs' stomachs is scraped off, chopped fine, and macerated for several days . in water acidu- lated with hydrochloric acid ; the strained and decanted clear liquid is mixed with a saturated solution of sodium chloride in water, and the separated pepsin after several hours is drained on a muslin strainer, and submitted to strong pressure. Pepsin, the ferment of the gastric juice, has the property, at 100 F. in an acid solution, of coagulating and dissolving albuminous prin- ciples. Two grains of pepsin, with an ounce of distilled water and ttjjv of hydrochloric acid, will dissolve 100 grs. of coagulated white of egg at 98 ° F. in about four hours. Of saccharated pepsin, " 1 part dissolved in 500 parts of water acidulated with 7.5 parts of hydrochloric acid should digest at least 50 parts of hard-boiled egg-albumen at ioo° F. in five or six hours." Since alcohol impairs the digestive property of pepsin, prepa- rations of it in wine are unreliable. Acid solutions favor its action, especially hydrochloric acid, and it may be combined with this acid if deficiency of the gastric juice be suspected. Glycerin is the most reliable agent for preserving the ferment of pepsin (Liebreich). The alkalies and mineral salts precipi- tate pepsin from solution, and hence are incompatible. Pepsin is now a good deal used in dyspepsia and in diarrhoea, especially I56 MATERIA MEDICA NEUROTICS. that occurring in infants or children, where the stools contain undigested food. It may be given in doses of gr. v-xx after each meal, suspended in syrup of orange-peel to disguise its disagreeable taste, or taken on bread. Of saccJiarated pepsin, the dose is gr. v to xx ; of vinum pepsinae, f5ss-j, an inferior preparation. Liquor pepsini is a solution of saccharated pepsin (40 parts) in hydrochloric acid (12 parts), glycerin (400 parts), and water (548 parts) ; dose, foj-iv. It is probably more effi- cient in cases of children than of adults. When nourishment is to be given by the rectum (as when food is rejected by the stomach), the addition of pepsin and a little hydrochloric acid to animal broths for rectal injection is highly useful. Ingluvin is a preparation from the gizzard of the domestic fowl ; it is an aid to digestion, its action depending, probably, more on the bitter principle which it contains, and which stimulates the gas- tric glands, than to any digestive action of the preparation itself. It is recommended to allay various forms of reflex vomiting, especially the vomiting of pregnancy. Dose, gr. v-xv. PANCREATINUM PANCREATIN. This is obtained, by Mattison's process, from the pancreas of recently-killed animals, which is dissected and macerated in water acidulated with hydrochloric acid for about forty-eight hours, then separated, and the solution of pancreatin is passed through a pulp-filter until it is perfectly clear ; to this clear solution is then added a saturated solution of sodium chloride, and allowed to stand until the pancreatin is separated ; this is skimmed off, and placed upon a muslin filter and allowed to drain, after which it is washed with a less concentrated solution of sodium chloride, and then put under the press ; when all the salt solution is removed, and the mass is nearly dry, it is rubbed with sugar of milk, and dried without heat, after which it is diluted until ten grains emulsify two drachms of cod-liver oil. Saccharated pan- creatin is employed to promote the digestion of fatty matters, and may be administered in the form of emulsion, or dissolved in diluted alcohol or glycerin, or as a powder. As the activity of pancreatin is destroyed by acid, it should be given from 2 to 4 hours after meals. It is a good addition to cod-liver oil. Dose, gr. v-x. It is not officinal. TONICS PREPARATIONS OF IRON. I 57 PAPAYA. This is the dried juice of the half-ripe fruit of the Carica papaya {Nat. Ord. Papayacese), a white, slightly astringent pow- der, soluble in water, containing the ferment papain. This prin- ciple has the property of digesting albuminoids and converting them into soluble albumen. According to Finkler, its action is that of a ferment, and not one of solution. Dr. Herschell * ascertained that it acted alike in acid, alkaline or neutral fluids, and that it would dissolve IOOO times its weight of fresh blood- serum. Antiseptics, as carbolic or salicylic acids, do not hinder its action. It has no effect on starch (Martinf). It also dis- solves intestinal worms and the diphtheritic membrane. It is said not to retain its activity except in the dry state. Thera- peutically it is employed as an aid to digestion in the various forms of dyspepsia, to dissolve the diphtheritic membrane, and as ataeniacide. Prof. JacobiJ applies it to the diphtheritic mem- brane in glycerin, I part to 4 ; Schaffer uses it in water, strength 5 per cent. — both frequently applied with a brush. The dose is about gr. j-v, to be taken after meals in powder, aqueous solu- tion, capsule, or compressed tablet. Further investigation and clinical experience are needed to place papaya on its proper therapeutical footing. MINERAL TONICS. FERRI PR^PARATA PREPARATIONS OF IRON. The preparations of iron (Ferrum), termed Ferruginea, Chaly- beates, and Martial preparations, are the most important of the mineral tonics. Physiological Effects. — Besides their local tonic-astringent effect, and their general corroborant action on the cerebro-spinal system, which they possess in common with the other mineral tonics, they exercise a restorative influence on the compo- sition of the blood, by increasing the number of its coloring particles and the amount of its solid constituents. Iron is in fact a natural constituent of the blood, and is to be considered as a nutrient rather than a medicine. The effects of the chaly- * Brit. Med. Journ., April, 1886, p. 640. f Journ. of Physiol., 1885, p. 336. % Therap. Gaz., 1886, p. 145. I58 MATERIA MEDICA — NEUROTICS. beates are best observed in conditions of the system in which there is a relative want of the red corpuscles of the blood. Under their use in such cases, while the digestive functions are promoted, the pulse becomes fuller and stronger, the skin as- sumes a healthy tint, the lips and cheeks become more florid, the temperature of the body is increased, and the muscular strength is greatly invigorated. On the other hand, the admin- istration of the ferruginous preparations in health, or too long continued, produces symptoms of plethora, vascular excitement, and a tendency to congestion and hemorrhage ; though, it may be doubted whether the blood will assimilate more than the normal proportion of iron. The iron salts stain the teeth a dark color, and possess an astringent taste. Taken with the food they assist the digestive process ; on an empty stomach, or when very large doses are taken, they irritate. The red corpuscles of the blood act as carriers of oxygen, which they take up from the inspired air in the lungs, and it is now believed that the iron in the blood-corpuscles converts oxygen into ozone, a more active form of this element. Iron is an essential constituent of hemoglobin, and observation has proven that a course of iron in anaemia increases the number of red corpuscles to double or treble (Robuteau). According to Cutler and Bradford this increase does not take place in health. The state in which it exists in the blood-corpuscles is un- known. Absorption : from the stomach it is thought to be absorbed as an albuminate. Metallic iron is oxidized, after inges- tion, by the help of water. The ferrous oxide and carbonate are rendered soluble by the hydrochloric acid of the gastric juice. Salts of the organic acids may be absorbed directly into the blood, the acidulous radical being burnt off and the basic iron remaining to combine with the red globules. Salts of the mineral acids, the nitrate, chloride, and sulphate, in doses not large enough to constringe the tissues, are absorbed without change. Secretions : the astringent preparations of iron, as the chloride, sulphate and nitrate, lessen the secretions generally, especially the gastro-intestinal. The excretion of urea is in- creased. The ferric salts possess more activity than the ferrous. Elimination : iron is eliminated by the bile, fseces and urine. TONICS PREPARATIONS OF IRON. I 59 The faeces are, during a course of iron, of a dark color,, owing to the formation of ferrous sulphide. Medicinal Uses. — The diseases in which chalybeates are most serviceable are those which depend on a deficiency of the red corpuscles of the blood, as various forms of ancemia, particularly where this is connected with irregularity of the uterine functions, as in chlorosis. In these conditions it is best given in rapidly- increasing doses pushed until it causes headache, vertigo, fever or some gastric disturbance, and laxatives should be occasionally administered during a course of iron, to unload the portal cir- culation and relieve the constipation which usually ensues ; for the salts of iron after absorption pass directly through the liver, while any unabsorbed portion acts as an astringent upon the gastro-intestinal canal. After its effects are obtained the size of the dose can be regulated to suit the case. When anaemia is associated with gastric disturbance, the bitter tonics and acids are more serviceable than iron, which, however, may be given in the form of bitter wine of iron, as these symptoms subside. Iron is also frequently combined with arsenic in the treatment of anaemia and chlorosis : 3^ Acidi arseniosi, gr. j ; ferri reducti, gr. xxx ; oleoresinae capsici, gr. v. M. S. — Ft. pil. no. xxx ; one pill t. d., increased to five daily if the arsenic be well borne. By some authors * the slightly soluble preparations (iron filings, or reduced iron) are given at first, followed, if well borne, by the more soluble ones. Iron in any form does harm in chlorosis or anaemia accompanying the early stages of phthisis. f In the management of anaemia and chlorosis important adjuncts will be found in rare meats, rich broths and suitable stimulation. Iron is also useful in scrofula, tuberculosis, degeneration of the viscera, and cachectic states of the system, characterized by paleness of the lips, face and conjunctivae. Many forms of nervous disorders, as neuralgia, chorea, hysteria and epilepsy, are very decidedly controlled by the preparations of iron, and they probably constitute the best remedies in these affections, when attended with anaemia. Several of the preparations of iron are also much employed both as stomachics and astrin- * Trousseau et Pidoux, 9th ed., Vol. 1, 1880, p. 5. f Ibid., p. 7. l6o MATERIA MEDICA NEUROTICS. The following are the officinal preparations of iron, which are needlessly multiplied in the U. S. P. : — Ferrum Reductum [Reduced Iron). Metallic iron is obtained for medicinal purposes in the form of an impalpable powder by reducing- the ferric hydrate by passing a stream of hydrogen gas over it. It is a light, tasteless, iron-gray powder, insoluble in water, but completely soluble in diluted sulphuric acid, and it should be kept in a well-stoppered bottle, owing to its great liability to oxidation. This preparation, sometimes called Que- venne's Iron, is a mild chalybeate, and is a favorite prescription with many practitioners in the treatment of chlorosis and other varieties of anaemia. Dose, gr. v to x, three times a day, after meals, in the form of pill made with sugar and gum ; or it may be swallowed readily in a bolus of soft bread. It is sometimes prepared with chocolate in the form of lozenges. It is well adapted to prolonged use. Ferri Oxidum Hydratum (Hydrated Ferric Oxide). This preparation {ferric hydrate) (Fe 2 6HO) is made by precipitating the ferric hydrate from its combination in any ferric salt (offici- nally, ferric sulphate) by means of ammonia. When dry, it is a reddish-brown powder, and is not an eligible preparation for medicinal use. It is furnished in the form of a freshly-precipi- tated, soft, moist, reddish-brown magma for use as an antidote to arsenious acid. Ferri Oxidum Hydratum cum Magnesia (Hydrated Ferric Oxide with Magnesia). In this preparation ferric hydrate is pre- cipitated by means of magnesia, instead of ammonia. It is readily prepared, and is used as an antidote to arsenious acid. It is to be preferred to the ordinary hydrate, because the mag- nesia by its purgative action aids in the removal of any of the poison which may remain after the action of emetics or the use of the stomach pump. Ferri Carbonas Saccharatus (Saccharated Ferrous Carbo- nate) is obtained by the double reaction of ferrous sulphate and sodium bicarbonate, and is protected from oxidation by the addi- tion of sugar. It is a greenish-gray powder, oxidizing slowly in the air, only partially soluble in water, but completely soluble in hydrochloric acid. It is a valuable preparation, particularly TONICS PREPARATIONS OF IRON. l6l adapted to cases of weak digestion when iron is indicated. Dose, gr. v-xxx. Trochisci Ferri {Troches of Iron) are made with ferric hydrate, vanilla, sugar and mucilage of tragacanth ; each lozenge contains of the iron gr. v. Emplastrum Ferri {Plaster of Iron) is made with ferric hydrate, lead-plaster, Burgundy pitch, and Canada turpentine. Massa Ferri Carbonatis {Pill of Ferrous Carbonate) — Vallefs Ferruginous Mass. To protect the ferrous carbonate (FeC0 3 ) from oxidation, it is prepared (as in the process last described) by dissolving the reacting salts in weak syrup instead of water ; honey and sugar being afterward added to preserve it unaltered and bring it to the pilular consistence. This preparation is one of the most popular of the chalybeates. It contains nearly half its weight of ferrous carbonate. From gr. v-xx of the pilular mass may be taken in divided doses through the day. Mistura Ferri Cornposita {Compound Iron- Mixture) {Griffiths anti-hectic mixture) is a mixture of ferrous sulphate and potas- sium carbonate with myrrh, spirit of lavender, rose-water and sugar, to resist oxidation. It is a favorite chalybeate in chlorosis and amenorrhcea. Dose, f5j to ij, t. d. Pilules Ferri Composites {Compound Iron-Pills) are prepared with sodium carbonate and ferrous sulphate with myrrh and syrup. Dose, from two to six pills three times a day. Both these preparations should be made only as wanted for use. Ferri Sulphas [Ferrous Sulphate) (FeS0 4 .7H 2 0), known, in its impure state, as green vitriol or copperas, is prepared for medicinal use by dissolving iron wire in diluted sulphuric acid, with heat. It occurs in transparent, pale bluish-green crystals, of the form of oblique rhombic prisms, of an acrid, styptic taste, soluble in water, but insoluble in alcohol. By exposure to the air they effloresce, absorb oxygen, and become yellowish-white, from the formation of ferric sulphate. When heated to 239 , they give out six of their seven equivalents of water, and are converted into a grayish-white mass known as the dried sulphate. The alkalies and alkaline earths and their carbonates, silver nitrate, and lead acetate, are incompatible with this salt. Ferrous sulphate is one of the most active of the ferruginous preparations, but its local effects are powerfully astringent, and in a concentrated form it 102 MATERIA MEDICA — NEUROTICS. acts as an irritant poison. It is preferred to other chalybeates where there is much relaxation of the solids, with excessive dis- charges ; but it is not so well adapted to long-continued use, on account of its local irritant action. Topically, it is employed in substance and solution as a styptic and astringent. Dose, gr. j-v, in pill ; of the dried sulphate (Jerri sulphas exsiccatus), gr. ss — iij . Ferrous sulphate is also used as a disinfectant, dissolved in water, to cleanse privies, drains, etc. Ferri Sulphas Prcecipitatus (Precipitated Ferrous Sulphate). In this preparation the ferrous sulphate is precipitated from a solution of sulphuric acid and water by alcohol. Dose, gr. j— v. Liquor Ferri Tersulphatis (Solution of Iron Tersulphate) (Fe 2 3S0 4 ). This preparation is made by dissolving ferrous sul- phate in a mixture of sulphuric and of nitric acids, with water. The nitric acid furnishes oxygen, which converts the iron from a ferrous to a ferric condition. It is a solution of the normal ferric sulphate. This solution is a clear, reddish-brown liquid, nearly devoid of odor, and of a sour, very styptic, and somewhat acrid taste. Its chief use is in making ferric hydrate, and it should be kept on hand for the preparation of the antidote for arsenious acid. It may be used as a styptic, but for this purpose it is inferior to the next preparation. Liquor Ferri Subsulphatis (Solution of Iron Subsulphate) (MonseVs Solution) is made in the same way as the last prepa- ration, except that only half the amount of sulphuric acid is used, and a basic ferric sulphate results (Fe 4 05S0 4 ). It has a syrupy consistence, a ruby-red color, is inodorous, and has a very astringent but not acrid taste. This is a solution of the basic ferric sulphate, and is less irritant than that of the normal ferric sulphate. It may be used internally, in hemorrhage from the stomach and bowels, in the dose of from ^v-xv. Exter- nally, it is one of the most efficacious styptics we can employ ; and has been injected into varicose veins with success for the cure of varicose ulcers, and applied by means of the atomizer, has been found efficient in hemoptysis. Diluted with water, it is a good local application to inflamed mucous surfaces. Cotton saturated with Monsel's solution (styptic cotton) and dried, may be pressed firmly into a wound to arrest capillary oozing. Ferri Chloridum (Ferric Chloride) (Fe 2 Cl 6 .i2H 2 0) is made TONICS PREPARATIONS OF IRON. 1 63 by heating iron wire with hydrochloric acid (by which ferrous chloride is formed), and afterward converting the ferrous into ferric chloride by heating it with hydrochloric and nitric acids. It occurs in fragments of a crystalline structure, an orange- yellow color, inodorous, of a strong chalybeate, styptic taste, deliquescent, and wholly soluble in water, alcohol and ether. Internally, it is used chiefly in the form of the tincture. Exter- nally, it is applied as a styptic, and in solution, of various strengths, as an astringent. One part, gradually added to six parts of collodion, forms a yellowish-red, limpid liquid, of valu- able styptic properties. Liquor Ferri Chloridi {Solution of Ferric Chloride) is prepared by dissolving iron wire in hydrochloric acid, heating to the boiling point, then heating the liquid, after filtration, with hydrochloric and • nitric acids, and afterward adding distilled water. A reddish-brown liquid, having an acid and strongly styptic taste, and sp. gr. 1.405. It may be used internally for the purposes of the chloride, in doses of ^ij-vj, diluted, and externally as a styptic. Tinctura Ferri Chloridi (Tincture of Ferric Cldoride) is made by mixing 35 parts of solution of ferric chloride with 65 parts of alcohol. It is a tincture of the chloride, though there is prob- ably some reaction between the acid and alcohol, as the prepa- ration has an ethereal odor. It is of a reddish-brown color, and has a sour, styptic taste. It is one of the most effective of the chalybeates, acting locally as an energetic astringent and styptic, and, in large doses, as an irritant. Its indications, both general and topical, are very analogous to those of the sulphate, and it is the preparation of iron usually employed internally. It is especially useful in erysipelas. Dose, ^x to xxx, which may even be gradually increased to f oj, in certain diseases (as erysipelas). It should be taken well diluted after eating, and through a glass tube to avoid injury to the teeth. Attention has been called by Prof. T. D. Reed* to the addition of potassium citrate in prescribing tincture of ferric chloride, which forms with it (probably ferric citro-chloride) a clear, light-green solution, possessing similar ferruginous properties, * Canada Med. and Surg. Jown., August, 1881, p. 7. 164 MATERIA MEDICA NEUROTICS. free from the roughness of the iron, and compatible with the astringents and bitters. ^ Tincturi ferri chloridi, fSij ; potassii citratis, 5j ; syrupus limonis, fSjss ; aquae, ad f§vj. M. S. — One tablespoonful represents ^x of the iron — an elegant prepara- tion. Mistura Ferri et Ammonii Acetatis {Mixture of Iron and Ammonium Acetate) {Baskam's Mixture) is made with tincture of ferric chloride, diluted acetic acid, solution of ammonium acetate, elixir of orange, syrup and water. By the reaction of the ferric chloride and ammonium acetate, ferric acetate and ammonium chloride are formed. A most excellent preparation, and of great benefit in chronic albuminuria and in chronic drop- sies generally where iron is indicated. Dose, fSss-j. Ferri Iodidum Saccharatum {Saccharated Ferrous Iodide). This salt is made by the addition of iron filings to a mixture of iodine in distilled water, and sugar of milk is added to prevent oxidation. By evaporation a yellowish-white or grayish powder is obtained, of a sweetish, ferruginous taste, deliquescent, and very soluble in water. Dose, gr. x-xxx. Syrupus Ferri Iodidi {Syrup of Ferrous Iodide), which is pre- pared by mixing iodine and iron wire in distilled water, and shaking the mixture until the solution has acquired a green color, adding syrup, heating to 21 2°, straining, and, when the liquid has cooled, adding distilled water. It must be kept in well-stoppered vials. It is a transparent liquid, of a pale-green color, and furnishes an excellent alterative tonic, combining the effects of iodine and of iron, and is particularly applicable to the treatment of scrofula, rickets, and phthisis. It is incompatible with the alkalies, their carbonates, and tannin. Dose, ^v-f5j. Pilulce Ferri Iodidi {Pills of Ferrous Iodide) are made with iodine, reduced iron, sugar, acacia, glycyrrhiza, extract of gly- cyrrhiza, and an ethereal solution of balsam of tolu. They keep very well. Each pill contains about gr. j of ferrous iodide and gr. y^ of reduced iron. Ferri et Potassii Tartras {Iron and Potassium Tartrate) is prepared by the addition of ferric hydrate to a mixture of potas- sium bitartrate in distilled water. It occurs in transparent scales of a ruby-red color, which are wholly soluble in water. The tartaric acid and potash, in combination in this preparation, TONICS PREPARATIONS OF IRON. 1 65 render it less constipating than the other chalybeates : and, from its agreeable taste, it is adapted to the diseases of childhood. It is, moreover, not incompatible with alkalies. Dose, gr. x— 5ss. Ferri Phosphas [Ferric Phosphate) is obtained by the double reaction of solutions of ferric citrate and sodium phosphate and evaporating to dryness. It occurs in bright-green transparent scales, insoluble in alcohol, but soluble in water ; by exposure to the light it becomes darker. According to Rother * it is a combination of ferric phosphate and sodic citrate. Dose, gr. v-x, in pill. Ferri Pyrophosphas {Ferric Pyrophosphate) (Fe 4 3P 2 7 .9H 2 0). It occurs in apple-green scales, of an acid, slightly saline taste, and is very soluble in water. A good chalybeate. Dose, gr. ij — v. Given also as a syrup. Ferri Hypophosphis {Ferric Hypo phosphite) (Fe 2 6H 2 P0 2 ) is obtained by the reaction of a solution of sodium or ammonium hypophosphite with a solution of ferric sulphate. It is a white, amorphous powder, insoluble in cold water, soluble in hydro- chloric acid, incompatible with the soluble salts of mercury and silver, but has the advantage of not being decomposed by the cincho-tannic acid of cinchona. This is a good chalybeate in diseases of degeneration of the nervous tissue, and has been also given in phthisis ; other hypophosphites are combined with it. Dose, gr. x-xxx, t. d. Ferri Citras [Ferric Citrate) (Fe 2 2C 6 H 5 7 .6H 2 0) is prepared by the addition of ferric hydrate to a solution of citric acid, and occurs in thin, transparent pieces, of a garnet-red color, with a mild, acid, chalybeate taste, slowly soluble in cold water, but readily soluble in boiling water. Dose, gr. v-x. It is officinal also in the form of Liquor Ferri Citratis [Solution of Ferric Citrate), a deep reddish-brown liquid, given in doses of gtt. x-xx ; and it is by evaporating this solution that the solid citrate is obtained. Liquor Ferri Nitratis [Solution of Ferric Nitrate) (Fe 2 6N0 3 ) is prepared by the gradual addition of diluted nitric acid to ferric hydrate. It is a pale, amber-colored liquid, with a strong, astringent acid taste. It is tonic and astringent, agreeing very well with the stomach, and is employed in the treatment of * Am. Jour. Pharm., 1876, p. 171, and 1883, p. 163. I DO MATERIA MEDICA NEUROTICS. chronic diarrhoea, hematemesis, hemorrhage from the bowels, and uterine hemorrhage, particularly when anaemic symptoms are present. Dose, gtt. x-xx, t. d., in dilution. Syrupus Ferri Bromidi (Syrup of Ferrous Bromide) contains 10 per cent, of ferrous bromide. It may be given with advantage where a bromide and iron are both indicated, notably in chorea occurring in delicate girls at the age of puberty, and associated with anaemia. Dose, foj. Ferri Oxalas {Ferrous Oxalate) (FeC 2 4 .H 2 0) is made by the reaction of solutions of oxalic acid and ferrous sulphate. It occurs as a lemon-yellow, crystalline powder, almost destitute of taste, slightly soluble in water, but easily acted upon by the diluted acids, and decomposed by the alkalies and their carbon- ates. This chalybeate has the advantage of being well borne by the stomach, and of being readily absorbed, while it is nearly destitute of astringency, and not disposed to change like the ferrous salts generally. Dose, gr. ij-iij, in pill, t. d. Liquor Ferri Acetatis {Solution of Ferric Acetate). Dose, f^x-xxx. Chiefly used in preparing Tinctura Ferri Acetatis (Tincture of Ferric Acetate), a solu- tion of ferric acetate in alcohol and acetic ether. Dose, ^x- f5ss, or more. Ferri Lactas {Ferrous Lactate) is made by mixing diluted lactic acid with iron filings. It occurs in greenish-white crys- talline crusts or grains of a mild, sweetish, ferruginous taste, sparingly soluble in water, and insoluble in alcohol. Used in chlorosis, it has a marked effect in increasing the appetite. Dose, gr. x-xx, in pill, lozenge or syrup. Ferri et Quinine Citras (Iron and Quinine Citrate). This salt is prepared by dissolving quinine in a hot solution of iron citrate and evaporating the solution. As found in the shops, it is a mechanical mixture of ferric citrate with a variable propor- tion of iron and quinine citrate. It occurs in thin, transparent scales, of a reddish or yellowish-brown color, with a tint of green, not very soluble in water, and of a ferruginous, moder- ately bitter taste. It combines the virtues of its two bases, and is thought to have an especial agency in diminishing the forma- tion of urea by the kidneys, whence its use in uraemia. Dose, gr. v-x. TONICS PREPARATIONS OF IRON. 1 67 Liquor Ferri et Quinine Citratis (Solution of Iron and Quinine Citrate). Dose, foj. Vinum Ferri Amarum [Bitter Wine of Iron) is a mixture of solution of iron and quinine . citrate, tincture of sweet orange peel, syrup and stronger white wine. Dose, f5j-ij. Ferri et Ammonii Citras (Iron and Ammonium Citrate) is made by adding water of ammonia to solution of iron citrate, and evaporating. It occurs in the form of garnet-red translu- cent scales, of a slightly ferruginous taste, and is readily soluble in water ; it has antacid properties. Dose, gr. v-x. Vinum Ferri Citratis ( Wine of Citrate of Iron), a solution of ammonio-ferric citrate in tincture of sweet orange peel, syrup and stronger white wine. Dose, f5j. Ferri et Strychnine Citras (Iron and Strychnine Citrate) is made by mixing a solution of strychnine and citric acid in distilled water with a solution of iron and ammonium citrate in water, and evaporating. It occurs in garnet- red scales, of a bitter, ferruginous taste, readily soluble in water. An excel- lent tonic. Dose, gr. ij-iij, t. d. Syrupus Ferri, Quinine et Strychnine Phosphatum (Syrup of Iron, Quinine and Strychnine Phosphates), an agreeable tonic. Dose, f5j. Ferri et Ammonii Sulphas (Iron and Ammonium Sidp hate, (NH 4 )2Fe2(S04)4.24H 2 0). This salt, called also ammonio-ferric alum, is made by adding ammonium sulphate to a hot solution of ferric sulphate. It occurs in octahedral crystals, of a pale- violet color and sour, astringent taste, efflorescent, and very soluble in water. Used in diarrhoea and chronic dysentery. Dose, gr. v-xv, two or three times a day. Ferri et Ammonii Tartras (Iron and Ammonium Tartrate) (2(FeQ)NH 4 C4H 4 6 .5H20) occurs in transparent, garnet-red scales, of a sweetish taste, soluble in water, insoluble in alcohol and ether. A mild chalybeate. Dose, gr. x-xxx. Ferri Valerianas (Fei'ric Valerianate), a dark, tile-red, amor- phous powder, with a mildly styptic taste and an odor of valerianic acid ; insoluble in cold water, but readily soluble in alcohol. Dose, gr. j-iij. Ferrum Dialysatum (Dialyzed Iron) has been introduced as a substitute for the tincture of ferric chloride, than which it is 1 68 MATERIA MEDICA NEUROTICS, much less efficacious. It is not apt to constipate, is almost tasteless, and may be given in doses of from gtt. xv-1 daily. Dialyzed iron is an antidote to arsenic in the stomach. To ensure its conversion into ferric hydrate in the stomach, its ingestion should be followed by a tablespoonful of sodium chloride. It is not officinal. Pills of aloes and iron and syrup of the hypophospJdtes with iron are also officinal. MANGANI PR.EPARATA PREPARATIONS OF MANGANESE. Manganese (Mn) is a normal constituent of the body, existing in small amounts in the blood, hair, bile, etc. When given inter- nally in small doses the appetite improves, the digestive functions are promoted and the body gains in weight ; these effects are supposed to be most conspicuous in conditions due to an insuf- ficiency of iron, and probably of manganese, in the blood. If a large dose be taken the cardiac action is depressed and the blood pressure lowered. After a toxic dose violent gastro- enteritis ensues. Injected into the blood, or given hypodermic- ally, the salts of manganese paralyze voluntary motion and reflex action and arrest the heart in diastole. They have been used as substitutes for, or combined with, the iron salts, in anaemia, chlorosis, and cachectic states, but are inferior to the latter remedies. The following are the officinal preparations : — Mangani Oxidum Nigrum {Manganese Black Oxide) is the " native, crude Manganese Binoxide, containing at least 66 per cent, of the pure oxide (Mn0 2 )." It is a heavy, grayish-black, amorphous or crystalline powder, odorless, tasteless and insolu- ble in water or alcohol. It has been used as a substitute for iron in the above-mentioned diseases and as a substitute for bismuth in gastrodynia and pyrosis. Dose, gr. j— x in pill, cap- sule or powder. Mangani Sulphas {Manganese Sulphate) (MnS0 4 4H 2 0) occurs in transparent and colorless or pale rose-colored crystals, slightly efflorescent in dry air ; without odor, but having a faintly bitter, astringent taste ; soluble in water but not in alcohol. Its effects are those as above stated, and it is much more active than the black oxide. It is believed, also, to act as a cholagogue, and TONICS MINERAL ACIDS. 1 69 it has been used for this purpose in jaundice, especially when due to catarrh of the biliary ducts or when of malarial origin. It has also been used as a substitute for iron. Dose, gr. ij-v. Potassium Permanganate is considered among the antiseptics, q. v. ACIDA MINERALIA MINERAL ACIDS. The diluted mineral acids are usually classed with tonics ; but, although they exert a very considerable corroborant influence on the system, their action is in many respects peculiar and dis- tinctive. In the concentrated form they are corrosive. When properly diluted with water and swallowed in medicinal doses, they allay thirst, increase the appetite, stimulate digestion, increase the flow of bile by duodenal irritation, and all possess great diffusive power. After absorption into the blood, they combine either with its alkaline bases or albumen, and often produce a restorative effect in morbid conditions of the circu- lating fluid, and in their passage out by the secretions act as astringents. Acids given on an empty stomach check the secretion of the acid gastric juice ; given on a. full stomach they render its contents more acid; hence, if there is an excess of acid secreted by the stomach, they should be exhibited before meals, in small doses and well diluted ; while if there is too little acid secreted, they may be given after meals to supply the deficiency. They are employed — as tonics, usually in combination with the vege- table bitters, in dyspepsia, especially where it is dependent on a deficiency of gastric fluid, in typhoid and other essential fevers, in purpura and in scurvy ; as astringents and styptics, in hem- orrhage from the stomach and bowels and in colliquative sweats and diarrhoea ; to allay febrile heat and cutaneous irritation ; in phosphatic lithiasis ; and locally, as escharotics ; and in very dilute solutions they are injected into the bladder as lithontrip- tics. In cases of poisoning from the mineral acids the proper antidotes are the alkalies or the alkaline earths to neutralize the acid and thus render it inert, and the free use of the fixed oils or albumen to protect the surface of the alimentary tract. Acidum Sulphuricum (Sulphuric Acid) (H 2 S0 4 ), formerly called Oil of Vitriol, is obtained by burning sulphur, mixed with nitre, over a stratum of water contained in a chamber lined with sheet-lead. It is a dense, colorless, inodorous, corrosive I70 MATERIA MEDICA NEUROTICS. liquid, of a strongly acid taste and an oily consistence, which unites with water in all proportions with the evolution of heat. Its sp. gr. should not be lower than 1.840. It should contain not less than 96 per cent, of absolute sulphuric acid, and not more than 4 per cent, of water. The diluted acid is readily detected by a soluble barium salt, which precipitates a white insoluble barium sulphate ; veratrine introduced into the diluted acid, and evaporated to dryness, leaves a crimson deposit. In the concentrated form it is not employed internally, but is some- times used externally as a caustic, acting by coagulating albu- men, and its affinity for water and organic bases. Diluted sul- phuric acid lessens thirst, aids digestion, and diminishes the secretions of the bowels and skin. According to Gubler, the mineral acids exist in the blood loosely combined with albumen, and by the action of the excretory organs this combination is broken up, the albumen remaining in the vessels and the acid passing out united with other bases. When swallowed, it acts as a violent corrosive poison, causing a burning pain in the mouth, throat and stomach, and usually staining the lips, mouth and fauces with black sloughs ; occasionally the action of the poison is spent upon the upper part of the larynx, and death takes place from asphyxia, without the entrance of the poison into the stomach. The chemical antidotes are magnesia, chalk, the alkalies or solution of soap, and mucilaginous drinks should be afterward freely administered. Acidum Sulphuricum Dilutum (Diluted Sulphuric Acid) con- tains one part of sulphuric acid and 9 parts of distilled water. It therefore contains 10 per cent, of the officinal (not the abso- lute) sulphuric acid. It is given as a tonic, refrigerant and astringent, in the dose of from gtt. x-xxx, t. d., in water, and should be sucked through a tube to prevent injury to the teeth. This acid is a particularly valuable remedy in typhus and typhoid fevers, colliquative perspirations, cholera and choleraic diar- rhoea ; and it is the best corrective for phosphatic lithiasis. It is used externally as a gargle and a wash to ulcers. Acidum Sulphuricum Aromaticum (Aromatic Sulphuric Acid*), or Elixir of Vitriol, is made by adding 200 parts of sulphuric acid to 700 parts of alcohol and allowing the mixture to cool, then add 45 parts tincture of ginger and 1 part of oil of cinnamon, TONICS MINERAL ACIDS. I/I with sufficient alcohol to make the product weigh ioocf parts. It is a reddish-brown liquid, with an aromatic odor and a pleasant acid taste ; and is an agreeable substitute for the diluted sulphuric acid, administered in the same doses. Acidum Nitricum {Nitric Acid) (HN0 3 ) is obtained by the action of sulphuric acid upon potassium nitrate. When pure it is colorless ; but as found in the shops it is usually of a straw-color, owing to the presence of nitric peroxide. It should have a sp. gr. 1.420 and contain 69.4 per cent, of anhydrous acid. It is a corrosive, sour liquid, evolving white fumes when exposed to the air. It may be recognized by giving off dense red fumes when added to copper turnings, by the morphine test (see p. 75), and by striking a blood-red color, changing to yellow in minute quantity, with solution of sulphuric acid and brucine. Nitric acid is readily absorbed by the blood, and probably exists there either in the form of nitrates or com- bined with albumen (Gubler). Nitric acid stimulates the glandular apparatus of the intestinal canal, apparently due to a local action. It is probably eliminated as a nitrate by the kidneys. Locally, nitric acid is a powerful caustic, acting by abstracting water and combining with the alkaline bases of the tissues. It is employed, in the concentrated form, as an escha- rotic to destroy warts and stimulate indolent sinuses, and diluted, as an astringent wash or gargle. Atthill * applies the fuming nitric acid within the uterus successfully, in the treatment of granulations of the mucous membrane, in hemorrhage after the removal of a polyp, cervicitis and endocervicitis, on cotton wrapped round copper wire or a catheter, the cervix being pro- tected by a vulcanite tube. He states that applied in this way it seldom causes pain. Cases of poisoning from this acid are to be treated with magnesia, the alkalies, or soap, and mucilaginous drinks. In poisoning from nitric acid, the fauces and mouth are covered with yellow eschars, due to the formation of picric acid. Internally, it is used in the form of — Acidum Nitricum Dilutum (Diluted Nitric Acid), which con- tains one part of nitric acid and six parts of water, by weight ; or 10 per cent, of absolute acid. This is given as a substitute * " Clinical Lectures on Diseases Peculiar to Women," 1883, pp. 104, 199, 378. 1/2 MATERIA MEDICA NEUROTICS. for sulphuric acid. Dose for internal use ^ij-xx, t. d., reduced with water. Acidum Hydrochloricum [Hydrochloric Acid — Muriatic Acid} is an aqueous solution of hydrochloric acid gas (HC1), of sp. gr. 1. 1 60, and is obtained by the action of sulphuric acid on a solu- tion of sodium chloride. The officinal acid is composed of 31.9 per cent, of absolute hydrochloric acid, and 68.1 per cent, of water. It is, when pure, a transparent, colorless liquid, but has often a yellow color, owing to the presence of chlorine, iron, or other contamination. It gives off dense white fumes when in contact with ammonia, and evolves chlorine gas when heated with manganese dioxide ; in the diluted stage it produces, with solution of silver nitrate, a white precipitate, insoluble in boiling nitric acid, but soluble in ammonia. Locally, it is an active caustic, abstracting water and uniting with the alkaline bases of the tissues. Strong baths of hydrochloric and other mineral acids exert a powerful influence upon the skin. Hydrochloric acid is readily absorbed by the stomach, either as a chloride or joined with albumen. Hydrochloric acid, in small quantities, augments the digestive power of the gastric juice, and, probably, exists normally in that fluid. Hydrochloric acid is chiefly eliminated by the urine. It has a corrosive taste and a suffo- cating odor, and is an active poison, though less irritating than sulphuric and nitric acids. A poisonous dose produces black- ness of the lips, redness of the tongue, difficulty in swallowing, and violent gastric pain. Magnesia, soap, or the alkalies are the chemical antidotes. Afterward mucilaginous drinks should be given. It is used externally as a caustic, and as an application in diphtheria, ulcerative and gangrenous stomatitis, and, inter- nally, in the form of Acidum Hydrochloricum Dilutum {Diluted Hydrochloric Acid — Diluted Muriatic Acid), which contains 6 parts of the officinal acid and 13 parts of water, by weight; or 10 per cent, of the absolute acid. This is employed in typhoid and typhus fevers ; also to counteract phosphatic deposits in the urine, and in dysentery. In gastric dyspepsia attended with deficiency of the gastric juice, since it exists probably normally* in this fluid, * " Human Physiology," 1887, p. 139. Chapman. TONICS MINERAL ACIDS. 1 73 it is useful, especially when combined with pepsin ; the liquor pepsini, as it contains both remedies, is an eligible preparation in this condition and should be taken after meals. Dose, *Kv— xx, which may be given in infusion of rose. Acidum Nitro-Hydrochloricum {Nitro-Hydrochloric Acid — Nitro- Muriatic Acid). This acid is made by mixing 4 parts of nitric acid with 15 parts of hydrochloric acid, the resulting reaction liberating chlorine, and forming chloronitrous acid and water, as follows : HN0 3 + 3HCI = Cl 2 + NOC1 (chloronitrous acid) -f- 2H 2 0. It has a deep golden-yellow color, and emits the smell of chlorine, which is the chief active constituent. Internally, it is employed as a stomachic tonic, and is thought also to be particularly efficacious in oxaluria and diseases of the liver. Rutherford's experiments on dogs show that it is an hepatic stimulant. It should not be given with mercurials. Externally \ it is used as a bath, either local or general, in oxaluria and chronic hepatitis, for which purpose one or two ounces of acid may be added to a gallon of water. Dose, from gtt. ij-v, properly diluted, and carefully increased. Acidum Nitro-Hydrochloricum Dilutum {Diluted Nitro- Hydrochloric Acid — Diluted Nitro- Muriatic Acid) is made by mixing nitric acid (4 parts) with hydrochloric acid (15 parts), and, when effervescence ceases, adding distilled water (j6 parts). Dose, ^ij-x. Acidum Phosphoricum [Phosphoric Acid) is made by boiling phosphorus in nitric acid and water, and driving off the nitrous compounds by heat. It contains 50 per cent, each of ortho- phosphoric acid (H3PO4) and distilled water, and is " a colorless liquid, without odor, of a strongly acid taste and reaction," and has a sp. gr. of 1.347. It is a powerful caustic, penetrating the tissues very deeply. In its effects it resembles the other acids. In small doses, well diluted, it stimulates digestion and increases the circulation ; when given for too long a time it disorders digestion by diminishing the secretion of acid gastric juice. In large doses it depresses the circulation, acting as a corrosive poison. Cases of poisoning by phosphoric acid are to be treated on general principles, viz. : neutralize the acid by alkalies, alka- line earths or soap ; protect the denuded surface by eggs, milk or mucilaginous drinks ; and counteract the resulting depression 174 MATERIA MEDICA NEUROTICS. by opium, nutrient and stimulating injections, etc. It is used internally in the form of Acidum Phosphoricum Dilutum (Diluted Phosphoric Acid) which is prepared by adding 20 parts of phosphoric acid to 80 parts of distilled water. It is a colorless, syrupy liquid, without smell, but having a sour taste, and contains 10 per cent, of orthophosphoric acid. It has been used as a tonic and alterative in scrofulous affec- tions and in rachitis, but in the latter disease the phosphates are justly preferred. It may be used in dyspepsia, especially in those forms attended with acid eructations, heartburn, and ulcerative stomatitis, and due to fermentation of food or excessive secretion of acid by the stomach. In these cases it should be given before meals. It is often added to cough mix- tures. As it contains no free phosphorus it should not be given to produce the medicinal effects of that drug (Farquharson). Dose, ^x-xxx diluted. ACIDUM LACTICUM LACTIC ACID. This acid (HC s H 5 3 ) is formed in the souring of milk by the fermentation of its sugar under the influence of casein, between 68° and 84 F., and is a " syrupy, colorless, or pale wine-yellow liquid, having a slight bland or no odor, a very sour taste, and a sp. gr. 1.2 1 2." The officinal acid contains 75 per cent, of absolute lactic acid. Lactic acid unites in all proportions with water, alcohol, and ether, but is insoluble in chloroform and carbon bisulphide. In its effects it resembles the mineral acids, aiding digestion in small doses, while in large doses it disorders the stomach, causing flatulence and epigastric pain. It is a normal ingredient of the gastric juice, and it seems probable that the acidity of this secre- tion depends partly upon its presence. At all events, as far as digestion is concerned, it answers equally well with HO. Given in large doses and long continued, it has caused rheu- matic pains. It has been used in certain forms of dyspepsia depending on a deficiency of acid in the gastric juice, as in atonic dyspepsia, apepsia, and irritative dyspepsia, when it is given after meals and frequently combined with pepsin ; in acidity and heartburn it may be given before meals to decrease the secretion of acid. I" TONICS PHOSPHORUS. I 75 It has also been used for the removal of phosphatic deposits in the urine when these depend on disordered digestion. As a solvent for the false membranes of croup or diphtheria it has been used as a gargle or by atomization. Dose, ^x-xxx, well diluted. PHOSPHORUS. Phosphorus (P), which is never found in a free state in nature, is obtained from the calcium phosphate of bone-ash, by removing the lime with sulphuric acid, and afterward deoxidizing the residuum by heating with charcoal. It is a translucent, highly inflammable, nearly colorless solid, resembling wax, without taste, but having a peculiar garlicky smell; sp. gr. 1.830. It is insoluble in water, and dissolves sparingly even in the oils, ether, and alcohol, but is soluble in carbon bisulphide. It emits, when exposed to the air, white fumes, which are luminous in the dark. It should be kept under water to prevent combustion. Physiological Effects. — Locally: when applied to the skin, phosphorus produces inflammation, ulceration, and even gan- grene. The fumes of phosphorus are irritating to the con- junctival and respiratory mucous membranes, and may produce necrosis of the maxillae, if the person exposed has t caries of the teeth. This form is mostly observed among the artisans of match factories. Nervous system : in small doses, it is a tonic and stimulant to the nervous system, aiding in the repair of waste. Circulation : phosphorus is absorbed by the blood, according to Bamberger. Either in the stomach or after enter- ing the blood, a portion must unite with oxygen or hydrogen, as the odor of a phosphuretted compound is generally percep- tible in the exhaled air of a person taking it. It stimulates the circulation, increasing the frequency and fullness of the pulse, and producing dilatation of the cutaneous capillaries. Large doses depress and weaken the cardiac action. Temperature : this is slightly elevated. Secretion : it increases the urinary secretion and the relative proportion of urea excreted, and gives to the urine an odor of violets. It stimulates the skin and in- creases the perspiration. In poisoning from phosphorus, albu- minuria and hematuria have been observed. Osseous system : it stimulates the formation of bone, 'especially of the compact tissue, and the proportion of inorganic to organic matter is I76 MATERIA MEDICA NEUROTICS. increased (Wegner *). Elimination : phosphorus passes out of the system by the liver and other glands, by the pulmonary mucous membrane, and by the skin. Poisoning : when taken in large doses, or for a considerable time, phosphorus acts as a gastro-intestinal irritant, causing vomiting, purging, abdominal pain, an alliaceous taste in the mouth, the vomited matters and sometimes the stools being* phosphorescent. Toward the end the pupils dilate, the abdo- minal walls are sensitive to pressure, there is great thirst and anxiety, and death may be preceded by convulsions. Hart- man,")" asserts that the temperature is finally elevated, the faeces of normal color, while the urine contains biliary pigment and acids. Jaundice is a frequent sequela; according to Alter,J the pathological changes involved in its production are swelling of the mucous membrane of the biliary passages and hypersecre- tion of bile — both due to fatty infiltration of the biliary epithe- lium and followed by absorption of bile. Wolfs, § who has studied the post-mortem appearances in sixteen cases, states that the blood is rendered more fluid, coagulation prevented, and the corpuscles altered in form. Vetter,|| however, found the latter in normal condition. Hemorrhages take place or form in the serous cavities, especially in the pericardium and pleura, due, doubtless, to the changes in the blood and fatty degeneration of the capillaries and arterioles. The liver becomes atrophied (not always), undergoes fatty degeneration of its cells, as do also the other tissues, notably the muscles. The heart is soft and pale, and the parenchyma and cortex of the kidneys infil- trated with fat cells. In fact, the ingestion of phosphorus, either in toxic amount or continuously, tends to the production of a general steatosis. Death has been caused by gr. jss-iij, also from swallowing an infusion of matches (Woodman and Tidy T). The period when fatal varies from a few hours to seven days. Antidotes: in cases of poisoning, an emetic should be adminis- tered at once, preferably copper sulphate repeatedly in small doses, partly for its emetic action and partly as a chemical anti- * Virchow' s Archives, 55, p. II. I " Zur acuten Phosphorvergiftung," Dorpat, 1866. % " Inaug. Diss.," Breslau, 1867. \ " Inaug. Diss.," Berlin, 1868. || Virchoiv's Archives, 53, p. 168. \ " Forensic Med.," etc., 1882, p. 95. TONICS PHOSPHORUS. 1 77 dote, since Bamberger * has shown that it forms with this salt a phosphide, thus checking the intensity of its effects. The oil of turpentine, an antidote introduced by Andant,t who exemplified its virtues in the case of a woman poisoned by matches, has been frequently and with success employed against phosphorus (LaboulleneJ Lecorche,§ Rommelaere ||). Personnel experi- menting on dogs poisoned with phosphorus, observed that almost all recovered to whom turpentine had been given. He thought it formed with phosphorus an insoluble mass or inert combina- tion (turpento-phosphoric acid, a spermaceti-like substance). French acid oil of turpentine, according to Vetter, (loc. cit.) must be administered, and it should be old, as the real antidote appears to be oxygen in the form of ozone contained in oxygenated oil of turpentine. Fats and oils are to be avoided, as they increase the solubility of phosphorus. The after-treatment consists in the exhibition of a brisk cathartic, such as magnesia. The most delicate test for free phosphorus is that of Mitscher- lich, which consists in distilling the suspected substance with weak sulphuric acid in a flask and conducting the vapor in a tube through a glass condenser, the tube terminating in a bottle containing water placed under the condenser. That portion of the tube passing through the condenser must be surrounded by cold water contained within the latter, which, if phosphorus be present in the distillate, will condense it, causing a peculiar luminosity to be visible when observed in the dark. The water in the bottle may also be tested for phosphorus. Uses. — In medicinal doses, phosphorus is a valuable stimulant and tonic to those tissues in which it is normally found, and has been employed with advantage in cases of nervous exhaustion and degeneration of nerve tissue, and especially in neuralgia; though Anstie ** says its utility is not extensive nor reliable in the last disease. It is administered with benefit in osteomalacia and rickets, and has proved useful in some cases of pernicious anaemia. It is one of the best remedies we possess in func- * Wilrzburger Medicinische Zeit., 1 866, p. 41. f Bull. Gen. de Therap , 75, p. 269; 76, p 273. % Gaz. des Hop., xlvi, p. 361 ; Gaz. Heb., 1874, p. 524. \ Arch, de Phys., t. i, p. 571 ; t. ii, p. 488. || Bull.Gen. de Thh-ap., 82, p. 145. ^ Bull. Gen. de Therap., 76, p. 353. ** " Neuralgia," etc., 1871, p. 180. 12 I78 MATERIA MEDICA NEUROTICS. tional impotence, and has been given in certain cutaneous affec- tions, as lupus and psoriasis. The dose of phosphorus is gr. 3^ ^2- The officinal preparations are: pilulce phosphori (phos- phorus pills); each pill contains gr. yto> °l eum phosphoratum (phosphorated oil), a solution of phosphorus (1 part) in ether (9 parts) and almond oil (90 parts) ; dose, gtt. v-xx. Zinci Phosphidum (Zinc Phosphide), (Zn 3 P 2 ), prepared by sub- jecting fragments of zinc and phosphorus together to ebullition in a retort, through which a current of dry carbonic acid gas has been previously passed, has been employed in cases where the administration of phosphorus is indicated. It occurs as a gray, crystallized body, unaltered by moist air, and easily decomposed in the stomach, with the evolution of phosphur- etted hydrogen. It has been found efficacious in eczema, psoria- sis, and other cutaneous affections. Dose, about gr. -^-\. ORDER V. ASTRINGENTS. These are medicines which produce contraction and corruga- tion of the tissues by a local action. Their constitutional effects are somewhat analogous to those of tonics ; and, like them, they increase the tone and vigor of the body, and exercise a control over various disorders of the nervous system. But they are chiefly employed to cure relaxation of the fibres and tissues, to subdue inflammation of superficial parts, and to arrest hemor- rhage and excessive discharges from mucous membranes or other secreting surfaces. In checking morbid discharges from the bowels, astringents diminish the secretions from the intes- tinal canal, and restrain their peristaltic movements, accomplish- ing this by a local action. They are divided into Vegetable and Mineral astringents. Most of the former owe their astringency to the presence of a principle termed tannic acid, and differ from tonics in the absence of bitterness. The mineral prepara- tions usually classed among astringents are those of lead, cop- per, zinc, silver, bismuth and alum, and are distinguished from the mineral tonics by their more decided astringency and a sedative action on the vascular system. ASTRINGENTS TANNIC ACID. 1 79 VEGETABLE ASTRINGENTS. ACIDUM TANNICUM TANNIC ACID. This acid, which is the active principle of the vegetable as- tringents, is usually extracted from powdered nutgall by the action of washed ether. The nutgall, made into a soft paste with ether, is enveloped in a canvas cloth, and is pressed be- tween tin plates ; the resulting cake is again mixed with washed ether and expressed ; and the expressed liquids are mixed, evaporated and dried ; the water seems to be the solvent which extracts the tannic acid. It is a light, feathery, non-crystalline powder, of a yellowish-white color and a strongly astringent taste, is very soluble in water, and soluble, though less so, in alcohol and ether. It produces a white flocculent precipitate with solution of gelatin, a bluish-black precipitate with ferric salts (ink), and white precipitates with solutions of the vegetable alkaloids ; and these substances are to be, therefore, considered incompatible with all the vegetable astringents. There is a variety of tannic acid (mimo-tannic acid) obtained from kino, catechu, and some other substances, which strikes a greenish- black pre- cipitate with the salts of iron, and is not convertible into gallic acid. Tannic acid (Ci 4 H 10 O 9 ) is a glucoside, yielding, besides glucose, gallic acid. Its hydrogen atoms are theoretically replaceable by bases, but the salts are not well defined. The most recent investigators consider tannic to be the anhydride of digallic acid. Effects and Uses. — Tannic acid applied locally to mucous mem- branes is a powerful astringent, and is applicable to all the cases in which astringents are useful. It precipitates peptones from watery solutions, but this does not take place in the presence of hydrochloric acid (Lewin). It checks the secretions of the mouth and stomach by constringing the caliber of the vessels, and it restrains intestinal peristalsis. Injected into the veins in large amount it coagulates albumen, causing fatal thrombosis. Intro- duced in the same way, more slowly, in moderate quantities, it exists as tannate of albumen, being held in solution by the alkaline carbonates (Lewin). According to Stockman's * inves- tigations tannic acid in the stomach unites with alkalies,- and in * Brit. Med. Jonrn., Dec. 4th, 1886, p. 1077. l80 MATERIA MEDICA NEUROTICS. the intestine is converted into gallic acid ; but it cannot be ob- tained as such, or at best a mere trace, from the blood. Tannic acid locally in dilute solution dilates the blood vessels, while strong contracts them, sometimes after brief dilatation. If its chemical affinities be satisfied it has no action on the vessels. Probably the alkaline tannates in the stomach are absorbed at once, and on the amount of this absorption depends the quantity in the urine ; for that in the intestine remains there a long while, being scarcely absorbed at all, is converted into gallic acid, and goes off by the bowel. Tannin is excreted in the urine of the rabbit as alkali tannate, while in man it may be given a long time before it can be detected there with ferric chloride. The remote effects of tannin as an astringent would seem to be valueless ; for when its affinities are satisfied in the blood, either with an alkali or albumen, it does not affect the calibre of the vessels or precipitate albumen. It is used ijttemally in the treatment of hemorrhage and colliquative sweats, while in diarrhoea and dys- entery it may act by forming a protective coating along the intestinal walls, and is frequently prescribed in the form of tinc- ture of catechu or kino. It is also used as an enema in diar- rhoea, dysentery, prolapsus ani and fissure of the rectum ; and, as a topical application, in hemorrhages, discharges from mucous membranes, as gonorrhoea (gr. ij-v to aq. fjjjj), and ulcers. It is doubtful if it possess the power to lessen the urinary albu- men in Bright's disease. Dose, gr. j— iv, in pill, occasionally repeated. Troches of tannic acid are made by rubbing together tannic acid, powdered sugar and powdered tragacanth, and form- ing a mass with orange-flower water ; each troche contains of tannic acid gr. j. Ointment of ta?inic acid (^unguentum acidi tan- nici) is made by rubbing up 10 parts of tannic acid with 90 parts of benzoinated lard. ACIDUM GALLICUM GALLIC ACID. This principle is found in many of the vegetable astringents, but less uniformly than tannic acid, and is probably the result of changes which the latter has undergone. It is prepared by exposing a mixture of nutgall and animal charcoal in water to the air, in a warm place, for a month, when the tannic acid is gradually converted into gallic acid by the absorption of a mole- ASTRINGENTS NUTGALL. I 8 I cule of water, since the most recent experimenters (H.,SchifT, Sac and Lowe) have shown that tannic acid is the anhydride of digallic acid ; it is purified by being boiled in water and filtered through animal charcoal. It is also prepared by boiling pow- dered nutgall in dilute sulphuric acid (Liebig). If the conver- sion into gallic acid be completed there will be no turbidity on the addition of solution of isinglass. Gallic acid (HC 7 H 5 05.H 2 0) is distinguished from tannic acid by not coagulating albumen or gelatin; and it unites with organic and inorganic bases to form gallates. For internal use, gallic acid is preferable to tannic, since it does not coagulate albumen. It occurs in small, silky, nearly colorless crystals, having a slightly acid and astringent taste, and is soluble in boiling water, and slightly so in cold water. Effects and Uses. — Gallic acid is an astringent, of doubtful value, which has been extensively employed in hemorrhagic disorders, as uterine hemorrhage, hemoptysis, hematuria, bloody diarrhoea, etc. But, according to Stockman (loc. cit) it has no other action than that of a weak organic acid, and only dimin- ishes the alkalinity of the blood. Sodium gallate is without effect on the caliber of the vessels. Both tannic and gallic acids have been employed to diminish the quantity of albumen in chronic Bright's disease, but the proof of their utility in this condition is by no means conclusive. Gallic acid has but feeble local astringent powers, and is probably converted into tannic acid in the blood. Given by the stomach, it is more efficacious than the latter acid. It may be given in doses of gr. ij-v, in pill, every two or three hours. The ointment contains 10 per cent, of gallic acid with benzoinated lard. GALLA NUTGALL. Nutgall is an excrescence found upon Quercus lusitanica, var. infectoria, the Gall Oak (Nat. Ord. Cupuliferse), a small tree or shrub of Asia Minor. The gall-nuts are produced by the puncture of the buds by a fly (Cynips quercusfolii or Diplolepis gallce tinctorice) to form a nidus for its eggs. This occasions an irritation and flow of juices to the part, resulting in the formation of a tumor around the larvae, which, on attaining maturity, per- forate the gall and escape. Galls are produced chiefly in Syria I 82 MATERIA MEDICA NEUROTICS. and Asia Minor, and are imported from the Levant. They are brought also from Calcutta, being collected to some extent in India. Galls are spherical, about the size of a hickory-nut, with small tubercles on their surface. The best are bluish or black externally and grayish within, without odor, and of a very astringent, bitter taste. They yield their properties to both water and alcohol, but best to the former, and contain tannic acid, 50 to 60 per cent., and gallic acid, 3 per cent. ; mucilage, sugar, etc. White galls are collected after they have been per- forated by the insect, and are inferior in astringency, containing only 30 per cent, of tannic acid. Effects and Uses. — Galls are powerfully astringent, but are not much used internally. In the form of infusion or decoction they are employed as enemata in diarrhoea and dysentery, and also Fig. 13. QUERCUS INFECTORIA (NUTGALL). as gargles. Dose of the powder, gr. x-xx. The tincture (20 per cent., in glycerin and diluted alcohol) may be given in the dose of f5j-iij, but it is used chiefly as a chemical test. The ointment (10 parts to benzoinated lard 90 parts) is a favorite application in hemorrhoids, and may be advantageously com- bined with opium (5ss to ointment Sj). CATECHU. Catechu, formerly called Terra japonica, is an extract of the wood of Acacia Catechu, a small prickly tree of India {Nat. Ord. Leguminosae). Twelve or fifteen varieties of the drug are described by pharmacologists ; but it is usually met with in the shops in masses of various shapes and sizes, of a rusty-brown color externally, and varying internally from a reddish or yel- ASTRINGENTS KINO. 1 83 lowish-brown to a dark-brown color. The best is of a dark color, and is easily broken into small angular fragments, with a smooth, glossy surface, bearing some resemblance to kino. It is without smell, and has an astringent, bitter taste. It contains about 50 per cent, of catechn-tannic acid, which strikes a greenish- black precipitate with ferric salts, and about 30 per cent, of an acid principle, called catechin, to both of which it owes its peculiar properties ; also, in small amount, quercitrin and catechu-red. Effects and Uses. — This is one of the most powerful and valu- able of the vegetable astringents, possessing also mild tonic properties. It is much employed in combination with other remedies in diarrhoea, dysentery, and hemorrhages, and is best administered half an hour before meals. It is a good deal used in relaxed conditions of the mouth and throat, to relieve the hoarseness of public speakers, also in aphthous ulcerations of the mouth and spongy affections of the gums. Topically, it is em- ployed as a styptic, and in solution as an injection in gonorrhoea and gleet. Dose of the powder, gr. x to 5ss in bolus or emulsion. Of the compound tincture (12 parts with cinnamon 8 parts in diluted alcohol to make 100 parts), the dose is f5j-iij. The troches each contain of catechu, gr. j, with sugar, tragacanth, and orange-flower water. KINO. The term Kino is applied to the products of several trees. Five varieties are known. 1. East India kino, which is the most common, and is the inspissated juice of Pterocarpus Marsupium (Nat. Ord, Leguminosae), a lofty tree of Malabar. 2. African kino, the original variety introduced into Europe, but not now met with ; obtained from Pterocarpus erinaceus. 3, Botany Bay kino, the concrete juice of Eucalyptus resinifera (Nat. Ord. Myrtaceae), a large tree of Australia. 4. Bengal or Palas kino, from the Butea frondosa (Nat. Ord. Leguminosae). 5. Jamaica and Caraccas kino, the extract of the wood and bark of Coccoloba uvifera, or Seaside Grape (Nat. Ord. Polygonaceae), a small tree of South America and the West Indies. East India kino is met with in small, angular, shining frag- ments, of a dark-brown or reddish-brown color, brittle, without smell, but with a very astringent taste. It contains kino-tamiic acid, kino-red, pyrocatechin (a trace), and kinoin. 184 MATERIA MEDICA NEUROTICS. South American kino comes in large masses, externally very- dark, and internally of a deep reddish-brown color. Jamaica kino resembles the last, but is contained in large gourds. Effects and Uses. — Kino is a powerful astringent, and is much used in diarrhcea, chronic dysentery, leucorrhcea, gonorrhoea, and hemorrhages. Externally, it is employed as a styptic, and as a stimulant to indolent ulcers. Dose of the powder, gr. x- 5ss ; of the tincture (10 parts, glycerin 15 parts, alcohol and water to make 100 parts of tincture), f5j-ij may be given, and it is frequently added to chalk mixture in diarrhcea. KRAMERIA. Krameria or Rhatany is the root of Krameria triandra and of K. tomentosa (Nat. Ord. Polygaleae), shrubs of Peru, Bolivia, and New Granada. It occurs in woody cylindrical pieces, of the thickness of a goose-quill to twice that size — many radicles being often united to a common head. They have a dark, red- dish-brown bark and a tough central ligneous portion, of a lighter red color. They are without smell, but have a very astringent, slightly bitter and sweetish taste, which is much stronger in the cortical than the ligneous portion ; and hence the smallest pieces should be preferred, as they contain the most bark. Rhatany yields a large proportion of kramero-tannic and rhatanic red. It imparts its properties to both cold and boiling water, but more fully to alcohol. Effects and Uses. — Rhatany is powerfully astringent, with some tonic properties. It is much used in the treatment of diarrhcea, dysentery and hemorrhages, and as an enema. Trousseau strongly recommends its use in fissure of the anus and in tenesmus due to chronic dysentery or hemorrhoids ; it is also used in hemorrhoids and leucorrhcea. The powdered extract is an ingredient in many tooth-powders, and the tincture is used also as an astringent mouth-wash. Dose of the powder, gr. xx-xxx ; watery extract, dose, gr. x-xv ; fluid extract, dose, f5ss-j ; tincture (20 per cent.), dose, f5j-ij ; and syrup, dose, f3j— iv. The troches each contain gr. ij of Krameria with sugar, tragacanth and orange-flower water. ASTRINGENTS WHITE OAK. 1 85 H^MATOXYLON. Logwood, or Campeachy wood, is the heart-wood of Hae- matoxylon campechianum {Nat. Ord. Leguminosae), a medium- sized tree of Campeachy and other maritime parts of tropical America, and now naturalized in the West Indies. The portion used in medicine, and also as a dye, is the heart-wood, from which the bark and white sap-wood are removed previous to exportation. It is imported in billets of different sizes, of a dark color externally and a deep red internally ; in the shops it is kept in chips or raspings. It has a sweetish, astringent taste and a feeble, not unpleasant, smell. It contains tannic acid, a coloring principle called hcematein, licematoxylin (C 16 H 14 6 ), resin, etc. Effects and Uses. — It is a mild astringent, useful in chronic diarrhoea and dysentery, and particularly well adapted to the weakened condition of the bowels which follows cholera infan- tum. Mothers should be told that the stools of infants taking hsematoxylon will stain their napkins red. It is also much employed in the diarrhoea of phthisis. It is given in decoction in the dose of fSj to adults, and f5j to children ; or watery extract, in the dose of gr. x-xxx in solution. QUERCUS ALBA WHITE OAK. The barks of several species of American oaks possess astrin- gent properties, and are probably to be found in the shops, but the only officinal variety is Quercus alba, White Oak {Nat. Ord. Cupuliferse). The inner bark is the portion used, but the leaves and acorns also are astringent. White-oak bark is distinguished by its whitish color. When prepared for use, it is deprived of its epidermis, and is of a light-brown color and fibrous texture, with an astringent and bitterish taste. Water and alcohol extract its virtues, which depend mainly on the presence of querci-tannic acid (C^H^O^), tannin, oak-red, etc. . - , ■ ^ Effects and Uses.- — A decoction of white-oak bark is a good remedy in diarrhoea and hemorrhoids, and is employed as an enema in hemorrhoids and prolapsus, and fissure of the anus, as a gargle in relaxation of the uvula, and as an injection in leucor- rhcea without inflammation and where the discharge is profuse, in checking which the mineral astringents have failed. It, how- ever, stains the linen. 1 86 MATERIA MEDICA NEUROTICS. It is also used on a cotton tampon in descensus uteri, recto- cele or cystocele when these conditions are due to relaxation of the parts, or when operative interference is not justifiable. Of decoction of white-oak fgij may be taken frequently. Fig. 14. GERANIUM MACULATUM. RHIZOME. GERANIUM. One of the most powerful of the indigenous astringents is Ge- ranium maculatum, Crowfoot, or Cranesbill {Nat. Ord. Gerania- ceae), a perennial herbaceous plant, growing- in moist woody situations, with an erect stem one to two feet high, pale-green, ASTRINGENTS — HAMAMELIS. 1 87 mottled leaves, and large purple flowers, which appear in April and May. The part used is the rhizome, which should be col- lected in the autumn. This, when dried, occurs in wrinkled, rough pieces, from a quarter to a half an inch in thickness, fur- nished with slender fibres, of a dark-brown color externally and a pale flesh-color within. It has an astringent but not bitter taste and no smell, and contains tannic and gallic acids with mucilage. Effects and Uses. — This ^is an excellent simple astringent, agreeing very well with the stomach, and might be advantage- ously substituted for more expensive foreign drugs. It may be used internally to fulfill the indications of kino, rhatany, etc., in bowel complaints and hemorrhages, and topically as an enema, gargle, injection, etc. It is also a styptic. Dose, in powder, gr. x to xx ; of the decoction, f gj-ij may be given. A decoction in milk is given to children. The fluid extract may be given in doses of f3ss-j. HAMAMELIS. Hamamelis virginica, or Witchhazel (Nat. Ord. Hamamelaceae), is a shrub, from six to ten feet high, growing in the damp woods of the United States and Canada. The leaves are the officinal part, and should be collected in autumn. They are bitter and astringent. The bark may also be used. Hamamelis contains tannic acid (8.10 per cent.), a bitter principle not yet accurately determined, etc. Effects and Uses. — Hamamelis is an astringent, and, according to Phillips, possesses probably a hemostatic and shrinking power over veins, especially those of the skin and mucous membranes. It has been used with success in passive hemorrhages, in hematemesis, hemoptysis,* and hematuria. It is beneficial in hemorrhoids,! checking the bleeding and reducing the size of the enlarged veins. For this purpose it may be given internally and used as an injection, beginning with 5j to water §ij, and gradually increasing the strength. The injection should be taken morning and evening, and retained, and it must be con- tinued for some time (H. M.). It is also recommended in * Bull. Gen. de Thkrap., cvi, p. 193. Dujardin-Beaumetz. Sur Hamamelis Virginica. f Ibid. I 88 MATERIA MEDICA NEUROTICS. varicocele, and locally in inflammations and congestions. The fluid extract is the only officinal preparation ; dose, f5ss-j. The following vegetable astringents deserve notice, though less frequently employed than the foregoing : — Rosa Gallica {Red Rose) ; Rosa Centifolia {Pale Rose) {Nat. Ord. Rosaceae). The petals of these two species of rose are officinal, but those of almost every other species of culti- vated rose may be employed for the same purpose as Rosa centifolia, which is not astringent. The red rose is a mild as- tringent. The fluid extract is used as a flavoring ingredient in gargles and mouth washes, to disguise the taste of other medi- cines, as Glauber or Epsom salts. The confection is used as a basis for pills. Mel Rosce {Honey of Rose), made with diluted alco- hol and clarified honey, is used as an addition to gargles ; the syrup is added to mixtures. The pale rose is slightly laxative. Aqua Rosce {Rose Water), distilled from the pale rose, is much employed in collyria, etc. Unguentum Aquce Rosce {Ointment of Rose Water) is made by melting together oil of almond 50 parts, spermaceti 10 parts, white wax 10 parts, and then gradually adding rose-water 30 parts ; this is a very soothing application, much used under the name of cold cream. Rhus Glabra {Sumach). This is an indigenous shrub grow- ing to the height of from four to twelve feet, having a somewhat bent stem " divided into straggling branches, covered with smooth light gray or some reddish bark, and imparipinnate leaves " with from twenty-one to thirty-one lance-oblong, pointed, and serrate leaflets. The fruit is in " clusters of small crimson berries which are subglobular, about one-eighth of an inch in diameter, drupaceous, densely haired, containing a roundish- oblong, smooth putamen." They contain acid calcium and potassium malates, tannin, color- ing matter, etc. (Maisch), and are excellent astringents, especially valuable as a gargle in aphthae and other forms of sore mouth and in pharyngitis, for which purpose the fluid extract maybe diluted with two or more parts of water. Rubus {Blackberry). The bark of the root of Rubus villosus, Rubus trivialis and Rubus Canadensis {Nat. Ord. Rosaceae), the former (the common American Blackberry) an erect, prickly shrub, and the two latter (Dewberries) creeping ASTRINGENTS PREPARATIONS OF LEAD. I 89 briers, are very efficient mild astringents, which have been used with excellent effect in bowel complaints, especially those of children. The astringency resides principally in the cortical portion, and hence the smallest roots should be preferred. The fluid extract may be given in doses of f 5j-ij ; the syrup is made by adding 20 parts of the fluid extract to syrup 80 parts ; dose, foss. Castanea {Chestnut). The leaves of the Castanea vesca {Nat. Ord. Cupuliferae), a stately tree indigenous to both hemi- spheres, are officinal. They should be gathered in the autumn while still green. They contain tannin, etc., and are used prin- cipally in whooping-cough. Dose of the fluid extract, f"5ss-ij. ,A large number of vegetable substances, both indigenous and foreign, have been used as astringents in addition to those enumerated, the astringent principle being the most common medicinal property with which plants are endowed. The fore- going list comprises the more important. mineral astringents. plumbi pr^parata preparations of lead. Metallic lead is considered inert. The sulphide and sulphate are probably also inactive ; but with these exceptions, all the compounds of lead possess more or less activity. When applied locally in solutions not too concentrated, they coagulate albumen, contract the blood vessels, and consequently blanch the tissues, but are not absorbed by the skin.* When more highly concen- trated solutions are applied, they act as irritants, producing inflammation. When administered in therapeutical doses, they act as astringents in the alimentary canal, checking secretion and causing constipation. Rutherford states that lead acetate is the only drug which decreases the secretion of bile without causing purgation, and attributes this effect to a direct action on the liver. The lead preparations probably enter the blood from the stomach as albuminates, and pass directly to the liver, f by which they are chiefly eliminated, though a trace may be found in the urine. From the intestine they are only absorbed slowly and in small quantity. After absorption they irritate the cardiac inhibitory centre and * Journal de V Anatomie et de la Physiol., 1873, p. 235. f Ibid. I9O MATERIA MEDICA — NEUROTICS. at the same time act on the terminal intro-cardiac branches of the vagus, thus diminishing the frequency of the cardiac beat (which under large doses becomes intermittent), lessening the duration of the systolic bruit, while prolonging the diastolic bruit, thus producing a diminution in the volume and frequency of the pulse.* They also decrease the activity of the secreting functions, and frequently arrest sanguineous discharges, both natural and artificial. In excessive doses, several of the satur- nine compounds are irritant and corrosive poisons, giving rise to gastro-enteric inflammation, and sometimes to paralysis, coma, and collapse. The toxic dose of lead acetate is 5j— ij, but it is rarely fatal, owing to the vomiting it produces. The proper antidote is sulphuric acid or some alkaline or earthy sulphate, in solution in a large quantity of diluent. The tests for lead are sulphuretted hydrogen and a solution of potassium iodide ; the former strikes a black and the latter a yellow precipitate with soluble lead salts. The editor f has ascertained that sulphuretted hydrogen will detect one part of a soluble lead salt in one million parts of water. When the system becomes impregnated with lead, either from the too long-continued use of its preparations medicinally, from drinking water drawn through lead pipes, or from exposure to its influence in lead factories, etc., a peculiar kind of chronic poi- soning is produced, which shows itself by a variety of symptoms. The most usual form of lead-poisoning is colic, sometimes termed colica Pictonum, and painter's colic, which is characterized by sharp abdominal pains, with hardness and depression of the abdominal parietes, obstinate constipation, nausea and vomiting. Dr. Ernest Harneck, from experiments on the lower animals, concludes that colica Pictonum is due to intense excitation of the intestinal ganglia by the lead, producing arrest- of peristalsis from spasm of the muscular coat, and recommends belladonna or atropine as affording speedy relief. According to Bardenhewer, pilocar- pine relieves the colic with equal rapidity. Next in frequency is lead-arthralgy, in which there are severe pains in the limbs, attended by cramps, hardness and tension of the painful parts. * Gaz. Hebdom., August, 1883, Curci. f Am. J. M. S., October, 1878, C. Biddle, m.d. ASTRINGENTS PREPARATIONS OF LEAD. I9I Lead-paralysis is another, though less common, variety of the disease, and is characterized by a loss of voluntary motion, owing to the want of contractility of the muscular fibres of the affected parts. It most frequently affects the upper extremities, and the extensor rather than the flexor muscles. Occasionally, functional disease of the brain is also observed as one of the consequences of lead-poisoning. The absorption of lead into the system is recognized by a saturnine coloration of the gums, of the mucous membrane of the mouth, and of the teeth. In a series of experi- ments made by the editor,* the fact was established that the emanations from fresh lead paint do not contain lead. It seems proven, therefore, that in order to induce saturnine poisoning, actual contact is necessary with paint or lead in some form. The antidotal treatment of chronic lead-poisoning consists in the internal administration of solutions of sulphuric acid and of soluble alkaline and earthy sulphates, and in the use of baths of potassium sulphide, dissolved in warm water, by which the salts of lead, deposited on the skin, are converted into the insoluble sulphide. Potassium iodide is employed as an eliminative remedy. For lead-colic, a combination of cathartics and opiates has been employed ; but the best remedy is alum, in doses of 5j-ij, every three or four hours, dissolved in some demulcent liquid. In the treatment of lead-palsy, strychnine and electricity may be used, but it is a very intractable form of the disease. The use of sul- phuric acid lemonade is resorted to, by workmen in lead factories, as a preventive of lead-poisoning. Milk has been found also to answer the same purpose. By passing a strong solution of potas- sium or sodium sulphide, heated to the temperature of 212° F., through leaden pipes, the interior surface will become coated with an insoluble lead sulphide, and the water distributed through them will be free from contamination. Therapeutically \ the preparations of lead are employed as astringents, sedatives and desiccants. For internal use the ace- tate is almost exclusively employed. It is a most valuable remedy in hemorrhages, obstinate diarrhoea and dysentery, and in the treatment of internal aneurism, from its combined seda- tive and astringent influence, and is also very serviceable in * Am. J. M. S., October, 1878, C. B. Prize thesis. I92 MATERIA MEDICA NEUROTICS. fluxes from the mucous membranes, particularly of the bowels. Topically, lead-washes are employed to relieve superficial inflam- mation, to arrest morbid discharges, and as desiccants. They are objectionable, however, as eye-washes, from their often form- ing precipitates of lead upon the cornea. Plumbi Acetas (Lead Acetate). This salt (Pb2C 2 H 3 2 . 3H 2 0), known also as saccharum saturni or sugar of lead, is made by immersing lead in distilled vinegar, or litharge in pyroligneous or crude acetic acid. It occurs in colorless, needle-shaped crys- tals, which effloresce on exposure to the air. They have an acetous odor and a sweetish, astringent taste, and are soluble in both water and alcohol. The mineral acids and their soluble salts, the alkalies and alkaline earths, and vegetable astringents, are incompatible with lead acetate. The lead salts are aided in their depressing action upon the circulation by prolonged cold, ergot and veratrum viride ; in their astringent effect on the tissues by the salts of zinc, copper, bismuth and silver ; and in their depressing influence on nutrition by mercury, antimony, copper and other metals which increase tissue waste. Effects and Uses. — The effects of this salt are those of the saturnine preparations which have been already described. Its medicinal influence is sedative and astringent. In hemorrhages it is employed internally, usually in combination with opium. This combination is also much resorted to in the treatment of diarrhoea, dysentery and cholera, and may be prescribed with advantage to arrest the secretion of bronchitis and the night- sweats of phthisis. In the cure of internal aneurism the acetate is prescribed alone, but with unsatisfactory results. In diarrhoea, if there be abdominal pain and frequent serous stools, the ace- tate should be combined with opium : Jfy Plumbi acetatis, gr. xij ; pulvis opii, gr. vj. M. S. — Ft; pil. no. vij, one after each stool. This is equally efficacious in dysentery, but the propor- tion of opium should be increased. In yellow fever it is em- ployed to check the hemorrhagic condition of the gastric mucous membrane. It is a dangerous remedy in chronic diseases, from the liability to lead-poisoning, when its administration is long continued. As a topical remedy, lead acetate, in aqueous solu- tion, is extensively employed to relieve inflammation and diminish morbid discharges. Dose, gr. j-ij-viij, two or three times a day. ASTRINGENTS PREPARATIONS OF LEAD. 1 93 When applied to mucous membranes, as in gonorrhoea, the strength of the solution may be gr. ss-j or ij to water f§j ; for phlegmonous inflammation, 5ij to water Oj. When it is desirable to combine opium with lead as an external application, the fol- lowing formula will be found a cheap and efficacious substitute for " lead-water and laudanum : " Ify Opii pulveris, 5j ; plumbi acetatis, §j. S. — Put the powder in a pint of boiling water and stir; when cool apply externally on a cloth of several thick- nesses. Liquor Plumbi Subacetatis {Solution of Lead Subacetate). This preparation, frequently termed Goulard's Extract, is an aqueous solution of lead diacetate (Pb 3 2 2C2H 3 02), and is made by boiling lead acetate and litharge in distilled water. It is a colorless liquid which is decomposed on exposure to the air, with the formation of insoluble lead carbonate, and occasions a dense white precipitate with solution of gum. In other respects it resembles a solution of lead acetate. Uses. — It is chiefly employed, diluted, to promote the reso- lution of external inflammation and arrest discharges from sup- purating, ulcerated and mucous surfaces. It is advantageously employed in the moist varieties of eczema, and also in acute cases accompanied with much heat. In orchitis, solution of the subacetate applied frequently to the scrotum, on lint, together with absolute rest and support of the parts, constitutes an effi- cient plan of treatment. The officinal dilution is liquor plumbi subacetatis dilutus, commonly known as lead-water, and consists of solution 3 parts to distilled water 97 parts. Ceratum plumbi subacetatis, or Goulard's Cerate, is made by mixing Goulard's extract (20 parts) and camphor cerate (80 parts) ; it is an admira- ble dressing to excoriated and blistered surfaces, burns and scalds. Linimentum plumbi subacetatis {liniment of lead subacetate) is made by mixing cotton-seed oil with Goulard's extract. Plumbi Iodidum {Lead Iodide) (Pbl 2 ) is made by the double reaction of solutions of lead nitrate and potassium iodide. It is a bright-yellow, heavy, inodorous powder, volatilizable by heat, sparingly soluble in cold water, but more soluble in boiling water. It may be given internally in the dose of gr. iij— iv, or more, in pill ; but it is principally employed externally in the form of oint- ment (10 parts to benzoinated lard 90 parts). 13 194 MATERIA MEDICA NEUROTICS. Plumb i Nitras (Lead Nitrate) (Pb2N0 3 ), made by dissolving litharge in diluted nitric acid, occurs in white, nearly opaque, octahedral crystals, permanent in the air, of a sweet, astringent taste, and soluble in water and alcohol. It may be given inter- nally, as a sedative astringent, in doses of gr. %—), twice or thrice daily, in pill or solution. But its principal use is as a topical agent in the treatment of wounds, ulcers, and cutaneous affec- tions. Dr. Fordyce Barker recommends it as an application to fissured nipples (gr. x in glycerin §jj), and the breast must be care- fully washed before nursing. Ledoyen's Disinfecting Fluid is a solution of lead nitrate 5j in water foj. Plumbi Oxidum (Lead Oxide) (PbO), or Litharge, is prepared by blowing air through melted lead, and is obtained also in the process for extracting silver from argentiferous galena^. It occurs in minute yellowish or orange-colored scales, insoluble in water, and is never employed internally. It is sometimes sprinkled over ulcers, but its chief use is in the preparation of cmplastrum plumbi, or lead-plaster (called also diachylon), a lead- soap, which is made by boiling litharge with olive oil in water, and is, chemically, a mixture of lead oleate and margarate. It serves as a basis for most of the other plasters. Unguentum diachylon (diachylon ointment) consists of lead plaster 60 parts melted with olive oil 39 parts, and incorporated when partly cool with oil of lavender 1 part. This is an excellent soothing appli- cation in chronic eczema with scales and infiltration, after the parts have been cleansed with sapo viridis, laid on with muslin. Emplastnim saponis (soap-plaster), made by rubbing up soap with lead-plaster, is an excellent discutient. Plumbi Carbonas (Lead Carbonate), or White Lead, is manu- factured in this country by exposing lead to the fumes of vinegar or acetic acid, carbonic acid being derived from the fermentation of tan, in which the pots containing lead are packed ; lead oxy- acetate as formed, is converted into carbonate. It is a white powder, without smell or taste, and insoluble in water, and, as it occurs in commerce, is a compound of lead carbonate and hy- drate (2PbC0 3 .Pb2HO). It is never administered internally, but it is employed as a dusting powder — though there is danger of its absorption. Unguentum plumbi carbonatis (10 parts to ben- zoinated lard 90 parts) is a good application to burns, etc. ASTRINGENTS PREPARATIONS OF COPPER. 1 95 White paint is used for the same purpose, but when applied to a large surface it may produce lead-poisoning. CUPRI PR^PARATA PREPARATIONS OF COPPER. Metallic copper is inert. The salts of copper act locally as caustics, irritants, and astringents, by their coagulating action on albumen ; applied to the sound skin they produce but little effect. They also constringe the tissues and lessen the blood supply to a part. In the blood they probably exist as albu- minates. Some observers have noted a gain in flesh, in animals and man, after a course of copper. Taken too long they give rise to symptoms similar to plumbic poisoning, viz., constipation, paralysis, etc. When exhibited in small doses, they seem to exert a corroborant influence over the cerebro-spinal system, and are occasionally employed to fulfill the indications to which tonics are applicable, as in neuralgia. In larger doses, they pro- duce gastric irritation and act as emetics. Lauder Brunton * has ascertained experimentally that copper sulphate injected into the blood likewise causes retching and vomiting, probably brought about, he thinks, by. irritation of the stomach and intestines, which is reflected to the vomiting centre of the medulla. In excessive doses, they produce gastro-intestinal inflammation and disorder of the nervous system ; death, in fatal cases, is usually preceded by convulsions, paralysis, and delirium. Copper is eliminated by the liver, intestines, and kidneys. Its salts are employed therapeutically, both as external and internal reme- dies ; externally as stimulants, astringents, styptics, and caustics ; internally as emetics, astringents, and tonics. In cases of poisoning from the cupreous compounds, the best antidote is albumen, as white of eggs, milk, wheaten flour. The potassium ferrocyanide is also very efficacious, forming with the cupreous compounds an insoluble copper ferrocyanide. This salt (which throws down a mahogany-colored precipitate), ammonia (which strikes an azure -blue color), sulphuretted hydrogen, or ammonium sulphide (which throws down a deep brownish-black precipitate), and metallic iron (on which metallic copper is deposited from a cupreous solution), are tests for the soluble salts of copper. * St. Bartholomew 's Hosp. Reports, XII, p. 145. I96 MATERIA MEDICA NEUROTICS. Cupri Sulphas {Copper Sulphate). This salt, known as blue stone and blue vitriol, is obtained by roasting the native sulphide, or by combining cupric oxide (CuO) and sulphuric acid. It is cupric sulphate (CuS0 4 .5H 2 0). It occurs in fine prismatic, blue crystals, which, by exposure to the air, effloresce slightly and become covered with a greenish-white powder. It has a styptic, metallic taste, is entirely soluble in water, but insoluble in alco- hol. As an astringent, it may be given in doses of gr. ^ to j, or more, in pill, repeated so as not to occasion vomiting, and will be found extremely valuable in the treatment of chronic diarrhoea, dysentery, and enteritis. It is also used as an anti- dote to phosphorus. As an emetic, the dose is gr. iij to v. Externally, it is used as a mild escharotic to granular lids, mucous patches, and ulcers, and in solution to arrest hemor- rhages, muco-purulent discharges, as gonorrhoea. In gonor- rhoea gr. y 2 -) to water f5j is a suitable strength to begin with. Cupri Acetas (Copper Acetate) (CU22C2H3O2.H2O) occurs in deep, bluish-green or green rhombic prisms. The dose is gr. \ to gr. \. It resembles the sulphate in its effects and uses. ZINCI PR^PARATA PREPARATIONS OF ZINC. Zinc in its metallic state is inert. Its compounds are very analogous in their effects on the system to those of copper, but are less energetic. Topically some of the zinc salts (nitrate, chloride) act as powerful caustics, by reason of their affinity for water and power of coagulating albumen. The soluble zinc salts (sulphate, chloride) are readily absorbed, and probably exist in the blood as albuminates, while the insoluble salts (oxide, carbonate) are slowly taken up by the blood. Zinc is eliminated from the system by the bile, intestines, and urine. The test for soluble zinc salts is ammonium sulphide, which throws down a white sulphide (the only white sulphide met with). The zinc preparations are employed topically as caustics, astringents, and dcsiccants\ and internally , as, tonics, astringents, and, in large doses, as emetics. In cases of poisoning (rare), albumen, demulcents, and opiates are to be administered. Zinci Sulphas {Zinc Sulphate) (White Vitriol) (ZnS0 4 .7H 2 0) is prepared by dissolving zinc in dilute sulphuric acid. It occurs in small colorless, transparent, prismatic crystals, resembling ASTRINGENTS PREPARATIONS OF ZINC. 1 97 those of magnesium sulphate. They have a metallic, astringent taste, are soluble in water and insoluble in alcohol, and produce their astringent effect by condensing the tissue and contracting the blood vessels. Internally, it is chiefly used in chorea, and by Hammond in large doses (gr. ij— xx, t. d.). Dose, as a tonic and astringent, gr. j to v ; as an emetic (acting by gastric irrita- tion), it is the promptest and safest that can be given in cases of narcotic poisoning, in the dose of gr. x-xx, well diluted in water. Externally, it is much used as a caustic, and in solution as a collyrium ; or in gonorrhoea, in the strength of gr. j — ij to water fSj ; in otitis, gr. v. to water f oj. Zinci Oxidum (Zinc Oxide) is made by roasting zinc in the air. This is an impure form, known as Commercial Zinc Oxide (Zinci Oxidum Venale), sometimes called tutty. A purer form is obtained by exposing precipitated zinc carbonate to heat, which expels the carbonic acid and water. It is a yellowish-white powder (ZnO), insoluble in water but soluble in diluted sulphuric and hydrochloric acids. It is occasionally used in the treatment of epilepsy; dose, gr. ij, in pill, gradually increased. It is now mostly employed externally as a dusting powder, or in the form of ointment (20 parts to benzoinated lard 80 parts). Zinci Acetas (Zinc Acetate) is made by heating commercial zinc oxide in a solution of acetic acid and distilled water, and occurs in white micaceous crystals (Zn2C 2 H 3 02.2H 2 0), very soluble in water, and efflorescent in dry air. It is used chiefly as a topical astringent in ophthalmia, gonorrhoea, or leucorrhcea (5j to tepid water Oj) in the proportion of gr. ij to vj, or more, to water, f§j. As an injection in the third stage of gonorrhoea, it was the remedy preferred by Bumstead,* and its strength should be regulated just short of irritation of the urethra. Zinci Carbonas Pr^ecipitatus (Precipitated Zinc Carbonate) is obtained by the double reaction of solutions of zinc sulphate and sodium carbonate. It is a soft white powder, a mixture of carbonate and hydrate (ZnC0 3 ) 2 .3Zn(HO),, similar in its action to the oxide, but is chiefly used as a dusting powder, and to make a mild astringent and desiccant cerate (oj to ointment §v). Liquor Zinci Chloridi (Solution of Zinc Chloride) may be * " Venereal Diseases," 1879, p. 59. Bumstead and Taylor. I90 MATERIA MEDICA NEUROTICS. used to disinfect water-closets and sinks. The evaporation of this solution yields Zinci Chloridum {Zinc Chloride) (ZnCl 2 ), a whitish-gray, semi- transparent, deliquescent mass, having the softness of wax, and soluble in water, alcohol, and ether. Its local action is that of a powerful caustic, and it is one of the best escharotics that can be exhibited, to produce healthy granulations in malignant or indolent ulcers, especially in lupus. It may be used as a lotion in the strength of gr. ij to fSj of water, or dissolved in a little alcohol, or in the form of paste, made with one part of the salt to two or four of flour. A solution of zinc chloride is employed as an antiseptic, and is also injected into the blood vessels of anatomical subjects to preserve them for dissection. Burnett's Disinfecting Fluid is a solution of about gr. cc in water f§j. Zinci Iodidum {Zinc Iodide) (Znl 2 ) is made by digesting an excess of zinc with iodine diffused in water. It occurs in the form of a white deliquescent mass, or of fine needles, of a metallic, styptic taste, very soluble in water. Externally, it is a most valu- able local stimulant and escharotic, equal if not superior in effect to the chloride, and is much used. Zinci Valerianas (Zinc Valerianate) (Zn2C 5 H 9 2 .H 2 0) is pre- pared by the double reaction of sodium valerianate and zinc sul- phate. It occurs in white, pearly scales, having a faint odor of valerianic acid, and a metallic, styptic taste. It dissolves in 100 parts of water and 40 of alcohol. Used in epilepsy and nervous affections, in the dose of gr. i-ij, repeated several times a day. ARGENTI PR.EPARATA PREPARATIONS OF SILVER. In the metallic state, silver is wholly inert. The only prepara- tion which is extensively employed is Argenti Nitras {Silver Nitrate). This salt (AgN0 3 ) is ob- tained by dissolving silver in diluted nitric acid. It is anhydrous, and occurs in transparent, colorless, shining, heavy, rhombic plates, which have a strongly metallic and bitter taste, are wholly soluble in distilled water, and become blackened by the action of light in the presence of organic matters. Its solution yields with hydrochloric acid or sodium chloride a white precipitate, entirely soluble in ammonia. Physiological Effects. — The topical action of silver nitrate to ASTRINGENTS PREPARATIONS OF SILVER. 1 99 mucous membranes is that of a caustic, by reason of its coagula- ting action on albumen. This action does not extend deeply, since a superficial protecting pellicle is formed. When mois- tened and applied to the skin, a white stain is formed, which soon becomes black on exposure to light, by reduction of the silver to the metallic state. Internally. — Nervous system : in animals, hypodermic injections of silver hyposulphite and albu- minate have caused paraplegia. In small doses, tetanic excite- ment, and in toxic, convulsions, were produced. On man the silver salts have caused vertigo, loss of memory and nervous depression. The effects of silver on the nervous system are cen- tric and not peripheral. Circulation : the intravenous injection of the silver salts impairs the coagulability of the blood, which is found to be dark and pitchy in color. Other symptoms noted by this method were probably due to the production of embo- lism and thrombosis. The silver salts do not exert a toxic influ- ence on the heart. They have a metallic, styptic taste. Small doses (oxide, gr. j£, nitrate, gr. J/£) may be taken with con- siderable impunity by the stomach. But, in excessive quantity (of nitrate gr. iij-v), it may occasion gastro-enteric irritation, with disturbance of the nervous system ; and in these cases the antidote is common salt (sodium chloride), or any inert chloride, which produces, when in contact with the nitrate, sodium nitrate and silver chloride. Silver nitrate has been thought always to undergo conversion into a chloride in the stomach ; but more probably it unites with albuminous matters, which render it soluble. In medicinal doses, it has a corroborant action on the nervous system; and, after prolonged use, since its elimination takes place slowly, produces a peculiar indelible blueness or slate color of the true skin (argyria), due to a deposition of the metal in the tissues. This, it has been asserted, is preceded by a' peculiar blue line on the gums, resembling that produced by lead poisoning. Prolonged use of the silver salts (in animals) causes a marked loss of weight. Elimination takes place by means of the bile, kidneys (chiefly) and intestines.* Medicinal Uses. — Internally, silver nitrate has been employed * Journal de F Anatomie el de Physiologie, 1873, P- 2 %9- 200 MATERIA MEDICA NEUROTICS. in the treatment of epilepsy, but it is much inferior to the bro- mides in the treatment of this intractable affection ; and its effect in discoloring the skin is an objection to its protracted use. It is used also successfully in locomotor ataxia, being especially extolled by Rosenthall, Charcot, and others, in the dose of gr. y£ y t. d. ; but in this disease the galvanic current, in addition to medi- cines, renders important aid. In gastric ulcer and chronic gas- tritis it is also efficacious in small doses in pill form, after the stomach is afforded rest by liquid diet, preferably with milk. As an astringent in chronic dysentery and diarrhoea, combined with opium its exhibition may prove serviceable. But it is as an external agent that it is most resorted to. It is one of the best applica- tions that can be made to inflamed mucous membranes, and, either in the solid form or in solution, it is employed in every variety of inflammation of this tissue. It is also extensively used to produce healthy granulations in wounds and ulcers, to arrest the progress of erysipelatous inflammation and variolous pustules, in porrigo and other skin diseases. The strong injections of silver nitrate formerly used to abort acute gonorrhoea are now rarely resorted to. In this disease, either of the male or female urethra, the best results are obtained by using solutions of the strength of gr. %'- \ to water foj, care being taken to avoid stain- ing the clothing with it. As a collyrium it is contra-indicated when ulcer of the cornea exists, for fear of forming an opacity. If a strong collyrium be used (gr. v-x-fSj), in uncomplicated con- junctivitis for the relief of which it is an excellent application, the effect on the conjunctiva should be counteracted by flushing it out with weak solution of salt and water, or even with cold water alone. Silver nitrate stains can be removed by moistening the spot with tincture of iodine and then washing it with solution 'of sodium hypophosphite. It may be used to destroy the virus of poisoned wounds, but its action as a caustic is too superficial to be of much service for this purpose. Administration. — The dose of silver nitrate internally is gr. \ y gradually increased to gr. \ or j, t. d., in pill, and given soon after a little light food has been taken. For external use, solu- tions are made of various strengths, from gr. ij-5ss or more in fsj of distilled water. An ointment is also employed. ASTRINGENTS PREPARATIONS OF BISMUTH. 201 Argenti Nitras Fusus {Moulded Silver Nitrate — Lunar Caustic}. For external use, in the solid form, silver nitrate is melted and poured into small moulds. Argenti Nitras Dilutus (Diluted Silver Nitrate) consists of 50 per cent, each of silver nitrate and potassium nitrate. It is used externally. Argenti Oxidum {Silver Oxide) (Ag 2 0) is obtained by adding solution of potassa to a solution of silver nitrate. It is a taste- less, olive-brown powder, very slightly soluble in water. Its action and applications are analogous to those of the nitrate, and it is considered to be free from liability to discolor the skin. Dose, gr. ss-j, twice or thrice daily in pill. Argenti Iodidum (Silver Iodide) (Agl) may be used in gastric and uterine affections instead of the nitrate. It is also said to have some alterant effects. Dose, gr. j-ij. BISMUTHI PR^PARATA PREPARATIONS OF BISMUTH. Metallic bismuth is inert. The salts are very insoluble, but to a slight extent are absorbed and eliminated * slowly, as bismuth has been found in the urine,f blood, etc., after their administration. The unabsorbed residue, passing down the ali- mentary canal, is converted into a sulphide and colors the stools black. Bismuthi Subnitras (Bismuth Subnitrate). This salt is pre- pared by forming bismuth nitrate by dissolving bismuth in diluted nitric acid, suitable means at the same time being taken to get rid of arsenical contamination, as metallic bismuth generally contains arsenic. Bismuth subnitrate, known as pearl white and magistery of bismuth (BiON0 3 .H 2 0), is a white, inodorous, taste- less powder, insoluble in water. Its medical properties are tonic, sedative and astringent. It is used chiefly to allay nausea and check vomiting in chronic affections of the stomach, as ulcer, in which gr. xv-xx should be given t. d., to relieve the pain of gas- tralgia, and also as an astringent in subacute and chronic diar- rhoea. As bismuth exerts its astringent influence on the intestinal tract by a local protective action, in the diarrhoea of adults it * Journal de V Anatomie et de la Physiologie, 1 873, p. 243. f Transactions Am. Neurological Association, 1883, p. 23. 202 MATERIA MEDICA NEUROTICS. may be given, advantageously, in large doses (5ss— j), to be taken one hour before each meal. 1 It is particularly useful in any form of diarrhoea where the stools contain mucus ; and acute cases of diarrhoea occurring during the summer season are frequently benefited by it also. The following combination is of great service : 1^ Morphinse sulphatis, gr. y 2 -) ; bismuthi subnitratis, 5j— ij ; sodii bicarbonatis, 5j ; sacchari lactis (seu pulveris cinna- momi), 5ij. M. et div. in chart, xii. Sig. — One powder after each alvine dejection. It is often advantageously given suspended in an emulsion of castor oil with laudanum, in these and similar complaints. Dose, gr. v-xx, or even 5ss, in powder or pill. Externally, it is a good remedy in skin diseases, in the form of ointment. The following forms a good antiseptic application in the treatment of ulcers : — ty Iodoformi, 5j ; acidi borici, 5y ; bismuthi subnitratis, 5iv; petrolati, §ij. M. Sig. — Ft. ungt. It is also well combined with camphor as a dusting powder, or boracic acid in the treatment of purulent otitis of the external auditory meatus. Bismuthi Subcarbonas (Bismuth Subcarbonate) — (Bi 2 2 C0 8 . H 2 0) — is recommended as a substitute for the subnitrate. It is thought to be more readily tolerated by the stomach, and is more soluble in the gastric juice, but it is less astringent. Dose, gr. v-xx, or even 5ss, in powder or pill. Bismuthi et Ammonii Citras (Bismuth and Ammonium Citrate), which occurs in glossy, translucent, colorless scales, of a slightly acid, metallic, but not disagreeable taste, very soluble in water, is a good preparation as an astringent. It is much more astringent than the insoluble preparations, but is more irritant ; dose, gr.ij. The valerianate- (not officinal) has been used in neuralgia; dose, gr. ^2-j, several times a day, in pill. The test for a soluble salt of bismuth is a piece of paper wetted with a solution of potassium sulphocyanide, and dried, which will produce a yellow spot at the point of contact. cerii oxalas — cerium oxalate. This salt (Ce^CsO^s.CjHiO) is usually made by adding a solu- tion of ammonium oxalate to any soluble salt of cerium, and is obtained also from the mineral cerite. It occurs as a snow-white, ASTRINGENTS ALUM. 203 granular powder, inodorous and tasteless, insoluble in water, alcohol, and ether, but dissolved by sulphuric acid. It resembles the salts of bismuth in its effects, and has been deservedly extolled in obstinate forms of vomiting, especially the vomiting of preg- nancy. In chorea and other neuroses it is also highly recom- mended. Its physiological action has not been investigated. Dose, gr. j, t. d., or oftener, in pill or suspended in water. The cerium nitrate has been also employed, and is more soluble. Dose, somewhat less. ALUMEN ALUM. Alum is a double salt, an aluminium and potassium sulphate (K 2 A1 2 4S0 4 .24H 2 0). It is manufactured from aluminous schist, and sometimes by the direct combination of its constituents. It crystallizes in regular octahedrons ; but is commonly found in the shops in large, colorless, transparent crystalline masses, without any regular form. It has an astringent and sweetish, acid taste ; by exposure to the air it slowly effloresces ; it is solu- ble in cold water, and more so in boiling water; and when heated it undergoes the watery fusion, swells up, and gives out its water of crystallization, and is converted into a white, spongy mass, called dried alum. The alkalies and their carbonates, lime solu- tion, magnesia and its carbonate potassium tartrate and lead acetate are incompatible with alum. It is aided in its action by the vegetable and mineral astringents. Besides the potassium alum, there are varieties in which the potassium is replaced by some other base, as ammonium or sodium ; the officinal alum was formerly the aluminium and ammonium sulphate, but this has been superseded by potassium alum. Physiological Effects. — The immediate topical effect of alum is that of a powerful astringent, in virtue of a chemical action on the tissues. When it is applied to a part in large quantities, the astriction is soon followed by irritation; and thus, taken internally in excessive doses, it gives rise to vomiting, griping, purging, and even inflammation of the gastro-enteric mucous membrane. After its absorption it acts as an astringent on the system generally, and produces astriction of the tissues and fibres, contraction of the capillaries, and a diminution of secre- tion, thus producing constipation. It is eliminated chiefly with 204 MATERIA MEDICA NEUROTICS. the faeces. After large doses, Orfila detected it in the urine of dogs. Death has resulted in man from dried alum ojss. Medicinal Uses. — Alum is employed internally in hemorrhages, chronic diarrhoea, and it is sometimes combined with cubeb in the treatment of gleet and gonorrhoea, as in the following pre- scription : 1^ Pulveris aluminis, 5j ; pulveris cubebae, §iv ; pul- veris cinnamomi, 5ss. M. et Sig. — Tablespoonful in half a glass of water 3 times a day ; an efficient mixture when it does not disorder the stomach. Alum is also used as an injection in leucorrhcea. It has also been given as an emetic in croup. Its use in lead-colic has been alluded to. As a topical remedy it is valuable as an astringent antiphlogistic in ophthalmia, diphtheria, and tonsillitis ; to produce contraction of the tissues, in relaxa- tion of the uvula, prolapsus ani, descensus uteri, cystocele or rectocele, and is used as a vaginal injection where the tissues become lax from wearing a pessary ; as a styptic in hemor- rhages ; and to arrest excessive secretion from the mucous sur- faces. In hemoptysis and bronchitis, a strong solution of alum may be applied by atomization. Dose, gr. x-xxx, in powder or solution, or made into pills with some tonic extract, and com- bined with an aromatic, as nutmeg, to prevent nausea. It may be agreeably given in the form of whey, prepared by boiling 5ij with milk Oj, and straining, of which the dose is f§ij. Topically, it is employed in the form of solution, and is useful in granular lids, conjunctivitis, and as an injection in gonorrhoea, attended with profuse discharge, gr. ij-vj to water f§ij ; in leucorrhcea, 5j to tepid water Oj. Dried alum [alumen exsiccatuni) is employed internally in the dose of gr. v-x, and externally as a mild escharotic. Aluminii Sulphas (Aluminium Sulphate) (Al 2 3S0 4 .i8H 2 0) is employed externally as an astringent and antiseptic application to ulcers, and as an injection in gonorrhoea. The aqueous solution is used to preserve bodies for dissection. ORDER VI. STIMULANTS. Stimulants are medicines which produce a rapid and tempo- rary exaltation of the vital functions. Their influence is most conspicuous in conditions of morbid depression, when a marked STIMULANTS ALCOHOL. 205 tolerance of their action is established, and large amounts are borne. In health, when the powers of the system are at the normal standard, stimulants soon induce depression. Topically, they irritate and inflame the parts to which they are applied, and hence are classed with irritants. Stimulants are employed principally in disorders known as asthenic, and in all conditions of the system attended with exhaustion. From their action in arousing the energies of the nervous system, they exercise a control over many nervous disorders, particularly those of a spasmodic nature. They are also frequently given with a view to their action on some one or other of the secretions. As stimulants to the gastrointes- tinal canal, they are administered to promote digestion (when they are called stomachics) and to dispel flatulence (when they are known as carminatives). Topically, they are employed as rubefacients and vesicants. The more powerful and rapid stimulants are called diffusible. In overdoses, they act as violent narcotics and sedatives. The diffusible stimuli usually employed are vinous and spirituous liquors and the preparations of ammonia. Vegetable stimulants which contain a volatile oil are termed aromatics, and are usually given as stomachics and carminatives. The volatile oils are also employed as local irritants. DIFFUSIBLE STIMULANTS. ALCOHOL. Alcohol is a product which results from a process termed the vinous fermentation, in substances containing grape-sugar. At a temperature of 8o° F., the presence of a fermenting body converts a solution of grape-sugar into alcohol and carbonic acid. Starchy substances, being convertible into grape-sugar, also yield alcohol. Alcohol is obtained from vinous or fer- mented liquors by repeated distillation. It is, chemically, an ethyl hydrate (C 2 H 5 HO). Officinal alcohol should be of the sp.gr. 0.820. It is a colorless, inflammable liquid, wholly vapor- izable by heat, and unites in all proportions with water and ether. Contamination of fusel oil or amylic alcohol may be detected by agitation with concentrated sulphuric acid, when, if the alcohol become colored, the presence of the impurity is indicated in 206 MATERIA MEDICA NEUROTICS. proportion to the depth of the color; or solution of silver nitrate, with exposure to a bright light, will convert fusel oil into a black powder. Pliysiological Effects. — Alcohol * is the intoxicating ingredient of all vinous and spirituous liquors"}". Locally, alcohol acts as an astringent by hardening the albumen and condensing the tissues. It evaporates rapidly, causing a feeling of coolness. When eva- poration is prevented, it acts as an irritant (due to absorption and paralysis of the cutaneous vessels), and may even produce inflam- mation. When inhaled it may produce anaesthesia, stupor and death. Nervous system : when taken internally, in small doses, it stimulates the cerebral hemispheres, possibly by the hypere- mia induced ; in large doses it causes excitement with impaired coordination of ideas ; and in excessive doses it produces coma. Small doses stimulate the spinal cord, while larger amounts weaken the centres governing automatic motion and coordination, and lessen the sensibility of the cutaneous nerves, especially that of the fifth pair of cranial nerves. Large doses paralyze the vaso- motor nerves, giving rise to dilatation of the arterioles, flushing of the surface, and sensations of heat. In inflammatory diseases, medicinal doses contract the arterioles by giving tone to the vaso- motor system, and prevent the migration of white corpuscles (Farquharson). In toxic doses, the nervous centres are involved in the following order: I. The gray matter of the convolutions and the higher functions of animal life (shown by disordered intellection). 2. The basic ganglia (shown by disordered sen- sation and motion). 3. The cerebellum (shown by disordered equilibration. This may be in part due to impairment of the muscular sense). 4. The spinal centres (shown by anaesthesia of the lower limbs, extending to the upper limbs and body, diffi- culty in performing automatic acts, impaired coordination, etc.). 5. The medulla oblongata (shown by labored breathing, and finally death from apncea). Circulation : alcohol at first stimu- lates, but afterward depresses, the cardiac motor ganglia. In * Alcohol considered chemically, physiologically, medicinally and as a cause of disease. Essay awarded the Henry C. Lea Prize, Jefferson Medical College, March, 1878, by Henry Morris, M. D. I According to Dujardin-Beaumetz the toxic effects of the alcohols increase with the sum of their atomic weights, with the exception of the highest and lowest. STIMULANTS ALCOHOL. 207 small doses it increases the frequency of the cardiac beat, -with- out affecting the force or rhythm, increasing the rapidity of the contraction and shortening the diastole (Parkes and Wollowicz), and also elevating the arterial tension. This is soon followed by slowing of the heart and lowered arterial tension, and if the dose has been larger, by weak and irregular contraction. Large doses depress and paralyze the cardiac muscle. Respiration is at first quickened, but afterward slowed. In alcohol-narcosis the breath- ing is very slow, and death may result from apncea. Tempera- ture: small doses slightly elevate the temperature. If large amounts have been taken, the temperature is depressed, owing to the radiation of heat from the dilated cutaneous vessels, to lessened oxidation of tissue, and, in alcohol-narcosis, or in the case of animals, to muscular inactivity. The power of resisting cold is lessened by the habitual ingestion of alcohol. Secretion : the secretions are at first increased, then diminished. Alcohol diminishes the quantity of urea, uric acid, sodium chloride, phosphoric and sulphuric acids excreted in the urine. Sugar is sometimes found in the urine after the ingestion of alcohol. Small doses stimulate the liver, while larger amounts alter the quality of the bile, which may be profuse or scanty. The amount of carbonic acid exhaled from the lungs is diminished. Stomach: small doses increase the flow of gastric juice, by producing hyperemia, and thus stimulate the appetite and digestion. Large doses check the gastric secretion, precipitate the pepsin, and cause anorexia and nausea. When taken habitually, it produces a slow interstitial inflammation of the mucous membrane with hyperplasia of the connective tissue elements, which, contracting, compress the gastric glands. The secretion will then be much diminished, and the mucous membrane covered with a ropy, glairy mucus. Blood : alcohol must be in a certain state of dilution before it can be absorbed. It is said to precipitate the albumen in the blood, but it must be in too diluted a condition to accomplish this, nor are the consequences of an occasional indulgence sufficiently serious to warrant this statement. It diminishes the power of the red corpuscles to carry oxygen, and changes the blood by its effect on the liver and digestion. Fat in the blood of drunkards is increased from 8.65 parts to 11.7 parts per 1000 (Lecann). Scharlau found 30 per cent, more 208 MATERIA MEDICA NEUROTICS. carbon in the blood of drunkards than in that of healthy persons. This is due to the avidity with which alcohol combines with oxygen, preventing the oxidation of the hydrocarbons. Mus- cular system : the muscular power is weakened and the muscular sense diminished. Elimination : alcohol is eliminated unchanged in small proportion to the quantity ingested by the kidneys, lungs, and to a slight extent by the skin, and probably by the liver, traces having been detected in the bile by Dr. Percy. A portion of the alcohol (about ff>iij) disappears in the system, being probably oxidized, for Anstie,* in a series of elaborate experiments on dogs, was able to recover only about one-fourth of the amount administered. The economy seems to be able to consume this quantity daily, storing it up as potential energy, anything above this being carried away under another form by the eliminating organs. Though fgiij may disappear in the sys- tem, yet it is not to be considered as contributing at all to the normal support of the body. Experience gained in Arctic voyages proved that alcohol was totally unnecessary as an article of diet, and that tea as a restorative stimulant was a much better sub- stitute. The symptoms of acute and of chronic poisoning by alcohol are too well known to need description. The treatment in cases of poisoning from alcohol is the same as that which is . to be pursued in cases of poisoning from opium, except the use of atropia and flagellation. Ammonia is a physiological anti- dote, and later the exhibition of strychnia does good. Mania-a- potu is found in acute poisoning from alcohol, and is due to the direct action of alcohol on a brain rather unaccustomed to- its effects. It differs from delirium tremens, which is a delirium of a trembling type found in chronic alcoholism. The habitual use of alcoholic narcotics in excess gives rise to a well-known train of mental and physical disorders ; viz., dyspepsia, visceral ob- structions, cirrhosis of the liver, gout, organic disease of the heart, delirium tremens, paralysis, and even confirmed insanity. Medicinal Uses. — Alcohol, in the form of vinous and spirituous liquors, is employed to rouse and support the system in debility, asphyxia, syncope, the latter stages of acute attacks, typhoid and typhus fevers, asthenic and malignant diseases, exhausting * The Practitioner, Vol. Ill, p. 15. STIMULANTS ALCOHOL. 200, hemorrhages and suppurations, gangrene, to counteract the effects of the bites of venomous reptiles, in delirium tremens, and in poisoning from digitalis, tobacco, and other narcotics ; also as a stomachic in colic, flatulence, indigestion, nausea, etc. In typhoid and typhus fevers, alcohol probably acts as a physiological antidote to the blood poison, and should be given in the very first stages of the fevers, regulating the size and frequency of the dose by the sounds of the heart and the character of the pulse. Rarely more than fSyj-viij are required daily. As a stimulant in diphtheria its administration is of the greatest service in counteracting the depressing effects of the poison, and in the treatment of acute lobar pneumonia, to prevent heart-insufficiency it is our most efficient remedy, the indications for its administration being the same as in typhoid fever. Indeed, the early administration of the preparations containing alcohol furnishes our best means of counteracting the depressing action of disease in general. The true stimulant or supporting effects of alcohol probably depend upon its appropriation by the system through oxidation or other agency. In disease, large quantities are administered which cannot be recovered in the execretions. But in health, when the powers of the economy are at the normal standard, it probably circulates in the blood unchanged, and accumulates in the viscera or is eliminated by the secretions. In wakefulness due to cerebral anaemia, a little alcohol at bedtime will often produce refreshing sleep. Alcohol, when prescribed to build up the system, should be given after food, in order to hinder it from diffusing too rapidly into the blood. The hypodermic injection of a syringeful of brandy or whiskey, repeated if necessary, is an efficient restorative in collapse, and in asthenic conditions generally, especially where dissolution appears to be eminent. As a topical application, alcohol is used to produce cold by its evaporation ; as a styptic ; to harden the cuticle over delicate parts ; and as a stimulant. Mixed with white of eggs, it forms a good coating to bed-sores. Alcohol Dilutum {Diluted Alcohol), or Proof Spirit, consists of equal parts of alcohol and distilled water, and has a sp. gr. O.928. It is used exclusively for pharmaceutical purposes. Vinum (Wine). The fermented juice of the grape consists of water and alcohol in varying proportions with fixed and volatile 14 2IO MATERIA MEDICA — NEUROTICS. acids, sugar, cenanthic acid and ether, tannic, malic and other acids, potassium bitartrate, etc. Wine loses most of its cream of tartar by age. It is employed medicinally in typhus and typhoid fevers, exhausting chronic diseases, extensive suppurations, gangrene, etc. In typh-fevers it constitutes our chief therapeutic resource, and may be administered to the amount of one or two pints in the twenty-four hours, either pure or in the form of wine-whey. This is made by adding from a gill to half a pint of white wine to a pint of boiling milk, separating the curd from the whey, and flavoring with sugar and spices. The officinal wines are Vinum Album {White Wine), contain- ing between 10 and 12 per cent, of absolute alcohol by weight; Vinum Album Fortius {Stronger White Wine), containing be- tween 20 and 25 per cent, of absolute alcohol ; and Vinum Ru- brum (Red Wine), containing between 10 and 12 percent, of abso- lute alcohol. Red wines are more astringent than white, as they contain more tannic acid. Port wine contains tannic acid, and is used in dysentery and diarrhoea, for its astringency. Madeira, which is the strongest of the white wines, is an excellent stimu- lant, but may be objectionable from its acidity. CJiampagne is a pleasant stimulant where gastric irritability is present. Madeira and port contain about 23 per cent, of alcohol ; sherry, 19 per cent.; champagne, 13 per cent. As articles of diet, the stronger wines, when used in excess, often produce gout, and diseases of the kidneys and liver ; and except in advanced age and in feeble constitutions, or where the tuberculous diathesis exists, cannot but be considered as objectionable. Spiritus Vini Gallici {Brandy) is obtained by the distillation of wine. It contains about 50 per cent, of alcohol, with water, volatile oil, tannic acid, coloring matter, etc. It is the best stimulus where a rapid and decided impression is called for, as in collapse and syncope ; and, from the tannic acid which it contains, is use- ful in bowel complaints. Spiritus Frumenti ( Whiskey), obtained from fermented grain by distillation, is of about the same alco- holic strength as brandy, and may be substituted for it ; it does not contain tannic acid. Rum (Spiritus Sacchari), the ardent spirit obtained from sugar, is more sudorific than brandy. Gin (Spiritus Juniperi) is corn-spirit flavored with oil of juniper ; and owing to the oil of juniper which it holds in solution, it is an STIMULANTS PREPARATIONS OF AMMONIA. 211 active diuretic as well as stimulant and stomachic. Arrack, the spirit of Eastern countries, is prepared from a fermented infusion of rice. Spiritus Myrci^e {Spirit of Myrcia), bay-nun, the spirit obtained by distilling rum with the leaves of myrcia acris, is a refreshing local application. The malt liquors are useful where permanent stimuli are called for, as in diseases tending to emaciation, chronic abscesses, etc. In wakefulness caused by cerebral anaemia, a glass of ale or beer, at bedtime, is an efficient hypnotic. They are contra- indicated in all chronic liver and renal affections and in disorders of the alimentary canal accompanied with acidity and flatulence, especially in those disorders depending on fermentation of food. Although they contain a much smaller proportion of alcohol (2 to 6 or 8 per cent.) than the wines, yet their habitual ingestion will inevitably cause fatty degeneration of the liver and heart, already alluded to. Besides alcohol they contain extract of malt, and are, therefore, to some extent, nutritive. The best are porter and ale. Extractum Malti (Extract of Malt) is officinal. It is made by macerating and then digesting coarsely-powdered malt (the seed of Hordeum distichum, or barley (Nat. Ord. Graminacese) caused to enter the incipient stage of germination by artificial means and dried) with water, straining and evaporating the fluid thus obtained to the consistence of a thick honey. It has a yellowish-brown color and the sweet taste of malt. It contains some dextrine, sugar, bitter and aromatic substances, and is used as a tonic in debility and nervous exhaustion. It possesses few advantages over good malt liquors. It is used as a vehicle for cod-liver oil. It aids the digestion of starch by promoting its conversion into dextrine and glucose. It may be given in doses of f5j-iv after meals. AMMONITE PR^PARATA— PREPARATIONS OF AMMONIA. Ammonia (sometimes termed volatile alkali) is a gaseous com- pound of hydrogen and nitrogen (NH 3 ), which is found abun- dantly as the result of the decay of organic substances, and is usually obtained by the action of lime on sal ammoniac (or am- monium chloride). It has a pungent odor, and is very soluble 212 MATERIA MEDICA NEUROTICS. in water ; it is a powerful stimulant and local irritant, but is rarely used in medicine. Physiological Effects. — Locally, ammonia in solution acts as an irritant, causing vesication, and, after prolonged contact, slough- ing of the surface. When inhaled it produces inflammation of the laryngeal and bronchial mucous membranes, and may cause pneumonia. Internally — Nervous system ; when injected into the veins of animals it causes convulsions, due to stimulation of the motor centres of the spinal cord and of its reflex functions. Circulation : after intravenous injections, a momentary fall in the arterial pressure takes place, followed by a decided and sudden rise (not due to any action on the vaso-motor nerves, as it occurs after section of the cord), and a corresponding increase in the rapidity of the pulse from stimulation of the accelerators of the heart. Blood: it prevents coagulation of the blood, assists in retaining the fibrogenous materials in solution, and impairs the function of the red corpuscles as oxygen-carriers. Respiration : when injected into the veins the respiratory act is greatly acceler- ated. Elimination : it is probably, to a great extent, oxidized in the system, and is eliminated as nitric acid, and perhaps as urea, by the kidneys. The effects just described are produced also by the following preparations of ammonia, which are employed as diffusible stimuli : — Aqua Ammonite Fortior {Stronger Ammonia-Water). This is an aqueous solution of ammonia of the specific gravity 0.900. It is a colorless liquid, wholly volatilizable by heat, of a caustic, acrid taste and has a very pungent odor of ammonia ; and is too strong for medicinal use internally in its unmixed state, con- taining 28 per cent., by weight, of gaseous ammonia. It is a powerful corrosive poison, for which the diluted acids, as vine- gar or lemon juice, are the antidotes. In the case of a man* who swallowed foj of it, death followed suddenly, his breathing being obstructed, and the lips, tongue, uvula and tonsils much swollen, reddened and glazed. It is used externally as a vesicant, and has the advantage over cantharides of a more speedy opera- tion and non-affection of the urinary organs, but is a very painful application. * Guy's Hosp. Reports, XVII, 3d ser., p. 225. STIMULANTS PREPARATIONS OF AMMONIA. 21 3 Aqua Ammonite {Ammonia-Water) has a specific gravity of 0.959, containing 10 per cent, by weight, of ammonia, and is employed as a stimulant, antacid and rubefacient. As a stimulant, ammonia is admirably adapted for speedily rousing the action of the vascular and respiratory systems, especially when it is an object at the same time to promote the action of the skin. For this purpose it is employed in low forms of disease, particularly in the typhoid exanthemata, in syncope, in asphyxia from nar- cotic poisons, and to counteract the effects of the bites of venom- ous reptiles. In dyspepsia it is useful with a view to the relief of both acidity and flatulence. For internal use other prepara- tions of ammonia are generally preferred, and this is used chiefly as a rubefacient. Dose, internally, gtt. x-xxx, largely diluted. As a rubefacient the officinal liniment {q. v) may be used. Spiritus Ammonle {Spirit of Ammonia) is a solution of ammo- nia in alcohol, containing 10 per cent, of the gas. It is given as a stimulant, antacid and carminative, in the dose of gtt. x-xxx, diluted with water. But a pleasanter preparation, with similar properties, is — Spiritus Ammonia Aromaticus {Aromatic Spirit of Ammonia). This is a solution of ammonium carbonate and water of ammonia, oil of lemon, oil of pimenta, and oil of lavender flowers, in water and alcohol. It is a very agreeable antacid, stomachic and stimu- lant, and may be given in the dose of gtt. xxx to f 5j, or more, diluted with water. Ammonii Carbonas {Ammonium Carbonate) (NH 4 HC0 3 .NH 4 - NH 2 C0 2 ), being analogous in its effects to those of the prepa- rations of ammonia, is considered here. It is prepared by subliming a mixture of ammonium chloride and chalk, and consists of a mixture * either of one or two molecules of acid ammonium carbonate and one molecule of ammonium carbamate. It occurs in whitish, transparent masses, wholly dissipated by heat, of a pungent, ammoniacal odor, an acrid, alkaline taste, and is soluble without residue in water. On exposure to air it becomes opaque, falls into powder, and deteriorates by the loss of ammonia. * "U. S. Dispensatory," 1888, p. 172. 214 MATERIA MEDICA NEUROTICS. Effects and Uses. — Its indications are the same as those of solution of ammonia, to which it is preferred for internal exhibi- tion as a diffusible stimulant, It is especially valuable in pneu- monia, and by some therapeutists is relied on to the exclusion of other medication in this disease. By others it is here regarded serviceable only as a stimulant ranking after alcohol, and without influence to prevent heart-clot (Loomis). The truth seems to be that it is adapted only to cases which can be antagonized by its proved physiological action. It is a useful adjunct to other remedies in the treatment of capillary bronchitis; and in chronic bronchitis with profuse expectoration, diminished strength and impeded cardiac action, its exhibition, gr. v, every hour or so, is indicated. It has been recommended in threatened thrombosis, as in the puerperal state. Dose, gr. v-x, in pill or preferable in solution with gum and sugar. The fluid extract of glycyrrhiza somewhat disguises its unpleasant taste. Mixed with some aro- matic oil (as that of bergamot or lavender), it is used as a smelling salt in syncope and hysteria. AROMATICS. Aromatics owe their virtues to the presence of oils obtained from them by distillation, and termed volatile oils (plea volatilia), sometimes also distilled and essential oils. These oils possess, in a high degree, the odor and taste of the plants from which they are procured. Locally, they are powerful irritants, and, when taken into the stomach in overdoses, act as acrid poisons. They pass partially into vapor at ordinary temperatures, and are completely volatilized by heat ; hence, decoctions and extracts are improper preparations of the aromatics. The distilled oils are inflammable, very slightly soluble in water, but soluble in alcohol and ether. Their ultimate constituents are, usually, carbon, hydrogen, and oxygen ; and on exposure to the air they gradually absorb oxy- gen, become thicker, less odorous, and of a deeper color, and are finally converted into resins. The effects and uses of most of the members of this group are similar. In medicinal doses they are used as carminatives, and are combined with purgatives to prevent griping. Most of them are also useful as flavoring ingredients. To many of the volatile oils emmenagogue virtues have been ascribed ; but these effects are only produced by poisonous doses. STIMULANTS CAPSICUM. 2 I 5 Locally, they are used as rubefacients, antiseptics and to allay neuralgic pains. CAPSICUM. Capsicum or Cayenne pepper is the fruit of Capsicum fas- tigiatum and other species of Capsicum {Nat. Ord. Solanaceae), American tropical plants, naturalized in most warm climates, and cultivated in our gardens. C. fastigiatum is a small shrub, with a crooked, branching stem, producing in each fork two or three fruits from one-half to three-quarters of an inch long, of a sub- conical form and crimson or yellow color. These pods, when dried and ground, form capsicum, the best of which is the African. Powdered capsicum has a bright-red color, which fades upon exposure to light, an aromatic, peculiar smell, and a bitterish, acrid, burning taste. A principle termed capsaicin * (probably a mixed substance), slightly soluble in water, but very much so in alcohol and ether, exists in capsicum, associated with resin and fixed and volatile oil. Effects and Uses. — Locally, capsicum acts as an irritant, and vesication may be produced by prolonged contact with the skin. Lntemally. — Circulation : it increases the action of the heart. Secretion : it stimulates the glands with which it comes in con- tact, and increases the flow of the saliva and the gastric and intestinal juices. Elimination : it passes out of the system by the kidneys, increasing the flow of urine, and sometimes producing vesical tenesmus and aphrodisiac effects. In large doses it acts as a gastro-intestinal irritant. Contra-indications : capsicum should not be given in acute inflammatory affections of the stom- ach, intestines or genito-urinary apparatus. Capsicum is princi- pally employed as a condiment and stomachic, and is very useful in torpid conditions of the digestive organs, or as an adjunct to other remedies to rouse the susceptibility of the stomach. Its constitutional effect is not in proportion to its local effect, and it is, therefore, of no great efficiency as a diffusible stimulant. It is a good stomachic in the dyspepsia of drunkards. It is employed as a gargle, and also as a cataplasm to cause counter-irritation. Dose, of the powder, gr. v-x, in pill ; of the tincture (5 parts to * Fliickiger, " Pharmacographia," 2d ed., p. 454, isolated also a volatile alkaloid having the smell of conium, from the seeds and pericarp of capsicum. 2l6 MATERIA MEDICA — NEUROTICS. diluted alcohol 95 parts), i^x-f5j ; of the fluid extract, f^v-x. The oleo-resin is a powerful rubefacient, and may be given internally in the dose of gr. ss-j. A plaster is also officinal. piper — PEPPER. Black pepper is the unripe fruit of Piper nigrum (Nat. Ord. Piperaceae), a vine of the East Indies. The berries are gathered before they are quite ripe, and dried in the sun. They are wrinkled and black, in consequence of the drying of the pulp over the grayish-white seed, and in this state are known as black pepper. If permitted to ripen, and soaked in water till the outer coat is removed, they constitute white pepper. Pepper has an aromatic, peculiar odor and a hot, spicy, pungent taste. Its pro- perties are taken up by alcohol and ether, and partially by water. It contains a volatile oil, an acrid resin, an alkaloid called piperine (C 17 H 19 N0 3 ), which is used as an anti-periodic remedy. Dr. C. S. Taylor reports success w T ith it where quinine failed, or the idio- syncrasy of the patient would not permit its employment. In warm-blooded animals it reduces the number of respirations, increases the frequency of the cardiac beats (apparently from paralysis of the vagus centre), dilates the pupils widely, and arrests the heart in systole. Effects and Uses. — The effects of pepper are similar to those of capsicum. It is a warm carminative stimulant, chiefly employed as a condiment, but it is also a useful stomachic. Dose, gr. v-xx- Of the oleo-resin the dose is gr. ss-ij. Piperina {piperine} may be prescribed in doses of gr. ij-iv. cinnamomum — cinnamon. There are two varieties of cinnamon — Ceylon cinnamon, which is the inner bark of the shoots of Cinnamomum zeylanicum, a tree of Ceylon and Java; and China cinnamon, or cassia, the bark of the shoots of one or more undetermined species of Cin- namomum {Nat. Ord. Lauraceae), trees of China. The most esteemed is the Ceylon cinnamon. It is found in the shops in long, cylindrical pieces, which are very thin and smooth, and of a yellow-brown color and a splintery fracture. It has a fragrant odor and a warm, sweetish, aromatic, slightly astringent taste. Its constituents are volatile oil, tannic acid, mucilage, sugar, mannit, STIMULANTS — MACE. 2\J etc. The greater part, however, of the cinnamon brought bo this country is the cassia cinnamon. It has the general appearance, smell and taste of true cinnamon, but the pieces are not doubly quilled. Its properties are identical with those of the Ceylon variety. Effects and Uses. — Cinnamon is an aromatic stimulant, with a slight astringency. It is used chiefly as a carminative, and as an addition to other medicines. Dose, gr. x-xxx; of the tincture ( 10 parts, alcohol and water enough to make 1 00 parts of tinc- ture), the dose is f5j-iij. Oleum cinnamomi {oil of cinnamon) is of a light-yellow color, which deepens by exposure to the air, with the development of an acid, termed cinnamic ; dose, gtt. i-ij. Aqua cmnamomi {cinnamon-water) is used as a vehicle for other medicines. Spiritus cinnamomi {spirit of cinnamon) contains 10 parts of the oil dissolved in 90 parts of alcohol ; dose, gtt. x-xx. Cinnamon enters into a large number of preparations. M YRISTICA— NUTM EG. MACIS MACE. The products are portions of the fruit of Myristica fragrans {Nat. Ord. Myristicaceae), a tree of the Moluccas, cultivated also in Java and Sumatra and other parts of the East Indies, and introduced into the isles of France and Bourbon and several of the West India islands. It bears a pyriform fruit about the size of a small peach, which has a fleshy pericarp, opened by two longitudinal valves. Within this is the arillus, a scarlet reticu- lated membrane, which, when dry, becomes yellow-brown and brittle, and is termed mace. The kernels of the seed are the nutmegs. They are oval, of the size of an olive, of a grayish- brown color, marked with furrows ; and to preserve them from the attacks of an insect, they are steeped in a mixture of lime and water. Mace has a pleasant, aromatic smell and a warm, bitterish, pungent taste. Nutmegs have a delightfully fragrant odor and a warm, aromatic, grateful taste. Nutmeg contains a volatile oil (consisting of myristicene, Ci H 16 , and a little myris- ticoll, C 10 H 14 O), fixed oil {2^ per cent.), starch, proteids, etc. From mace, also, a volatile oil, etc., is obtained. Effects and Uses. — Nutmeg is one of the most agreeable of the aromatic stimidants, and is muck employed for its carminative 218 MATERIA MEDICA NEUROTICS. virtues, also as a flavoring ingredient, and to obviate the griping effects of cathartics. It possesses narcotic properties. Mace is chiefly employed as a condiment. Dose of either, gr. xx-xxx. Oleum myristicce (oil of nutmeg) is of a pale straw color; dose, gtt. ij-iij. Spiritus myristiccE is made by dissolving 3 parts of the oil in 97 parts of alcohol; dose, f5j-ij. CARYOPHYLLUS CLOVES. Cloves are the unexpanded flowers of Eugenia caryophyl- lata (Nat. Ord. Myrtacese), an evergreen tree of the Moluccas. They are from five to ten lines long and from one line to one line and a half thick, the corolla forming a ball or sphere at the top, and the calyx a tapering, somewhat quadrangular base, resembling a nail, whence the common name, from the French clou. When good, they are of a dark-brown color, with a yellowish-red tint ; they have a strong, fragrant odor, a hot, acrid taste, and when pressed with the nail, should give out oil. They contain a highly pungent volatile oil, tannic acid, resin, etc., and two crystalline principles, termed caryophillin and eugenin ; the oil consists of a hydrocarbon (C 10 H 16 ) and a colorless oil termed eugenol or eugenic (QoH^C^). Effects and Uses. — Cloves are among the most stimulating of the aromatics, but are used chiefly as a flavoring ingredient and as a condiment. Dose, gr. v-x. The oil, oleum caryopliylli, is pale or yellowish, becoming darker by age ; dose, gtt. iij-vj. PIMENTA. Pimenta, called also Allspice, is the unripe berries of Eugenia Pimenta (Nat. Ord. Myrtaceae), a handsome evergreen tree of the West Indies and South America. It comes exclusively from Jamaica, and consists of round, brown, roughish berries, rather larger than black peppercorns, with an external hard, brittle shell, inclosing two dark- brown seeds. They have an aromatic, agreeable smell and a strong clove-like taste. They are princi- pally used as a condiment. The oil, oleum pimentce, has a brown- ish-red color, and consists of a hydrocarbon and eugenic acid ; dose, gtt iij-vj. Oleum Cajuputi (Oil of Cajeput). The volatile oil distilled from the leaves of Melaleuca cajuputi (Nat. Ord. Myrtaceae), a STIMULANTS — CARDAMOM. 2 I O, tree of the Moluccas, is a powerful diffusible aromatic stimu- lant, much employed in Eastern countries, and of late coming into use in the United States. It is a transparent oil, of a fine green color, a lively, penetrating odor analogous to that of camphor and cardamom, and a warm, pungent taste. It is an admirable remedy for the relief of nausea and intestinal pain, and is added as a carminative to purgative pills to prevent grip- ing ; dose, gtt. j-v. ZINGIBER GINGER. Ginger is the rhizome of Zingiber officinale (Nat. Ord. Taxy- giberaceae), a perennial herbaceous plant, growing to the height of two or three feet. Its native country is Asia, where it has been cultivated from time immemorial, and was early introduced into the tropical regions of America. Ginger-root occurs in flattish, jointed, branched or lobed pieces, which rarely exceed four inches in length. In the young state, the roots are pre- served in sugar, and form a very pleasant sweetmeat. When old, they are taken up, scalded in hot water, and dried, when they are known as black ginger. Sometimes they are scraped previously to being dried, and are then called white ox Jamaica ginger. Both varieties have a powerful odor and a warm, pun- gent, aromatic taste. They impart their virtues to water and alcohol, and contain a pale-yellow volatile oil, gingerol (to which the hot taste is due), resin, starch, etc. Effects and Uses. — Ginger is a pungent, aromatic stimulant, much employed as a stomachic in flatulency, and spasm of the stomach and bowels. It is used also as a condiment, and to correct the unpleasant taste and nauseating qualities of other medicines. A paste made of the powder and warm water is used as a counter-irritant. Dose, gr. x-xx, in pill. The officinal preparations are : tincture — dose, f5ss-j ; fluid extract — dose, gtt. xx-xxx ; syrup — used as a vehicle for other medicines ; oleo-resin — dose, gtt. j-ij ; and troches (made by mixing the tincture with tragacanth, sugar, and a little syrup of ginger). cardamomum — cardamom. Cardamom is the fruit of Elettaria Cardamomum (Nat. Ord. Zingiberaceae), a perennial plant, from six to nine feet high, found in the mountainous parts of Malabar. Three varieties 220 MATERIA MEDICA NEUROTICS. of Malabar cardamoms are known in commerce : shorts, short- longs, and long-longs, all furnished by the same plant. They are ovate-oblong, from three to ten lines long, coriaceous, ribbed, and of a grayish or brownish-yellow color, and contain a number of blackish or reddish-brown seeds, which have a pleasant, aromatic odor and a warm, aromatic, agreeable taste. They yield a colorless volatile oil, a fixed oil, starch, etc. Effects and Uses. — Cardamom is a very agreeable aromatic, devoid of acridity, and is employed as a stomachic and carmina- tive, and as an adjuvant and corrective of other medicines ; dose, gr. v-x. The tincture (15 parts to diluted alcohol 85 parts) is the preparation chiefly used ; dose, f5j-ij. The compound tincture contains cardamom, and also caraway, cinnamon, cochineal, diluted alcohol, and glycerin. Pulvis Aromaticus {Aromatic Powder) consists of cinnamon and ginger, each 35 parts, cardamom and nutmeg, each 15 parts. It is used as a carminative in doses of gr. x to xxx. Extractum Aromaticum Fluidum {Aromatic Fluid Extract) is a fluid extract of aromatic powder. It is chiefly used as a flavor- ing ingredient in mixtures, but may be used where aromatic powder is indicated in doses of f5ss-j or more. CALAMUS. The rhizome of Acorus calamus or Sweet Flag {Nat. Ord. Araceae), an indigenous marshy plant, with long, sword-shaped, radical leaves (giving out a delicious fragrance when rubbed), is a valuable aromatic stimulant, with some tonic properties. It is found in the shops in somewhat flattened pieces, deprived of their epidermis, wrinkled, and of a yellowish color, and has a strong, fragrant odor and a warm, bitterish, aromatic taste. It contains volatile oil, acorin (probably a glucoside), resin, starch, etc. Dose, gr. xx to 5j- A fluid extract is officinal; or it may be given in infusion. GAULTHERIA. Gaultheria procumbens, Partridge-berry, Deer-berry, or Tea- berry {Nat. Ord. Ericaceae), is a small indigenous evergreen plant, with reddish stems, a few inches in height, bright-green leaves, and white, ovate, five-toothed flowers, followed by scarlet berries. STIMULANTS GAULTHERIA. 221 The leaves are the officinal portion, and contain a very stimu- lant volatile oil (oleum gaultherice), which, when first distilled, is colorless, but gradually becomes reddish, and is distinguished as being the heaviest of the volatile oils. It consists of gaultheri- Fig. 15. ACORUS CALAMUS. RHIZOME. lene (C 10 H ]6 ), and methyl salicylate (CH 3 .C 7 H 5 3 ). The leaves also contain arbutin, ericolin, urson, tannin, sugar, etc. The offici nal preparations are the oil and the spitit (containing 3 parts of 222 MATERIA MEDICA NEUROTICS. the oil in ioo of the preparation.) An infusion of the leaves is in very general popular use as a carminative and stomachic. The oil of gaultheria has been used with considerable success in acute rheumatism. Dr. Kinnicutt* reports twelve cases treated by it with the following results : complete absence of pain in about three days; duration of fever, 3^ days ; average stay in hospital, 24^ days. Gottheilf finds that it reduces the local swelling and relieves the pain (four cases) ; while A. Flint, Sr.,J states that the average length of confinement to hospital was, in eleven cases, less than five days — a very favorable showing. All of these observers gave it in frequently repeated doses (gtt. x), Flint, in flaxseed tea. Fig. 16. GAULTHERIA PROCUMBENS. LEAVES. Dr. Pinkham § reports four cases of poisoning by oil of gaul- theria, in which f 5ss was the fatal dose in each. In all severe symptoms of irritation of the gastro-intestinal tract and disturb- ance of the cerebral functions were noted. It seems to be a narcotico-irritant poison. *N. Y. Med. Record, 1882, p. 505. ^Ibidem, 1883, p. 256. %Ibidem, 1883, p. 725- \ Boston Med. and Surg. Journ., Dec. 8th, 1887. STIMULANTS SWEET ORANGE-PEEL. 223 AURANTII AMARI CORTEX BITTER ORANGE-PEEL. ,, AURANTII DULCIS CORTEX SWEET ORANGE-PEEL. The rind of the fruit of Citrus vulgaris, or Bitter Orange, and Citrus aurantium, or Sweet Orange [Nat. Ord. Aurantiaceae), is much employed as a flavoring addition to other medicines. They contain volatile oils, hesperidin (a bitter crystalline gluco- side), etc. The flowers (aurantii flores) yield a delightful vola- tile oil termed oil of neroli (officinal). The following are the officinal preparations : orange-flower water (aqua aurantii florum), an agreeable vehicle, possessing slight antispasmodic virtues; syrup of orange-flowers and syrup of orange are used as excipients and vehicles for medicines of unpleasant flavor : oil of orange- peel ; fluid extract of bitter orange-peel ; spirit of orange ; elixir of orange-peel. The tincture of bitter orange-peel and tincture of sweet orange-peel may be given in doses of f 5j-ij. The following aromatics, of the natural order Labiate, are pleasant carminatives and stomachics : — Lavandula (Lavender). The flowers of Lavandula vera, a small European shrub, cultivated in our gardens, about two feet high, with fragrant blue flowers, which are gathered in June, and dried in the shade. They have an agreeable, fragrant odor and a pungent, bitter taste They contain volatile oil, resin, a little tannin, etc. The oil (oleum lavandula? florum), which is of a pale-yellow color, or the oil of lavender (oleum lavandidce — a vola- tile oil distilled from the whole herb), may be used in the dose of from gtt. j-v. But the preferred preparations are the spirit (spiritus lavanduloi) and the compound tincture (tinctura lavaiidulce compositd), which contains also oil of rosemary, cinnamon, cloves, nutmeg, and red saunders ; dose, f5j. Mentha Piperita (Peppermint) and Mentha Viridis (Spear- mint) are European plants, naturalized in the United States. The leaves and tops are employed ; they have an aromatic odor and a pungent, somewhat bitter taste, followed by a sensa- tion of coolness. Mentha viridis contains a volatile oil, gum, resin, etc.; Mentha piperita a volatile oil (consisting of Ci H ]8 O and a crystallizable substance termed menthol, C 10 H2oO), a little tannin, resin, etc. 224 MATERIA MEDICA NEUROTICS. Menthol {Mint- Camphor) is obtained by the fractional distillation of the oil of peppermint, and to it the oil owes its peculiar odor. It occurs in colorless prisms which are said to correspond to the Chinese solid oil of peppermint. It has, of late years, been extensively used as an anodyne application in the treatment of neuralgic pains, especially those occurring in the supra-orbital and temporal regions, but is equally efficient in neuralgias affecting other regions. It is also recommended for the relief of rheumatic pains. It is found in the shops in cones or pencils under the name of Menthylene, etc., but the best preparation for external use is a solution in alcohol ( gj of the pure crystals to f^ss) painted over the part with a brush (H. M.). A. Rosenberg* uses menthol 20 parts to ether 100, or 50 of alcohol, as a substi- tute for cocaine to produce local anaesthesia of the nasal cavities and pharynx. He finds that it quickly induces anaemia of the mucous membrane and diminution of sensibility. Braddon f has recently called attention to the antiseptic prop- erties of peppermint oil, and he experimentally found it (up to 1 to 3000) to be superior, in the prevention of decomposition, to such agents as corrosive sublimate and carbolic acid. For minor surgical operations he used successfully gtt. j to olive oil f 5j soaked in lint. The results obtained by him with the inha- lation of the pure oil, as a germicide in phthisis, are scarcely conclusive, though in some cases it seemed to be beneficial. The oils may be given in doses of gtt. j-v ; but they are usually ad- ministered in the form of spirit in the dose of gtt. x-xx-xl. Two waters are also officinal (aqua menthce piperita and aqua mentha viridis, both much used as vehicles). The oil of peppermint is the stronger of the two, and is strongly recommended as an anodyne application in allaying neuralgic pains in herpes zosterj. Troches of peppermint are made by rubbing up oil of peppermint with sugar and mucilage of tragacanth. Vinum Aromaticum {Aromatic wine) is made by percolation, and contains I part each of lavender, origanum, peppermint, rose- mary, sage, and wormwood, with sufficient stronger white wine to make the filtered liquid weigh 100 parts. Rosmarinus {Rosemary). Rosmarinus officinalis, or Rose- mary, a European evergreen shrub, cultivated in our gardens, contains a very stimulant volatile oil (oleum rosmarinus) which is chiefly used as an ingredient of rubefacient liniments. It is also * Central, fiir gesamt. therap., Oct., 1886, p. 441,. f The Lancet, March, 1888, pp. 512, 567. \ The Practitioner, London, August, 1882, Meredith. STIMULANTS SWEET ORANGE-PEEL. 225 used in making spiritus odoratus (cologne water). The leaves are used. They enter into vinum aromaticum. Hedeoma {Pennyroyal}. Hedeoma pulegioides, or Pennyroyal, is an indigenous annual plant, about a foot high, with oblong lanceolate, serrated leaves, and small, pale-blue flowers arranged in axillary whorls. The leaves and tops are used, which con- tain a light-yellow essential oil, similar in properties to the mint oil, but somewhat more powerful. A body, termed hedeombl (C 10 H 18 O), has been extracted from the oil by Franz,* of which it constitutes 33 per cent. Origanum. The herb of Origanum vulgare, or common Marjoram. The essential oil is an ingredient in stimulating liniments, but is not officinal. Origanum enters into vinum aromaticum. Marrubium (Horehound). Marrubium vulgare possesses mild, stimulant, tonic and expectorant properties, and, in large doses, proves laxative. It is used chiefly in cough syrups and candies. The leaves and tops are employed. Salvia {Sage). The leaves of Salvia officinalis, a European plant, cultivated in our gardens, are used as a condiment, and may be used in infusion as a gargle in sore throat ; they are slightly tonic and astringent, as well as aromatic. It is an ingredient of vinum aromaticum. Oleum Thymi (Oil of Thyme). The volatile oil distilled from the Thymus vulgaris is often substituted for oil of origanum, and is used as an external application. The oil of thyme con- sists of cymene (C 10 H 14 ), thymene (C 16 H 16 ), and thymol (C 10 H 14 O), occurring in highly aromatic colorless crystals, and has been found a valuable antiseptic and antifermentative agent (see Anti- septics). The following aromatic seeds are derived from plants of the natural order Umbellifer^e : — Fceniculum (Fennel). The fruit of Fceniculum vulgare, a European plant, cultivated in our gardens. It may be used in infusion; the dose of the oil is gtt. v-xv. Fennel water is officinal. * Am. Jour, of Pharm., April, 1888, p. 161. 15 226 MATERIA MEDICA NEUROTICS. Carum {Caraway). The fruit of Carum Carvi, a European plant, cultivated in this country. Dose of the oil, gtt. j-x. Anisum (Anise). The fruit of Pimpinella anisum, cultivated throughout the south of Europe. Dose of the oil, gtt. v-xv. Anise-water (aqua anisi) and spirit of anise are also officinal. Coriandrum (Coriander). The fruit of Coriandrum sativum, an annual plant of the south of Europe. The oil is officinal. Illicium (Star anise). The fruit of the Illicium anisatum (Nat. Ord. Magnoliaceae), an evergreen tree of China and Japan, is officinal. It contains a volatile oil (which is chemically iden- tical with the oil of anise, but has a slightly different odor and taste),/^, resin, etc. (Maisch). The oil possesses analogous prop- erties to those of the oil of anise, and is much used as a substitute for it. VANILLA. This is the fruit of Vanilla planifolia (Nat. Ord. Orchidaceae), a climbing plant of Cuba and Mexico, cultivated also in various parts of tropical America, in the Mauritius, Reunion, and Java. The pods, when gathered, are yellow, but by exposure to the sun they assume a dark copper color. They are cylindrical, somewhat flattened, wrinkled, six or eight inches long, three or four lines thick, and contain a soft black pulp, in which numerous small black seeds are embedded. Vanilla has a strong charac- teristic, highly pleasant odor, and a warm, aromatic, sweetish taste; the interior pulpy portion is most aromatic. The odorous principle of vanilla is a crystalline substance termed vanillin (C 8 H 8 3 ), which can be made synthetically from coniferin ; it is found only in the interior and not in the exterior fleshy portion. It is a mild diffusible stimulant, chiefly used, however, as a per- fume and flavoring ingredient. The tincture is officinal. ORDER VII. SEDATIVES. Sedatives are medicines which diminish the frequency of the action of the circulation. They are employed therapeutically to reduce excitement of the vascular system. With sedatives may be included also the medicinal agents termed refrigerants, comprising nearly all the neutral alkaline salts, as well as those in which the acid predominates, and the SEDATIVES ACONITE. 227 vegetable acids. These substances have little power of dimin- ishing the ordinary or healthy temperature ; but they lower febrile heat, allay thirst, restore the secretions, and in this way are Very useful adjuvants in the treatment of febrile complaints. ACONITUM ACONITE. Aconitum Napellus, Aconite, Wolfsbane, or Monkshood {Nat. Ord. Ranunculaceae), is a native of the mountainous parts of Europe and Asia. The tuberous root is the officinal portion. They are brought from Europe, India, and Japan, and other species of Aconitum than A. Napellus furnish some of the aconite of commerce. Their taste is bitterish and acrid, and when chewed they occasion a peculiar feeling of tingling and numbness in the tongue and interior of the mouth. These properties are impaired by long keeping, when the plant loses its medicinal efficacy. The active principle of aconite is an alkaloid named aconitine (C^H^NO^). Four other alkaloids, pseiidaconitine (CajH^NOn), aconine (C^H^NOu), pseudaconine (C 2 7H 41 N0 8 ), and picraconitine (C 31 H45NO 10 ), have been found in it, but the chem- istry of aconite is not well settled. Aconitine exists in combination with a peculiar acid termed aconitic, and is prepared from an aqueous solution of an alco- holic extract of aconite-root, by the addition of sulphuric acid (which converts the natural salt of aconitine into a sulphate). It is a white amorphous powder, with a tinge of yellow (though it has been obtained in crystals), without smell, of a bitter, acrid taste, and produces in the mouth a sense of numbness. It is partially soluble in water, and is readily dissolved by alcohol and chloroform, less readily by ether. There is no characteristic chemical test for aconitine, but a strong aqueous solution of hydrobromic acid saturated with bromine throws down the aco- nite salts, or aconite itself, as a yellow precipitate, even if it be present in minute quantity ( 25 ^ 00 , Wormley). In medico-legal cases, the physiological test, by producing numbness and tingling of the lips or skin, must be resorted to. As aconitine is easily decomposed, the commercial article is more or less impure. Wright and Luff* isolated from the roots of Japanese aconite only one alkaloid, * Journal of Chemical Society, vol. I, p. 387, 1879. 228 MATERIA MEDIC A NEUROTICS. japaconitine, which can be split into japaconine, both of which closely resemble aconitine and aconine in physical properties. / Aconitine is an exceedingly virulent poison, more powerful when pure than hydrocyanic acid. It is scarcely adapted to internal use, as even gr. -^ has produced alarming results. Mor- son's aconitine, prepared from the cultivated A. Napellus, is terribly potent, even gr. yoVo" producing numbness of the tongue (B). In several instances a drachm of the tincture of aconite has destroyed life. Physiological Effects. — Aconite applied locally causes a sensa- tion of numbness and tingling, induced by its benumbing effect on the sensory nerves. The following account of the action of aconite is based on the investigations of Mackenzie,* Laborde et Duquesnel,f and of Plugge.J Nervous system : taken in small doses aconite exerts no influence upon the cerebrum, but its taste is pungent and benumbing, and it produces a feeling of numb- ness in the head, face, and extremities. Aconite has no action upon the motor nerves, the loss of reflex action caused by it being due to paralysis of the sensory end-organs, extending to the nerve-trunks, and finally to the spinal sensory centres. The motor spinal centres are only involved when total palsy has set in. Circulation : aconite exerts a marked influence on the circu- latory apparatus. Small doses reduce the heart's action and lower the arterial pressure ; lethal doses stop the heart in dias tole. Aconite applied directly to the heart slows it so that it may be concluded that the drug is a cardiac poison acting on its motor ganglia. It is also believed to stimulate the cardiac in- hibitory apparatus. According to the researches of Ringer 'and Murrell, aconite paralyzes all nitrogenous tissues, and it is in this way that the heart's beats are retarded. In other words, it acts directly against the heart's contained motor apparatus. Respiration : these movements tend to become slow, and the temperature is lowered. Secretions : aconite increases the secre- tion of the skin and kidneys, and is probably eliminated by the latter. In larger doses, its effects are those of an acro-narcotic poison, the symptoms being a burning or benumbing sensation * The Practitioner, XX, 1878, pp. 100, 185. f Revue de Med., iii, 1883, p. 804. % Ibidem, p. 1045. SEDATIVES ACONITE. 229 in the mouth, throat, and tongue, followed by gastric irritation, spasmodic purging, short, shallow, and superficial respirations, contraction or expansion of the pupils, though dilatation is the rule ; numbness or paralysis of the limbs ensues, the skin is cold and clammy, convulsions set in, the pulse fails, and death results from syncope. Aconitized animals remain conscious until death takes place. In case of poisoning, the stomach is to be thoroughly evacuated, and cardiac stimulants, externally and internally, are to be freely administered. The object of physiological antidotes being to keep the heart acting, hypodermics of atropine sulphate and aqua ammoniae will be found powerful excito-motors for this purpose. Digitalis is advised by Fothergill. Medicinal Uses. — Aconite is a powerful remedy in the treatment of neuralgiae, especially when the 5th pair of cranial nerves are affected. It is often combined with quinine in these cases, and should be given in doses sufficient to produce its characteristic physiological effects to a slight degree. A local application of the tincture or of a liniment or ointment is often resorted to with advantage, while the drug is administered internally. From its influence on the circulation it is applicable to those cases of inflammation in which general bloodletting was formerly resorted to with advantage, as it reduces the pulse-rate and lowers arterial tension, at the same time lowering the temperature and causing diaphoresis and diuresis. Thus it is used in all cases of sthenic inflammatory fever, occurring in robust young adults with a full, tense, bounding, strong and frequent pulse, and does most good before the effu- sion of inflammatory products has taken place. It is contra-indi- cated in typhoid conditions of the system, where the heart is weak or where there exists any acute inflammation of the gastro- intestinal mucous membrane. In surgical fever it is better given in small doses, frequently repeated until its effects on the pulse are manifested, when the interval between the doses should be increased, and it may be administered either alone or combined with other remedies, as in the following fever mixture : 1^ Morphinae sulphatis, gr. j-ij ; tincturae aconiti, f^xxiv; potassii acetatis, Sss ; spiritus aetheris nitrosi, f5yj ; liquoris ammonii acetatis, f^iss; syrupus limonis, ad., fohj. M. S. — f 5j in water every 2, 3 or 4 hours as indicated. 23O MATERIA MEDICA NEUROTICS. Aconite may be prescribed in this way and for these effects, not only in surgical fevers but also in idiopathic inflammatory conditions, provided the indications for its employment are present. In acute tonsillitis it will not infrequently cut short the attack if administered in time ; in acute pharyngitis, acute laryn- gitis or acute catarrhal bronchitis, it is of undoubted value when given early, in small doses and frequently repeated. An incipient coryza may be aborted by the timely use of aconite, given as above, until the pulse is reduced in volume and frequency, although for this purpose veratrum viride is generally preferred. In the early stages of acute otitis media, much relief is afforded by a combination of aconite with morphine and potassic bromide, and the external application of heat. In certain diseases of the respiratory organs, aconite is of great value, not only from its action on the circulation, but because it slows the respiratory act. Thus in acute pleurisy before the stage of effusion has been reached, if the patient be strong and robust and the pulse is full and bounding, tincture of aconite gt. j should be given every 1 5 or 20 minutes, until the pulse is influenced, while morphine (gr. -g— J) should be administered hypodermically, and wet or dry cups freely applied to the affected side, followed by a large poultice. In acute catarrhal pneumonia aconite is also beneficial, and even in the first stage of lobar pneumonia it may be cautiously administered combined with some of the ammonium salts, but it must be discontinued as soon as effusion has taken place. It possesses no advantage over veratrine in these cases, and the latter is probably the safer remedy. In phthisis, when the disease tends to spread, it may be given cautiously, to reduce the pulse rate and moderate the fever. In acute peritonitis aconite is of the greatest value and should be combined with large doses of opium. In those forms of peritonitis occurring during the puerperal period and due to septic infection, aconite is contra-indicated, a supporting and antiseptic plan of treatment giving better results {vide p. 148). In acute cerebral or acute spinal meningitis aconite is also of great value. It is indicated in many of the essential fevers, as in febricula, in which disease a fever mixture containing aconite, and the administration of small doses of calomel, frequently cut short the attack. SEDATIVES ACONITE. 23 I To moderate the excessively rapid pulse of scarlatina, as well as for its antipyretic, diaphoretic and diuretic action, aconite is of the greatest utility. In measles, also, and in sthenic cases of medical erysipelas it has been advantageously employed. In the early stages of cerebro-spinal fever before exudation has taken place, it may be given with large doses of opium and potassic bromide, while the local abstraction of blood by leeches, followed by cold to the head and neck, is employed. To moderate the fever in the hot stages of intermittent and remittent fever, aconite is also used, and in the latter affection is often efficacious in relieving the intense headache which so fre- quently accompanies this stage. From its effects on the heart itself aconite is of the greatest value in cases of cardiac hypertrophy when not compensatory to valvular lesion. In cases of simple hypertrophy and over- action it is our most available remedy combined with rest in the recumbent posture, but should any valvular disease exist, great caution must be exercised in prescribing it. In cerebral con- gestion of active type, by diminishing the force and frequency of the cardiac contractions, it proves most beneficial. It has also been resorted to in the treatment of internal aneurism. Aconite is recommended in suppressio mensum from taking cold, but is not always successful. In congestive dysmenorrhea it has also been employed, but possesses no advantage over other remedies. It has also been recommended to check the vomiting of preg- nancy. As a topical anodyne, aconite, as might be inferred from its local benumbing action, is a most useful remedy in neuralgias and chronic rheumatism, either painted over the part in the form of tincture or applied as a liniment or ointment, and sometimes when thus used it has a marked beneficial effect. Admixture with chloroform aids the absorption of its alkaloid, and thus enhances its effect ; but when thus used it should be employed with care and not applied to too large a surface for fear of too rapid absorption.* *"A Text-Book of Pharmacology, Therapeutics and Materia Medica." By T. Lauder Brunton, m.d., etc. London : 1885, p. 753. 232 MATERIA MEDICA NEUROTICS. Aconitine has been used internally and locally in the treatment of tic douloureux and other forms of trigeminal neuralgia. Duquesnel's aconitine is preferred for internal administration in doses* of gr. 3 ^ ' 1 ^ . It is a very active poison, and if employed at all, should be used with the greatest care. Locally, it is used in neuralgiae, as sciatic, or facial, in alcoholic solution (gr. j-ij to alcohol f5j), or as an ointment (gr. ij to lard 5j, rubbed up with alcohol gtt. vj). When applied to the temple or brow great care should be exercised to prevent any from coming in contact with the conjunctiva, as absorption from the membrane is very rapid and may occasion poisoning. Administration. — The dose of the powdered root is gr. *^ to j ; of the abstract, gr. y 2 to j ; of the fluid extract, ^ |— iij ; of the extract (alcoholic), gr. %-% ; of the tincture, which is by far the best preparation (400 parts of the powder are contained in 1000 parts of the tincture), *% J^-v. These doses are to be repeated twice or thrice daily, and cautiously increased till the effects of the medicine are apparent, or in acute febrile affections the smaller doses may be given and repeated every 15 to 30 minutes until the pulse is influenced or diaphoresis occurs. The tincture may be used externally. VERATRUM VIRIDE. Veratrum viride, known as American Hellebore, Swamp Helle- bore, Poke-root, Indian Poke, etc., {Nat. Ord. Melanthaceae), is a swampy plant, indigenous to the eastern portion of the United States, growing to the height of from three to six feet. The rhizome and rootlets are the officinal portions. The rhizome is an inch or two in length, thick and fleshy, with numerous yellow rootlets, and is found usually in the shops in slices or frag- ments, externally of a blackish color and internally of a dingy- white color. It is inodorous, but has a bitter, acrid taste, which leaves a permanent impression on the mouth and fauces. For use, attached portions of the dried stem should be rejected, as they are inert. C. L. Mitchell's * analysis of this rhizome shows it to contain veratroidine and jervine (the latter found also in V. album), rubi- * Proceedings Am. Pharm. Associat., 1 874, p. 397. SEDATIVES VERATRUM VIRIDE. 233 jervine, pseudojervine, with resin and oily matter. Some authori- ties state that it contains also veratrine (Wormley), but this is still an open question. Veratroidine is a white, uncrystallizable pow- der, of a bitter taste, leaving a tingling sensation in the fauces, soluble in alcohol, ether and chloroform. Jervine is a white, tasteless powder, which will crystallize from an alcoholic solution, insoluble in water and ether, and freely soluble in alcohol and chloroform. Physiological Action. — Veratroidine is an emetic, and sometimes a cathartic, and a depressant to the circulation. Nervous sys- tem : in animals poisoned by veratroidine, twitching and finally convulsions are produced ; the reflex spinal centres are at first depressed, afterward paralyzed. Circulation : applied directly to the heart, it paralyzes the cardiac muscle When given hypo- dermically* to animals, it at first lessens the rapidity of the pulse and lowers the arterial pressure (due to stimulation of the inhibi- tory nerves) ; soon, however, the heart's beat becomes greatly increased in force, but not in frequency, and the blood pressure falls to normal ; then suddenly the pulse becomes very rapid, and the cardiac force is lessened (due to peripheral paralysis of inhibitory nerves), and the tension rises much above the normal (caused by increasing asphyxia). Respiration : in animals poisoned by veratroidine, death is caused by asphyxia, due to paralysis of the respiratory muscles. Muscular system : there is great muscular weakness in poisoned animals. Gastro-intestinal tract : veratroidine is an irritant, causing violent vomiting and purging in poisoned animals. Jervine produces general weakness (without, however, vomiting or purging), lowering of arterial pressure and slowness of the pulse, profuse salivation, and finally convulsions. Locally, jervine is a feeble irritant. Nervous system : the effects of jervine are similar to those of veratroidine, but, in addition, the vaso-motor nerves are paralyzed. Circulation f : when applied directly to the According to Wright and Luff % the alkaloids of veratrum viride are essentially jer- vine, pseudojervine, cevadine, with a trace of veratrine and veratalbine, cevadilline being absent; of veratrum album, pseudojervine, jervine, veratalbine, rubijervine, and veratrine (a trace). * Phila. Med. Times, Vol. iv. H. C. Wood. | Ibid - % Journal of Chemical Society, Vol. I, 1 879, p. 405. 234 MATERIA MEDICA — NEUROTICS. Fig. 17. VERATRUM VIRIDE. SEDATIVES VERATRUM VIRIDE. 235 heart (of the frog), it paralyzes it. When an animal is poispned with jervine, the frequency of the pulse is diminished, and the arterial pressure falls greatly, due to the direct action of the drug on the cardiac muscle, as well as to paralysis of the vaso-motor centres. Respiration : death takes place from asphyxia. The alkaloids exist, in both V. viride and album, in but small propor- tions, and can scarcely be profitably extracted. The effects of veratrum viride are similar to those of its alka- loids. It is an active local irritant. Taken internally, it some- what promotes the flow of urine, and in doses of about five grains, proves emetic. In continued doses it produces a marked sedative action on the circulation, irrespective of the nausea induced, which, indeed, may be prevented by careful administration, and the temperature of the body is much lowered. It has not generally proved laxative. A few fatal cases are recorded from its use — though stimulants almost invariably counteract any excessive sedation. Recovery has taken place after fSj of the tincture had been swallowed, while f3j of the tincture has destroyed life,* and in another case| about ^xxx proved fatal. Uses. — Veratrum viride is used principally as a cardiac and vaso-motor depressa?it. In pneumonia, in which the danger is chiefly from failure of cardiac power, the use of veratrum requires caution and is serviceable in the early stage only, before exuda- tion has taken place. It is also useful in cardiac affections, as over-action of the heart, or hypertrophy unaccompanied by valvu- lar disease. In active hemorrhage and in acute congestions gen- erally it is also of value as a sedative. It has been recommended in puerperal eclampsia^, on account of its depressing influence on the reflex centres of the cord (Fordyce Barker, Boyd, N. L. Guice, etc.); it should be given in doses sufficiently large to reduce the pulse to 60 or 80 beats per minute and this effect should be main- tained. A few drops of the tincture repeated every hour or two, according to the condition of the pulse, will abort an ordinary " cold in the head," if given early enough (H. M.). The pre- parations of veratrum viride should only be given to strong, robust patients, and must never be made use of in any asthenic * Med. Times, Aug., 1884, p, 863. f Med. ana Surg. Reporter, May, 1873, p. 379. \ Canadian Practitioner, March, 1 885, p. 366. 236 MATERIA MEDICA NEUROTICS. disease. Dose, of the powder, gr. j-ij to begin with ; of the tincture, gtt. v-x ; of the fluid extract, gtt. iv-v. Veratrina {Veratrine) (C 3 2H 52 N 2 8 ) is an alkaloid or mixture of alkaloids obtained from the seeds of Asagraea officinalis {Nat. Ord. Melanthacese), an herbaceous plant of Mexico, which con- tains no jei'via* It is made by evaporating a strong tincture of the seeds to the consistence of an extract, from which the alka- loid is dissolved by diluted sulphuric acid, and afterward pre- cipitated by magnesia. When pure it is white, but it is usually a grayish or brownish-white powder, without odor, but very irri- tant to the nostrils, and of a bitter, acrid taste, producing a sense of tingling or numbness in the tongue ; scarcely soluble in cold water, but readily soluble in alcohol, and of an alkaline reaction. A delicate test for veratrine is Trapp's — a permanent lilac-red color, resembling a solution of potassium permanganate, afforded by boiling it in hydrochloric acid. Physiological Effects. — Locally, veratrine acts as an irritant,f producing heat, pain, numbness, and perhaps redness in the part to which it is applied. Nervous system : its action on the brain is not marked, and the reflex excitability of the spinal cord is diminished in animals after the administration of a large dose (Ott). Veratrine acts as a direct poison upon nerves (Ott, Wood, H. C, etc.), but whether it affects the nerve-trunk or its end- organs is still sub judice. Circulation and blood : in animals, small doses stimulate the excito-motor cardiac ganglia and increase the frequency of the cardiac beat ; large doses stimulate the pneumo- gastric nerve, and as the excito-motor ganglia become exhausted, the cardiac beat is slowed. It also poisons the cardiac muscle. It probably paralyzes the central vaso-motorj apparatus eventu- ally. The blood pressure is, at first, elevated, then lowered, and the blood is rendered less coagulable. Respiration and tempera- ture ; small doses increase, while larger doses diminish, the fre- quency of the respiratory movement, and the temperature is low- ered. It destroys life by paralysis§ of respiration. Excretion : * Proceed. Am. Pharm. Associat., 1874, p. 397. C. L. Mitchell. f Bull. Gen. de Therap., cv, 430. Sur Paction physiologique de veratrine. % Arch, fur Exper. Pathol, u. Pharmakol., 1 887, p. 36. Untersuchungen liber die Wirk. der Veratrumalkaloide, von H. Lissauer. \ Ibid. SEDATIVES PASQUE-FLOWER. 237 the excretions from the skin and kidneys are increased. Gastro- intestinal tract : in large doses it is an irritant poison, causing severe Vomiting and purging.* Muscular systemf : muscular irritability is at first exalted (producing convulsions), but is after- ward entirely lost. HeatJ increases and cold lessens the effects of veratrine on muscle. Its toxic action§ is comparable to that of its congeners. Elimination : it is eliminated by the kidneys. Stimulants and ethereal inhalation would be the proper treat- ment in cases of poisoning. Uses. — Veratrine is rarely used internally; the dose is gr. ^ to \ repeated ; it is most used externally, in the form of ointment (4 parts, to alcohol 6 parts, and benzoinated lard 96 parts) ; or dis- solved in alcohol, as an application to rheumatic and neuralgic parts. Oleatum veratrince (veratrine oleate) consists of veratrine 2 parts, to 98 parts of oleic acid. PULSATILLA PASQUE-FLOWER. The herb of Anemone pulsatilla, Anemone pratensis and Anemone patens (Nat. Ord. Ranunculaceae), is found in both hemispheres. It should be collected soon after flowering and carefully preserved, but should not be kept more than a year. It contains an acrid volatile oily substance, easily converted into anemonin, Cj 5 H 12 6 , and anemonic acid, C ]5 H 14 7 (Maisch). Physiological Effects. — Locally, fresh pulsatilla is an irritant, and after prolonged contact with the skin may cause inflammation, or even gangrene. When the powder is inhaled, it produces itching of the eyes, colic, vomiting, diarrhoea, etc. (Phillips). Nervous system : motor and sensory paralyses are produced in animals by large doses, but how they are produced has not been ascertained. After poisonous doses, dilatation of the pupil, sopor, coma, and convulsions occur. Circulation : pulsatilla is a cardiac depres- sant, and lowers the arterial pressure. Respiration and tempera- ture : it slows the respiration (Clarus), and reduces the tempera- ture. Gastro-intestinal tract: it is an irritant poison, in large doses producing vomiting and purging. Elimination : probably * Bull. Gen. de Therap., cv, 430. Sur Taction physiologique de la veratrine. f Journal de P Anatomie et de la Physiologie, 1868, p. 206. \ The Journal of Physiology, Vol. iv, p. I. \ Bull. Gen. de Therap., etc. 238 MATERIA MEDICA NEUROTICS. takes place through the kidneys. Incompatibles : caustic alka- lies, tannic acid, and metallic salts. Medicinal Uses. — Pulsatilla, owing to its irritant action on the digestive tract, is not well borne, and, moreover, possesses no superiority over more efficient sedatives like aconite. The powdered herb may be given in doses of gr. ij-v, or an extract or tincture may be made. ARNICA. Arnicae Flores, Arnica Flowers ; Arnicae Radix, Arnica Root. Arnica montana, Leopard's Bane {Nat. Ord. Composite), is a perennial herbaceous plant, found in northern Germany and other northern countries of Europe, and also in the northwestern por- tions of America. The flower heads and the rhizome and rootlets are the officinal portions. Both contain volatile oil, arnicin, resins, etc. ; the root contains, in addition, inulin and tamiin. Effects and Uses. — Locally, arnica is a stimulant and often an irritant to the skin. The internal effects of this drug are not well understood. Large doses cause headache and dilatation of the pupils ; poisonous doses paralyze the nervous system, and death ensues from collapse. Moderate doses lower (in dogs) the pulse by stimulating the pneumogastrics peripherally and centrally, raise slightly the arterial pressure, and depress the respiration and temperature. (H. A. Hare.*) Small doses are said to excite the action of the skin and kidneys. In large amounts it is an irritant to the gastro-intestinal tract, producing nausea, vomiting and purging of a choleraic character, and also great muscular weakness. In this country it is principally used externally, in the form of fomentation or lotion, for the relief of bruises, sprains and local paralysis. The extract of the root [alcoholic) is given in doses of gr. v-x. This is chiefly used, however, in making a plaster (em~ plastrum arnica). The fluid, extract of the root is given in doses of "n^x-xx. The tincture of the root and the tincture of the flowers may be given in doses of ^v-xxx. They are often used externally combined with soap liniment. In applying arnica * Boston Med. and Surg. Journ., Jan. 12th, 1888. SEDATIVES PHYTOLACCA. 239 externally, the irritating qualities of the drug should be brorne in mind. PHYTOLACCA. Phytolacca Bacca, Phytolacca Berry ; Phytolacca; Radix, Phytolacca Root. Phytolacca is the fruit and root of the Phytolacca decandra (Nat. Ord. Phytolaccacese), commonly known as Poke-Berries and Poke- Root. It is a perennial herb, indigenous to North America, growing to the height of four to eight feet, and found in waste places. The young stems, collected in the spring and boiled, are sometimes eaten at table. The root contains resin, starch, tannin, etc. ; the berries contain sugar, gum, coloring matter, etc. An indifferent crystalline principle termed pliytolaccin has been iso- lated, by Claassen. * Partee, f in a recent analysis of the root, could detect no alkaloid. Effects and Uses. — Phytolacca paralyzes the motor centres of the cord and medulla. In overdoses it causes dimness of vision, coma and sometimes convulsions (Stille and Maisch), and death is produced by paralysis of the respiratory centre. Phytolacca depresses the cardiac action and respiration, and produces nausea and vomiting, which does not take place until about an hour after the drug is administered, and which is accompanied by great de- pression. Purging also takes place, and Rutherford found it to be a powerful hepatic stimulant, increasing the secretion of bile. It is eliminated by the kidneys. Phytolacca has been used with success as an alterative in the treatment of rheumatism of syphilitic origin (Stille and Maisch). It is useful in phlegmons J of the breast, to allay the inflam- mation and prevent suppuration, and possibly may exert a like influence on other inflamed glands. It is recommended as a local application to leg ulcers (Tidd §) and eczema, and also in scabies and tinea capitis||. It should not be used as an emetic, because of the great depression which it induces. Dose of the powder, gr. j-xxx; or a tincture (ojv-Oj), or fluid extract may be used, dose ^v-f5j. For local use, an * The Pharmacist and Chemist, 1879, p. 466. f Am. Jour n. of Pharmacy, March, 1888, p. 123. % Am. Jour. Med. Sci., 1873, p. 275. \ The Clinic, Vol. v, p. 273. || J. Bigelow, quoted in Piffard's " Mat. Med. and Therap. of the Skin." 240 MATERIA MEDICA NEUROTICS. ointment may be prepared (5j-oj). These preparations are not officinal. STAPHISAGRIA. Staphisagria, Stavesacre or Licebane is the seed of the Del- phinium Staphisagria {Nat. Ord. Ranunculaceae), a beautiful biennial plant, with terminal racemes of blue flowers, native of southern Europe. It contains three alkaloids, delphinine (C 2 4H35N02o), delphinoidine and delphisine, and staphisain (C 16 H23N0 2 ) ; also fixed oil, etc. Physiological Effects. — When applied to the skin delphinine acts as a rubefacient and even irritant. When given internally to ani- mals it causes convulsions, and finally clonic spasm ; the reflex centres of the cord are palsied (Cayrade,* and cutaneous anaes- thesia is produced (Falck and Rorigf), and finally the respiratory centre is paralyzed, causing death from asphyxia. The effects on the circulation are most marked. It slows the cardiac action and paralyzes the heart by a direct action on its muscle and nervous supply (Falck and R6rig,J L. Van Praag). It causes dyspnoea, slows the respiratory movements and paralyzes the voluntary muscles. It causes salivation and induces vomiting (an early symptom), due to irritation of the end-organs of the pneumogastric nerves. It is eliminated by the bowels and kid neys, producing constipation and difficult urination during excretion (Albers,§ Schroff||). Staphisain also causes death by asphyxia ; but its action on the nervous system and circulation is said to be less marked. Medicinal Uses. — It is chiefly used as a local parasiticide in phthiriasis and scabies. Dose of the powder, gr. j-iij ; or a tincture (i part to alcohol 5 parts — dose ^ x -xv), or fluid extract may be used. An ointment (digest 5ij of bruised seed in lard 0} and strain while hot) is the best form for external use. None of these preparations are officinal. * Journ. de PAnat. et de Physiol. Mai et Juin, 1869. 317. f Archiv. fur phys., Heilkun., 528-548, 1852, and Rorig's Dissert, de Effedu Delphini, Marburg, 1852. % Virch. Arch., Bd. VI., 385-448, und 435-457. I Allg. Zeitschr. Psych. XV, 348. 1858. || Pharmakologie, 3 aufl.,ip. 547. SEDATIVES PREPARATIONS OF ANTIMONY. 24 1 ANTIMONII PR^EPARATA PREPARATIONS OF ANTIMONY. Antimonii Oxidum (Antimonious Oxide) (Sb 2 3 ) is a heavy grayish-white, insoluble powder, having the general therapeutic properties of the antimonials, and though not quite certain in its effects — as its solubility depends on the amount of hydrochloric acid which may exist in the stomach — it is believed to produce the sedative operation of tartar emetic, with less nausea and derangement of the stomach. Dose, gr. ij-iij, repeated. Antimonii et Potassii Tartras {Antimonium and Potassium Tartrate). This salt, familiarly known as tartar emetic and tartar- ized antimony, is prepared by boiling water and cream of tartar with antimonious oxide. It occurs in colorless, transparent, rhombic, octahedral crystals, which become white and opaque from efflo- rescence on exposure to the air. When pure its powder is per- fectly white ; but it is to be preferred in the crystalline state, as in this form it is less liable to adulteration. In testing for anti- mony the metal itself should be reduced, as by Marsh's test (see Arsenious Acid). The powder of tartar emetic is sometimes adulterated with cream of tartar, which may be detected by adding a few drops of a solution of sodium carbonate to a boil- ing solution of the antimonium salt, and if the precipitate formed be not re-dissolved, no potassium bitartrate is present. Tartar emetic (2KSbC 4 H 4 7 .H 2 0) is inodorous ; has a nau- seous, metallic taste; is soluble in 15 parts of cold and 3 parts of boiling water ; insoluble in pure alcohol ; and is decomposed by the alkalies, alkaline carbonates, and the vegetable astrin- gents. Physiological Effects. — Tartar emetic is a powerful local irritant. Applied to the skin, it occasions an eruption of pustules, resem- bling those of variola or ecthyma. When taken into the stomach, in full doses, it causes vomiting, purging, griping pains, etc., and in excessive quantity it acts as an irritant poison, and has produced death, with great prostration, syncope, dimi- nution of reflex irritability, and even convulsions and delirium : very large doses have, however, been given medicinally with entire safety. The proper antidote is tannic acid ; and opium, stimulants, and demulcents should be also administered. The constitutional effects of tartar emetic, when taken internally in small doses, are an increase in the secretions and exhalations 16 242 MATERIA MEDICA NEUROTICS. generally, especially from the skin ; the amount of carbonic acid exhaled by the lungs is increased ; the amount of urine excreted is lessened, but the urea is much increased (Ott) ; after large doses albuminuria is often seen ; in somewhat larger doses, these effects are accompanied with nausea and vomiting, relaxation of the tissues (particularly the muscular fibres), a feeling of great feebleness and exhaustion, and at first a stimulant, later a power- ful sedative, action on the circulation and respiration, the cardiac action becoming slow, weak and finally irregular, and the arterial tension being lowered. It acts on the heart by depressing the excito-motor nerves and paralyzing the cardiac muscle. After poisonous doses the red blood corpuscles are altered in form, and together with the albumen, are diminished in amount, in the blood of animals ; the fibrin is increased (Ott). The temperature of the body is lowered. In small, repeated doses, continued for some time, it produces fatty degeneration of the liver. It is eliminated slowly by the bile, milk, perspiration and urine, also by the bronchial mucus and the intestinal secretions. The minimum fatal dose for an adult is gr. ij ; for a child, gr. ^ (Taylor). On the other hand, very large quantities have been taken without fatal results. Medicinal Uses. — Tartar emetic is employed internally as an emetic, sedative, sudorific and expectorant, and locally as a counter- irritant. It is to be used with great caution on account of the prostration which it produces, and should never be given to young children, nor when gastro-enteric inflammation is present. It should only be used in sthenic cases in robust adults. As an emetic, it creates more nausea and depression than any other substance ; and hence, while other emetics are to be preferred to it, when our object is merely to evacuate the contents of the stomach with as little constitutional disturbance as possible, it is of value when vomiting is resorted to as a means of making an impression on the system and thereby checking the progress of disease. As a sedative antiphlogistic, in large doses it is a most powerful remedy in the treatment of acute inflammation, with fever, from its combined action in reducing the force and fre- quency of the circulation, moderating the heat of the skin, and promoting diaphoresis. When given in this way, at intervals, tartar emetic ceases to produce emesis, owing to the establish- SEDATIVES — PREPARATIONS OF ANTIMONY. 243 ment of tolerance of the medicine. It is inferior to other seda- tives, as aconite, etc. In the early stages of acute laryngitis and bronchitis, it is a remedy of great value. From gr. yV~i ma y De given every two hours in gradually increasing doses, until some amelioration of the symptoms takes place, when the doses are to be again decreased ; a favorite combination with many physicians is : 1^ Antimonii et potassii tartratis, morphinse sulphatis, aa gr. j ; aquae, f§ij. M. One teaspoonful contains gr. -^ each of tartar emetic and morphine. As a diaphoretic, it is very useful in small doses (as from y 1 ^— J-, repeated), in continued fevers, inflammation from wounds, injuries, etc.; and as an expectorant, when there is fever, a full pulse, and but little expectoration, as in acute bronchitis, in the same doses; it is also employed in various pulmonary affections with advantage. As a local irri- tant, it is rarely used, and is in many cases injurious. Administration, — The dose of tartar emetic, as an emetic, is gr. j-ij, and it is frequently combined with ipecac. As a sedative antiphlogistic -, gr. ^— \ to gr. j-ij. As a diaphoretic and expectorant, gr. T X g— \, may be given in solution, and in each case repeated every two or three hours. It is advantageously combined with small doses of morphine, when decided diaphoresis is aimed at. Vinum Antimonii {Antimonial Wine) is a solution of tartar emetic (4 parts) in boiling distilled water (60 parts) and stronger white wine (to make 1000 parts). It is employed as an expec- torant and sudorific, in the dose of from gtt. x-xxx, frequently repeated ; and as an emetic for children, in the dose of gtt. xxx to f5j, repeated every quarter of an hour. Other emetics are to be preferred. Antimonii Sulphidum {Antimonious Sidphide), the native sul- phide, purified by fusion, and Antimonii Sulphidum Purificatum {Purified Antimonious Sulphide), are used in making the other preparations. Antimonium Sulphuratum {Sulphurated Antimony) is a red- dish-brown, odorless, almost tasteless, insoluble powder, and is chemically a mixture of antimonious sulphide (Sb 2 S 3 ) and oxide (Sb 2 8 ). Its effects are analogous to those of tartar emetic. Dose, gr. j-iij ; as an emetic, gr. v-xx. Pilulce Antimonii Composites {Compound Pills of Antimony), sometimes called Plummers Pills. They are used as an alterative 244 MATERIA MEDICA NEUROTICS. in rheumatic and cutaneous affections. One pill contains of calomel and sulphurated antimony each gr. ss. Pitlvis Antimonialis . An antimonial powder is prepared in imitation of the cerebral James's powder, by mixing antimonious oxide (33 parts) with precipitated calcium phosphate (67 parts). It is a white, gritty, tasteless, odorless powder. Dose, gr. iij- viij. POTASSII NITRAS POTASSIUM NITRATE. This salt, commonly called nitre and saltpetre (KN0 3 ), occurs in both the inorganic and organic kingdoms of nature. It is obtained, for medicinal use, principally by the purification of the native nitre of India ; and it is found also in saltpetre caves in various parts of the United States, associated with calcium nitrate, from which it is separated by lixiviation. It is artificially pro- duced in several parts of Europe, in nitre beds or saltpetre plant- ations, by bringing together decayed organic animal and vege- table matters. And it is manufactured sometimes by the double decomposition of sodium nitrate and potassium chloride. Nitre is refined by re-solution and crystallization of the crude nitre. As purified for medicinal use, it is found in the shops in large, trans- parent, colorless crystals, of the form of six-sided striated prisms, with dihedral summits, which are unalterable in the air. They have no odor, a sharp, cooling taste, are wholly soluble in water, and insoluble in pure alcohol. They have no water of crystal- lization, but frequently have a portion of the mother liquid mechanically lodged in the spaces of the crystals, which may be driven off by heat, and the salt fused and cast into moulds, when it is termed sal prunelle. Physiological Effects of the Potassium Preparations. — As the effects of the potassium salts are largely due to their base, it will be more convenient to consider them together, pointing out any differences when the various preparations are considered. Locally, some of this group, as potassa fusa, abstract water from the tissues, dissolve albumen and saponify fats, and hence are caustics. The nitrate is a violent irritant when applied to mucous mem- branes or raw surfaces. Nervous system : in large doses, they may produce coma, and they act on the spinal centres, by lowering reflex excitability and causing paralysis of the lower extremities when given in large amounts. Circulation : all the potassium SEDATIVES POTASSIUM NITRATE. 245 salts are cardiac poisons, their activity being due to the potas- sium, and varying with the amount of the base they contain. In moderate doses they slow the heart and increase the arterial pressure, while in large doses they both diminish the frequency of the cardiac pulsations and lower the blood pressure. Animals poisoned by them die from cardiac paralysis (the heart being arrested in diastole), caused by direct action on the cardiac muscle and also by paralysis of the cardiac ganglia. Blood : after large doses, or when taken for some time, the blood is found to be less coagulable (the fibrin being diminished), the white cor- puscles relatively increased, and the venous blood lighter in color (Phillips). After large doses of the nitrate or chlorate, the blood becomes dark and refuses to take up oxygen, and the hemo- globin is decomposed. The compounds with the vegetable acids increase the alkalinity of the blood. Temperature is reduced by large doses, especially when the nitrate or chlorate has been given. Secretion : the alkaline potassium compounds, like alka- lies in general, when applied to the orifices of glands with acid secretions, increase, but when applied to glands with alkaline secretions, diminish, their secreting power (Ringer). This does not apply to the nitrate. They increase the water of the urine and the urea, and lessen the amount of uric acid. If the bi- carbonate is given during fasting, the acidity of the urine will be increased, but the urine will be alkaline if it is administered during digestion. The alkalinity of the urine is most marked after the ingestion of the salts with the vegetable acids (as the tartrate, citrate, etc.). The nitrate and chlorate do not affect the reaction of the urine. Gastro-intestinal tract : when alkalies are given on an empty stomach, the secretion of the acid gastric juice is increased ; if given when gastric digestion is in progress, they neutralize the acidity of the secretion. In large amounts, potassa or the chlorate, nitrate, carbonate or chloride excites vio- lent inflammation, causing vomiting, purging, etc. Nutrition : alkalies in small doses improve digestion, aid in saponifying fats, and promote oxidation of tissue, but when administered for too long a time, especially if given in large doses, they cause emacia- tion and pervert nutrition. Elimination : the potassium salts are eliminated chiefly by the urine, but to some extent also by the other secretions. The salts with the vegetable acids, during 246 MATERIA MEDICA NEUROTICS. their passage through the system, are converted into carbonates and are eliminated under this form. Potassium nitrate and chlor- ate are eliminated unchanged in the urine and as sulphates in the faeces. In excessive doses, nitre may act as a fatal poison, pro- ducing irritation of the alimentary canal and derangement of the nervous system ; the symptoms are burning pain in the throat and stomach, bloody stools, a tendency to syncope, collapse, and death, sometimes preceded by dilated pupils, insensibility and convulsions. There is no antidote for it, and cases of poisoning are to be treated by demulcents, opiates, stimulants, etc., after evacuation of the contents of the stomach. Medicinal Uses. — Nitre is not as much used as it was formerly. It may be given as a refrigerant and sedative remedy in fevers, inflammations, hemorrhages, etc. In fevers it is sometimes pre- scribed with calomel and tartar emetic, under the name of nitrons powders (nitre, gr. x ; tartar emetic, gr. \ ; calomel, gr. \ to -J-). In large doses it was given formerly in acute rheumatism, and this practice has been revived with success in France. It is some- times combined with Dover's powder (of each gr. iij-v or viij) in the treatment of acute muscular rheumatism. Dose, gr. x-xxx. From oiv-vj are given in twenty-four hours, in acute rheumatism, and the quantity is increased to 5viij-x, or xij. Charta Potassii Nitratis (Potassium Nitrate Paper) consists of strips of white unsized paper immersed in solution of potassium nitrate (20 parts to 80 parts of distilled water). The inhalation of the fumes arising from the burning of these papers is used with advantage in spasmodic asthma. Sodii Nitras {Sodium Nitrate, NaN0 3 ). This salt, commonly called cubic nitre), is found in large deposits in South America, chiefly in Peru, but also in Bolivia and Chili. The crude salt occurs in rather soft and pliable lumps, of white, yellow or gray color ; it is often purified in Peru by solution, crystallization and desiccation, but it is usually refined after importation. It occurs in colorless rhombohedral crystals, slightly deliquescent, and wholly soluble in water, without odor, and of a sharp, cooling and bitter taste. Effects and Uses. — Sodium nitrate has been little used in medi- cine, its employment having been limited chiefly to dysentery, in which it is highly praised by German physicians, in amounts SEDATIVES SOLUTION OF AMMONIUM ACETATE. 247 of from oss-j, in mucilaginous solution, during the day. Its effects are analogous to those of potassium nitre. The sodium salts are not as powerful cardiac poisons, neither do they affect the temperature nor act on the nervous system to the same extent. They impede coagulation, but do not alter the blood corpuscles. REFRIGERANTS. POTASSII CTTRAS POTASSIUM CITRATE. This salt (formerly known as Salt of Riverius) is made by satu- rating a solution of citric acid with potassium bicarbonate, and evaporating to dryness. It is white, granular, inodorous, of a saline, slightly bitterish but not unpleasant taste, deliquescent, and wholly soluble in water (K 3 C 6 H 5 7 .H 2 0). It is an excellent refrigerant diaphoretic, much employed in febrile affections. Dose, gr. xx-xxv ; 3yj are usually dissolved in water Oss, and foss of the solution is administered every hour or two. The salts of the alkalies with vegetable acids, as citrates, tartrates and acetates, during their passage through the body are con- verted into carbonates. Liquor Potassii Citratis {Solution of Potassium Citrate) may be made by dissolving separately citric acid 6 parts and potassium bicarbonate 8 parts in water enough to make the combined solutions weigh ioo parts; dose, f§ss. Mistura Potassii Citratis {Mixture of Potassium Citrate, or Neutral Mixture) is made by saturating fresh lemon-juice with potassium bicarbonate; or, when the lemon-juice cannot be had, a solution of citric acid, flavored with oil of lemon, may be used as a substitute. This preparation contains some free carbonic acid, which renders it more grateful to an irritable stomach than the ordinary solution of the citrate. Under the name of effer- vescing dratight the potassium citrate is often prepared extempo- raneously (fresh lemon-juice foss with an equal measure of water, added to a solution of potassium carbonate 5ij in water fSiv), and is given in the state of effervescence ; it is an excellent remedy for irritable stomach, with fever. LIQUOR AMMONII ACETATIS SOLUTION OF AMMONIUM ACETATE. This solution, termed also Spiritus Mindereri, or Spirit of Mindererus, is made by saturating diluted acetic acid with 248 MATERIA MEDICA NEUROTICS. ammonium carbonate, and is a solution of ammonium acetate (NH4C2H3O2). When pure it is a colorless liquid, with a saline taste ; it should always be made freshly when dispensed. The physiological effects of the ammonium salts have already been considered (vide p. 212). In small doses it is refrigerant ; in larger doses, diaphoretic and diuretic. It is employed in febrile and inflammatory affections, sometimes in conjunction with nitre or one of the sedatives, sometimes combined with camphor and opium. Given in full doses, frequently repeated, it is one of the best means of removing the effects of drunkenness. Dose, f Sss-j every two, three or four hours, in sweetened water. SPIRITUS ^THERIS NITROSI SPIRIT OF NITROUS ETHER. This preparation, commonly known as Sweet Spirit of Nitre, is a solution of ethyl nitrite (C 2 H 5 N0 2 ) in alcohol. Spirit of ni- trous ether is a volatile, inflammable liquid, of a pale-yellow color, inclining slightly to green, has a fragrant, ethereal odor, free from pungency, and a sharp, burning taste, and mixes with water and alcohol in all proportions; sp. gr. 0.823 to 0.825. It contains five per cent, of nitrous ether. It should not be long kept, as it becomes strongly acid by age. Effects and Uses. — Sweet spirit of nitre is antispasmodic, refrig- erant ^ diaphoretic, and diuretic. As a diaphoretic, small doses should be given, largely diluted and frequently repeated. It is much used in febrile affections, and, from its diuretic properties, is often combined with other diuretics in the treatment of drop- sies. From its pleasant taste and smell it is very acceptable to children. Dose, f5ss-j, frequently repeated. The inhalation of sweet spirit of nitre has produced dangerous and even fatal effects : pallor of the face, livid discoloration of the lips and fingers, weak- ness of the pulse, muscular prostration, precordial oppression, and headache are the symptoms described. A case is recorded in which death was attributed to the inhalation of the ether from a broken bottle in a sleeping apartment. The same symptoms may be produced by excessive doses. ACIDA VEGETABILIA VEGETABLE ACIDS. The vegetable acids are refrigerant, and, when properly diluted, form useful drinks in fevers, etc. Those chiefly employed are SEDATIVES VEGETABLE ACIDS. 249 acidum aceticum {acetic acid), acidum citricum (citric acid), .and acidum tartaricum (tartaric acid). Effects and Uses. — The following description is based on the investigations of H. Bence Jones * and F. Walter, f Applied to a raw surface or (if sufficiently concentrated) to the mucous mem- branes, they act as irritants. Acetic acid is the most powerful, and will, when applied to the skin, cause blanching, from contrac- tion of the capillaries. Citric acid is the least irritant. After large doses the cardiac beat is slowed and weakened, but this is possibly due to the resulting gastro-enteritis. According to Walter they do not neutralize the alkalinity of the blood. It is un- known under what conditions they exist in this fluid. The general law regarding the action of acids on secretion holds good in the case of the vegetable acids, viz. : that when applied to the orifices of glands secreting an acid fluid they diminish, while when applied to glands secreting an alkaline fluid they increase their secreting power. Thus they augment the flow of saliva and the intestinal secretion. The ingestion of the vegetable acids increases the acidity of the urine. They also promote the ex- cretion of both the water and the solids of the urine, particularly free uric acid (and may thus lead to calculus). Their continued use causes abdominal pain, flatulence, and diarrhoea. In large doses they produce gastro-enteritis, and continued for a lengthy period they induce scorbutic symptoms. There are no recorded cases of poisoning with citric acid ; tar- taric S/4 is alleged to have caused death in one instance, and fatal results from acetic are equally rare.J The antidotes are the alkalies. They are probably converted into carbonic acid in the system, unite in part with bases to form salts, and are eliminated by the kidneys and intestinal mucous membrane. Acetic Acid (HC 2 H 3 2 ) is employed internally only in the form of diluted acetic acid (strong acid 1 7 parts to distilled water 83 parts). Externally, strong acetic acid (sp. gr. 1.048, and con- taining 36 per cent, of monohydrated acid) or glacial acetic acid (nearly absolute acetic acid — sp. gr. 1.058) is employed as an * Medical Times and Gazette, Oct. 21st, 1854. f Arch, ficr Exper. Pathol, u. Pharm., 1877, p. 148. % Medical Press and Circular, Nov. 17th, 1880, p. 417. 250 MATERIA MEDICA NEUROTICS. escharotic to remove warts and in the cure of lupus. Acetic acid is less used internally as a refrigerant than citric acid, from its liability to produce colic and diarrhoea. Vinegar and water is one of the best injections for the cure of vaginal gonorrhoea in the female. Spongings with vinegar and water are useful to relieve the heat of the skin in fevers, and the vapor is grateful to the sick. Concentrated acetic acid is a corrosive poison, for which the alka- lies and their carbonates, soap, etc., are the antidotes. Citric Acid may be agreeably administered in the diluted juice of lemons, limes, sour oranges, and tamarinds. When these cannot be obtained, a solution of citric acid (gr. xx to water Oj) may be substituted. Citric acid is manufactured from lemon or lime juice, by saturating it with calcium carbonate and afterward de- composing the calcium citrate which is formed, by the addition of sulphuric acid. It occurs in colorless crystals (H 3 C 6 H 5 7 ,H 2 0), having the form of rhomboidal prisms with dihedral summits, freely soluble in water, and soluble in alcohol ; 5ixss, added to distilled water Oj, form a solution of the average strength of lemon- juice. In the dose of f 5j every hour or two, lemon-juice, limonis succus (the juice of the fruit of Citrus Limonum), has been em- ployed with success in acute rheumatism and gout. Of late years, however, it has given place to more reliable modes of treatment. Properly diluted and mixed with sugar, it forms the delightful refrigerant known as lemonade. Lemon-juice (or, still better, lime-juice) is the most efficient known remedy for scurvy. It has also proved of advantage in jaundice and torpor of the liver. Syrup of citric acid consists of citric acid (8 parts) and water (8 parts) with oil of lemon (4 parts) and syrup (980 parts). Lemon- syrup, which is pleasanter, is made by heating lemon-juice (40 parts) to the boiling point, adding lemon-peel (2 parts) and letting it stand until cool ; then filter and add enough water to make the filtrate weigh 40 parts ; dissolve sugar (60 parts) in the filtrate and strain. Spirit of lemon (sometimes called essence of lemon) is made by dissolving oil of lemon 6 parts (obtained from the rind of the fruit), in alcohol 90 parts, and adding freshly-grated lemon- peel 4 parts ; dose, f5j-ij. Tartaric Acid is the acid of grapes, and is extracted from tartar or crude cream of tartar. It is a white crystallized solid, in the form of irregular six-sided prisms (H 2 C 4 H 4 6 ), and is found in the shops as a fine white powder. SPINANTS NUX VOMICA. 25 I It is soluble in water and alcohol. Being cheaper than citric acid, it may be used as a substitute for that acid. It is employed in making Seidlitz powders. Tartaric acid yields a precipitate (cream of tartar) with a solution of carbonate or other neutral salt of potassium, while citric acid yields none. ORDER VIII. SPINANTS. Under the term Spinants, or Spastics, are comprised medicines which are employed to excite muscular contraction, or whose ultimate effect is the production of motor paralysis, and may, accordingly, be divided into excito-motors and depresso-motors. Of the first class, the most important articles are vegetable sub- stances containing the alkaloids strychnine and brucine, which are employed therapeutically in torpid or paralytic conditions of the muscular system ; ergot, which is used to excite muscular contraction of the uterus ; and digitalis, which is given for its tonic effect on the heart. The latter class contains such remedies as conium, physostigma, woorara, etc. EXCITO-MOTORS. NUX VOMICA. Strychnos Nux vomica, or Poison-Nut (Nat. Ord. Logania- ceae), is a middling-sized tree of the coast of Coromandel and other parts of India, which bears a round, smooth berry, the size of a pretty large apple, of a rich orange color, and containing numerous seed imbedded in a juicy pulp. The seed are the officinal portion ; but the bark also is poisonous, and is known as false angustura bark, from its having been confounded with angustura bark. The seed are round, peltate, less than an inch in diameter, nearly flat, or convex on one side and concave on the other, and surrounded by a narrow annular stria. They have two coats : a simple fibrous outer coat, covered with short, silky hairs, of a gray or yellowish color, and a very thin inner coat which envelops the nucleus or kernel. This is hard, horny, of a whitish or yellowish color, and of very difficult pulveri- zation. The seed have no odor, but an intensely bitter taste, which is stronger in the kernel than in the investing membrane. They impart their virtues to water, but more readily to diluted 252 MATERIA MEDIC A NEUROTICS. alcohol, and contain two active alkaloids, strychnine (officinal) and brucine, both of which exist in combination with an acid called igasuric ; another alkaloid, termed igasurine, much more soluble in water than the two first named, has been lately extracted from nux vomica. Strychnina {Strychnine) (CsiH^NsOa) is obtained by the fol- lowing process : Nux vomica is digested and boiled in water acidulated with hydrochloric acid, and the resulting strychnine and brucine hydrochlorate is decomposed by milk of lime. The strychnine is separated from brucine and impurities by boiling alcohol, from which it is deposited when cool, the brucine being left in solution. It is then converted into a sulphate by the addi- tion of diluted sulphuric acid, next decolorized by purified ani- mal charcoal, and again precipitated by solution of ammonia. Fig. 18. STRYCHNOS NUX VOMICA. A, B. SEEDS. Thus obtained, it occurs as a white or grayish-white powder (but may be made to crystallize in the form of white, brilliant rhombic prisms), of an intensely bitter taste, almost insoluble in water, slightly soluble in cold alcohol, but readily soluble in boiling alcohol. A very delicate test for strychnine is the potassium bichromate, which, added to a solution of strychnine in concen- trated sulphuric acid, produces a violet color, which after a time changes to wine-red, and then to reddish-yellow. Lead bin- oxide, manganese peroxide, potassium ferrocyanide and per- manganate act in the same way. In these tests the reagent is nascent oxygen. The presence of morphine in excess, of certain undefined organic substances,* and of curare, may disguise the * " Micro-Chemistry of Poisons," 1885, p. 569. SP1NANTS NUX VOMICA. 253 color test ; here an alkaline mixture of chloroform should be-used to separate the strychnine from morphine ; while curare can be distinguished by its amorphous state. The physiological test should be always resorted to : if a small frog be placed in an ounce of water containing yj-g- of a grain of strychnine salt, in two or three hours it will undergo tetanic spasms, and soon die. Brucine (C^H^^O^ unofficinal) resembles strychnine in its action (Mays*). It differs from it in being locally analgesic and often destroying life without a trace of spasm. In the case of an adult f gr. ij induced convulsions which were counteracted by chloral. The dose is gr. \-\. PJiysiological Effects. — Nux vomica or its alkaloid, strychnine, increases the reflex excitability of the spinal cord, and thus pro- duces convulsions. Its action seems to be especially directed to excitation of the spinal motor centres. Klapp % affirms that even lethal quantities in the frog have no action on the sensory or motor nerve-endings, nor upon their trunks. This statement, however, is denied by Vulpian § and others. After death, galvan- ization of the motor trunks causes little or no contraction in response, due to direct action on, and exhaustion of the motor trunks. It stimulates the vaso-motor centres of the brain and spinal cord (Ott), and also the respiratory centre. Large doses paralyze these centres at once (Klapp), but the vagi are not affected either in warm- or cold-blooded animals. Death is due to as- phyxia. In very small and repeated doses, it has a tonic and diuretic effect, and sometimes operates slightly on the bowels and skin, but has no effect on the circulation. In somewhat larger doses, the stomach is often disturbed, the cardiac action is accelerated from stimulation of the cardiac ganglia, the visual sense is rendered more acute and the retina becomes hyperaemic, and in still larger doses, the muscular system becomes disordered. A sense of weight and weakness in the limbs, and increased sen- sibility to external impressions of all kinds, manifest themselves, * Pamphlet, " The Differential Action of Brucine and of Strychnine," Phila., March 1887. • I Med. and Surg. Reporter, 1882, 194. % The Journ. of Ment. and Nerv. Dis., Oct. 1878, p. 619. " Physiological Action of Strychnine on the Brain, Spinal Cord and Nerves." \ Arch, de Physiologie Norm, et Path., hi, 1870, 116. " Remarques touchant Taction de la strychnine sur les grenouilles." 254 MATERIA MEDICA NEUROTICS. with depression of spirits and anxiety ; the limbs tremble, and slight convulsive movements of the muscles appear. If the medi- cine be continued, or if a toxic dose be taken, convulsive parox- ysms of the whole muscular system ensue, with erotic desires, painful sensations in the skin, and occasionally eruptions ; the heart is slowed, and the blood pressure increased, probably through vaso-motor spasm. In paralytic patients the effects of the medicine are principally observed in the paralyzed parts. When taken in excessive doses the symptoms usually come on suddenly, and within half an hour, and consist of paroxysms commencing with a sudden shuddering, quickly passing into a tetanic convulsion of all the voluntary muscles. The body is bent backward until the occiput and heels support its weight (opisthotonus), the corners of the mouth are drawn up in a ghastly grin(risus sa7'donicus), and the face, at first pale, becomes livid as the paroxysm continues, from interference with respiration. Trismus (an early symptom in tetanus) occurs finally in severe cases. After a variable time the muscles relax and an interval of quiet succeeds, during which there is sometimes a slight rigidity of the muscles, but no marked stiffness as in tetanus. As a rule the paroxysms are painful. If the dose has been sufficient to cause death, the paroxysms rapidly succeed one another, in- creasing progressively in severity and duration until death occurs from fixation of the muscles of respiration, the intellect being usually unaffected up to the fatal termination. The convulsions resulting from the use of strychnine are of spinal origin, and are due to an exaltation of the reflex functions together with a stimu- lation of the motor cells of the cord. The reflex centres are in such an irritable condition that the slightest irritation of the sur- face, as by a breath of air, will produce a convulsion. There is no chemical antidote, unless, perhaps, tannic acid and the iodu- retted potassium iodide. The patient should be kept perfectly quiet and all sources of irritation, as draughts or loud noises, should be excluded, as likely to cause a tetanic paroxysm. The stomach should be emptied and the physiological antidote given. Chloral is the best physiological antidote. It* acts chiefly by lowering the activity of the parts which conduct the excitation * Schmidt's Jahrb., June, 1881, quoted by Am. J. M. Set., April, 1882. SPINANTS NUX VOMICA. 255 to the spinal cord, preventing the too frequent repetition of the tetanic spasms and lessening their intensity. In grave cases arti- ficial respiration should also be resorted to. Some relief is afforded by holding the limbs or even by applying friction to them, during the paroxysm. The antidotism between strych- nine and chloral is not reciprocal. Opium, conium, ether, chloro- form, Calabar bean or potassium bromide, may also be exhibited as physiological antidotes. Paraldehyd is recommended by Cer- vello as a physiological antagonist. The action is not reciprocal (vide p. 86). According to Bignon,* cocaine will save the life of a dog poisoned by strychnia by maintaining cerebral excitement until the poison is eliminated. Recently Prof. Anrepf has called attention to urethan as a physiological antidote to strychnia and other tetanizers. Dr. Kratter announces that strychnine is excreted entirely unaltered by the urine, the excretion beginning within one hour and ending within forty-eight hours after admin- istration. The entire amount taken can be demonstrated in the urine J. Fatal Quantity. — The poisonous dose varies considerably, for a case§ is reported (that of Dr. Warner) in which gr. x / 2 killed an adult in twenty minutes, while recovery followed in a soldier || who had eaten about gr. xv. Medicinal Uses. — This medicine is our chief resource in torpid or paralytic conditions of the motor or sensitive nerves, or of the muscular fibre. When, however, paralysis is the result of inflam- mation of the nervous centres, it is injurious, and accelerates organic changes. It is most beneficial in those forms of paralysis which are independent of structural lesion, as lead palsy or pa- ralysis from drunkenness. In paralysis arising from cerebral hemorrhage — after the absorption of the effused blood, when the paralysis remains, as it were, from habit — the cautious employ- ment of nux vomica is often attended with advantage. In amau- rosis, free from cerebral complication, especially when due to alcohol or tobacco, it is very useful. In these cases strychnine * Bull. Gen. de Therap., CVII, p. 397, 1884. f Bull. Gen. de Therap., Feb. 15th, 1887. Quoted. \ Sep. Abd. Wien. Med. Wocken., 8, 9, 60, 82 ; quoted in Med. and Surg. Re- porter, Phila., Nov. 1 8th, 1882. $ Guy's Hosp. Reports, xi, p. 296. || Medico-Legal Journal, Parker, 1885, p. 375. 256 MATERIA MEDICA NEUROTICS. is recommended in doses of gr. -^ injected into the correspond- ing temporal region. It should be administered daily, and the dose increased until slight twitchings of the muscles are produced. In atrophy of the optic nerve-fibres, it has not met with the suc- cess which was predicted, but is of undoubted use before the stage of atrophy is reached. It has also been found very bene- ficial in chronic constipation, either alone or as an adjunct to cathartics : 1^ Resinae podophylli, gr. iij ; extracti colocynthidis compositi, gr. xij ; extracti nucis vomicae, gr. vj ; extracti hyoscy- ami, gr. xxiv. M. et ft. pil. xxiv. Sig. — Take one pill once, twice or three times a day, as necessary: ^ Aloin, gr. ij ; strych- nine sulphatis, gr. y^ ; extracti belladonnas alcoholici, gr. j. M. et ft. pil. xxiv. Sig. — One pill after each meal, three times a day. In dysentery, cholera, diarrhoea, impotence, incontinence of urine, spermatorrhoea, and other affections depending on functional atony and relaxation of muscular fibres ; in chorea and in epi- lepsy it is highly recommended ; in dyspnoea due to chronic bronchitis, dilated bronchi, emphysema, or incipient phthisis, it is of value as a respiratory stimulant ; it may be advantageously combined with digitalis when dyspnoea is due to cardiac disease, acting not only as a respiratory, but also as a cardiac stimu- lant; and in pure cardiac dilation it is well to alternate strych- nine (gr. g 1 ^-) with digitalis, giving either for a week or two at a time ; in combination with other remedies, as iron, in anaemia and chlorosis : 3^ Strychninae sulphatis, gr. %-% ', tincturae ferri chloridi, f5ij-iv ; acidi acetici diluti, f5j ; liquoris ammonii acetatis, f§iij ; elixir aurantii, q. s. f§vj. M. et S. — Two teaspoonfuls, largely diluted, three times a day, after meals. 3^ Ferri sulphatis exsic- cati, quininae sulphatis aa gr. xl ; strychninae sulphatis, gr. ss., mannae q. s. M. ft. pil. xx. S. — One t. d. In small doses it has been used with excellent effect as a general tonic where there is loss of nerve power, and as a stomachic in dyspepsia, and to relieve the vomiting of pregnancy, for which purpose the tinc- ture maybe given in ^J^—j doses, repeated several times at intervals of half an hour. In the treatment of the symptoms induced by the excessive indulgence in alcohol, Dobrowravow* reports good results from * Bull. Gin. de Thirap., Dec. 15th, 1887, quoted. SPINANTS IGNATIA. 257 the hypodermic injection of strychnia, his observations extending over forty cases. Administration. — Dose of the powder, gr. ij or iij, in pill, several times a day, and increased till an effect is produced ; of the abstract, gr. ss-ij ; of the extract (alcoholic), gr. ss-j, to be repeated and increased ; of the fluid extract, ^j-v ; of the tincture, gtt. v to xx, and this is sometimes used as an embrocation to paralyzed parts. A tolerance of nux vomica and strychnine is rapidly established in the system. Strychnina {Strychnine). The preparation and tests for this alkaloid have already been considered (vide p. 252). The effects of strychnine are similar to those of nux vomica but more violent ; its local action is that of an irritant. It is employed for the same purposes as nux vomica, and should be given in very minute doses, as gr. 32 -" iV to De gm with, to be gradually increased, carefully watching the patient and suspending its administration as soon as twitching of the muscles, or an approach to the risus sardonicus, is observed. The salts of strychnine may be also employed in the same doses, but as they are more soluble than the alkaloid, they are more active. For endermic use, gr. ^-q of the alkaloid may be used ; it is best used in amaurosis hypodermically, dose, gr. -^ to begin with. The salts are pre- ferred for hypodermic use, because of their greater solubility. Strychnine Sulphas (Strychnine Sulphate) is made by dis- solving a mixture of strychnine in distilled water, with diluted sulphuric acid, and evaporating. It occurs as a white salt, in colorless, prismatic crystals, efflorescent, odorless, very bitter, readily soluble in water, sparingly soluble in alcohol, and insolu- ble in ether. It responds to the tests for strychnine, and may be used for the same purposes and in the same doses. IGNATIA. The seed of Strychnos Ignatii, or St. Ignatius' Bean (Nat Ord. Loganiaceae), a tree of the Philippine Islands, contains a large proportion of strychnme, some brucine, etc., and possesses medi- cinal properties analogous to those of nux vomica. It may be given to fulfill the same remedial indications as nux vomica. An abstract (dose, gr. %-]) and a tincture (dose, ^v-xx) are offi- cinal. 17 258 MATERIA MEDICA NEUROTICS. HYDRASTIS. The rhizome and rootlets of Hydrastis canadensis, Yellow Root or Golden Seal {Nat. Ord. Ranunculacese), a small indi- genous plant, with yellow, fugacious flowers, and a red fruit resembling raspberries, has from recent experiments been classed among the excito-motors. It contains the alkaloids hydrastine (C 2l H 21 N0 6 ), berberine (C2oH 17 N0 4 ), and xanthopuccine* , which is simply impure berberine; also starch, sugar ; etc. (Maisch). Physiological Effects. — According to A. J. Slavatinski,f when hydrastine is given hypodermically to frogs in small doses (.001-002 gm.) it causes incoordination of movements, general sluggishness and weakness, quickened respiration, and a reduc- tion of the cardiac frequency from J— J of the normal rate, and at the same time the individual contractions are very energetic. When a larger dose (.003-005 gm.) is given, general convul- sions occur (resembling those caused by strychnine), which disappear on section of the spinal cord. The effects on the heart are intensified, and the cardiac action is interrupted by diastolic arrests. If a still larger amount (.005-01 gm.) be given, the convulsions are followed by prostration, paralysis and death, the heart stopping in diastole. When placed on the cut-out heart, the cardiac action stopped and the heart could not be made to respond to further irritation. It probably acts on the heart not only through the par vagum, but also through the cardiac ganglia, and in large doses, paralyzes the cardiac muscle directly. It stimulates the reflex centres of the cord, exalts the irritability of the motor nerves, and probably depresses the end- organs of the sensory nerves. Given to warm-blooded animals it slows the cardiac action, causes general depression, dis-coordi- nation and incessant tremor ; large doses cause death, which is due to tetanus of the respiratory muscles, and is preceded by general paralysis. The action of hydrastis is less powerful but of longer duration than that of strychnine, which it resembles. It acts, also, as a diuretic, and according to Rutherford, it is a hepatic stimulant of considerable power, and a feeble intestinal * Proc. Amer. Pharm. Associat., 1884, p. 456; F. B. Power. f Meditz Obozr., No. 16, 1884, p. 346; quoted by Lond. Med. Pec, Nov. 15th, :88 4 , p. 498- SPINANTS COCCULUS INDICUS. 259 stimulant. According to Givopiszew* hydrastis always provokes uterine contractions, which are less intense than those of ergot. Medicinal Uses. — It is recommended as a nerve tonic and anti- fermentative in atonic dyspepsia and chronic gastritis. From its action on the liver and intestines it is useful in duodenal catarrh, catarrhal jaundice, and constipation due to deficient secretion. It is an efficient diuretic, and has been used for this purpose in promoting the discharge of calculi from the kidneys. It is also used in chronic cystitis, and has been employed internally and by injection for the cure of gonorrhoea, in the stages of decline, and in gleet, and also as an injection in uterine and vaginal leucorrhceas. It is an excellent remedy against uterine hemor- rhage due to inflammation of the organ, coincident with the menopause or too abundant flow at the monthly period. (Givo- piszew, loc. cit.) From the study of its effects, it should be useful in the same class of cases in which strychnine is employed. Dose, of the fluid extract, f5j-iv; as a stomachic tonic, t^v-xv before meals. The tincture may be given in doses of r^x-foj, t d. As an injection in gonorrhoea, hydrastine may be used in the strength of gr. x-xv to mucilage f§»j. % Rhus Toxicodendron {Poison- Oak). The fresh leaves of Rhus toxicodendron, or Poison-Oak {Nat. Ord. Terebinthaceae), an indigenous shrub from one to three feet high, and other species of Rhus, possess properties somewhat analogous to those of nux vomica, and have been employed with success in paraly- sis. They contain toxicodendric acid y to which their poisonous and medicinal activity is due. Dose, gr. j-iij, or more, to be repeated and increased. In cases of poisoning, the irritation of the skin is relieved by glycerite of carbolic acid or alkaline solutions. COCCULUS INDICUS. Cocculus Indicus (not officinal) is the dried seed of Anamirta paniculata {Nat. Ord. Menispermaceae), a climbing shrub of India. The fruit is a one-celled berry, of a dark purplish color, * These, St. Petersburg, 1887, quoted by Bull. Gen. de Therap., cxiv, 189. 260 MATERIA MEDICA — NEUROTICS. with a soft pulp, and a single seed the size of a pea, containing a bitter kernel. The active properties reside in a peculiar white, crystallizable bitter principle which is officinal under the name of picrotoxinum (picrotoxin, C 9 H 10 O 4 ). It is partially soluble in water, and very soluble in alcohol, chloroform and ether. Pic- rotoxin is not precipitated by the reagents for the alkaloids, and does not neutralize acids. In the shell, an alkaloid termed menisp ermine has been found, and a neutral principle of the same composition as the alkaloid, termed paramenispermin. Effects and Uses. — Picrotoxin is an acrid cerebro-spinal narcotic, capable, in large doses, of producing death by tetanic fixation of the respiratory muscles. Its cerebral effects are variously described, such as stupor, giddiness and vertigo. In doses suffi- cient to produce these effects it is apt to nauseate. It is a tetaniz- ing agent, the tetanus being followed by convulsions, paralysis and coma. According to Chirone * the chief action of the drug appears to be that of an excitant of the centres located in the medulla oblongata and spinal cord. The convulsions can be brought on in an animal from which the brain has been removed. Picrotoxin is capable of originating an artificial epilepsy, and it acts independently of the psycho-motor centres, its influence being most decided when they are removed. During the con- clusive stage the heart's action increases, while in the stage of coma it becomes slow, and after death it is found to be in dias- tole. Picrotoxin induces decided diaphoresis. It has not been much used internally, except in the night sweats of phthisis, for which Murrell recommends it, in doses of gr. yJtt to To> kut m the form of decoction or ointment it is employed to destroy lice and other parasites, and for the cure of tinea and porrigo of the scalp. It is said to prevent the secondary fermentation of malt liquors, into which it is sometimes introduced as an adulteration. ERGOTA ERGOT. Ergot is a fungus growing from the diseased ovary of Secale cereale, or Rye (Nat. Ord. Graminaceae). The U. S. Pharma- copoeia styles it the Sclerotium of Claviceps Purpurea (Nat. * Annali Univer. di Med. le Ckirurgia, vol. 251, 1 880, p. 289. Ricerche speri- mentali sulFazione biologica della picrotoxina; pel V. Chirone. SPINANTS — ERGOT. 26 1 Ord. Fungi), replacing the grain of Secale cereale. In the, pro- duction of ergot there are three stages, as follows: 1st, in the flowering season one or more ovaries in an ear of rye are covered by a sweet yellowish mucus — the honey dew of rye — which con- tains numerous microscopic cells called conidia, a sugar, and is the product of the decomposition of the constituents of the ovary caused by the developing mycelium of the fungus. This is formed of filamentous cells termed hyphcB, and the first stage ends when the hyphae have penetrated the ovary and separation of the conidia have ceased. 2d, when the hyphse unite at the base of the ovary into a purplish-black body (ergot) extending to the apex of the grain. 3d, the development of the fungus is completed. It will be seen that ergot is the dormant or intermediate stage of a fungus called Sclerotium, compound mycelium or spawn. Its predis- posing cause is unknown, and it is not peculiar to rye, many other grasses being subject to it, as abortion in grazing animals has been frequently produced by their eating grasses affected with ergot. The ergot usually projects out of the glum or husk of the plant, beyond the ordinary outline of the spike or ear. It should not be collected until some days after it has begun to form, as it is thought not to possess full activity until about the sixth day of its formation. As found in the shops it consists of cylindrical or somewhat prismatical tapering grains, curved like the spur of a cock, of a purplish color externally, and of a yellow- ish or grayish-white color within. Its smell is peculiar and nauseous ; its taste is at first faint, but becomes bitterish, acrid and disagreeable. It yields its virtues to water and alcohol, and does not keep well, being liable to the attacks of a minute worm. It deteriorates much more rapidly in powder than when in grain, in the former condition soon becoming inert. Numerous analyses have been made of ergot, but there is still some uncertainty as regards its active principles, though this is gradually growing less. The investigations of Dragendorff seem to show that the specific effects of the drug depend in a high degree upon a proximate principle of an acid character, to which the name of sclerotic acid is given. It is odorless and tasteless, soluble in water and boiling alcohol, but not at all in cold alcohol. Good ergot contains about 4 to 4.5 per cent, of the acid. The most reliable investigations upon this question are those of 262 MATERIA MEDICA NEUROTICS. Kobert,* which point to the following conclusions : viz., that ergot does not owe its ecbolic power to ergotinic acid, which has no Fig. 19. SECALE CEREALE. A, A. ERGOT. influence on the uterus, but that spliacelinic acid, a resinous body insoluble in water, never failed to produce powerful contractions * The Practitioner, Dec, 1885, p. 414; and Arch, fur Exp. Pathol, u. Phar- makol., 1884, XVII, p. 316. SPINANTS ERGOT. 263 in the gravid uterus, while cormitin, gr. y$, either in the pregnant or non-pregnant uterus, likewise exhibited the same action. Ac- cording to this observer, the only active preparation is one con- taining both cornutin and sphacelinic acid, and, finally, that no sample of ergot, either European or American, retained its virtues for more than 12 months. Ergot also contains scleromucin (2 to 3 per cent.), sclererytherin, scleroiodin, picrosclerotin (poisonous), sclerocryslallin, and scleroxanthin (inert), and an alkaloid, ergo- tinine (Maisch). Physiological Effects. — The effects of ergot are not well under- stood, especially as regards its action on the nervous system. In medicinal doses it acts most conspicuously on the circulation and on the female system, in which it excites powerful contractions of the uterus. After labor has commenced, in ten or twenty min- utes from its administration, it increases the violence, frequency and continuance of labor pains, which usually never cease until the child is born. Administered before labor, it frequently origi- nates the process, though its effects in this respect are less con- stant. And even in the unimpregnated uterus it produces painful contractions, and evinces an influence over morbid conditions of the organ by checking uterine hemorrhage and expelling polypi. Ergot induces * contraction of the unstriped muscular fibre wherever found, causing a shrinkage in the caliber of the blood- vessels everywhere, and it is thus available generally as a remedy in cerebral and spinal congestions, hemorrhages, tumors, morbid growths and enlargements. In large doses it produces vomiting, purging, increased peristalsis, and a marked sedative f effect on the circulation, slowing the heart (10-36 beats), probably by direct action on the cardiac muscle, and causing an enormous rise in the blood pressure, through the contraction of the arte- rioles and stimulation of the vaso-motor centres of the cord and medulla ; decided toxic doses lower the blood-pressure, by depressing the heart and vaso-motor centres (Brown-Sequard). In excessive quantities it acts as an acro-narcotic poison on both sexes. When it is used for a length of time as an article of food * Arch, de Physiol. Norm, et Pathol., in, 1870, p. 584. Effets de 1' extraitd' ergot sur la pression arterielle ; par Ch. L. Holmes. | Bull. Gen de Therap., lxxviii, pp. 433, 481. Ergot, ergotine, action physiol., etc. M. Bailley. 264 MATERIA MEDICA NEUROTICS. it produces a peculiar morbid condition, termed ergotism, which assumes two forms, one attended with convulsions, the other with dry gangrene of the limbs. Medicinal Uses. — From its action on the pregnant uterus, ergot has long been used in obstetric practice. With few exceptions ergot had better not be administered while any product of con- ception remains within the uterine cavity, because, while causing contraction of the muscular fibres of the fundus, which would produce expulsion of the uterine contents, it also causes con- traction of the sphincter-like fibres of the cervix, and thus pre- sents an obstacle to the emptying of the uterus. As the intermittent contractions of the uterus become continuous and tetanic under the influence of a large dose of ergot, it is obvious that rupture of the uterus may occur if the resistance offered to the expulsion of the uterine contents be sufficiently great. Partly on this account, and partly because the tetanic contraction of the uterus induced by ergot would interfere with the circulation of the fcetus, it should never be administered during the first stage of labor. During the second stage of labor, it may be given if the expulsive pains are feeble and inefficient (uterine inertia), when there is a proper conformation of the pelvis and soft parts , when the os uteri, vagina, and os externum are dilated or readily dilatable, and when the presentation of the child is such as to offer no great mechanical impediment to speedy delivery. In these cases it is best to administer it in small doses (^viij— x of the fluid extract), as when thus given it simply intensifies the natural ute- rine contractions without causing them to become continuous. It has also been used in the second stage of labor in women sub- ject to flooding, given just before delivery, but even in these cases it is better to withhold the drug until the placenta is expelled, as otherwise the uniform contraction induced may lead to its retention. After the third stage of labor is completed, if hemorrhage is likely to occur from uterine inertia, ergot is one of the best remedies we possess, as the tetanic contractions which it pro- duces permanently arrest the bleeding by compressing the orifices of the vessels. It has been used in the hemorrhage due to abortion, but as the bleeding will only stop when the uterine cavity is empty, and as ergot delays this by preventing dilata- SPINANTS ERGOT. 265 tion of the cervix, the tampon and other means are preferable. When, after an abortion, the placenta is retained by adhesions so firm that it is impossible to destroy them, a tampon may be employed and ergot given simultaneously. Ergot has also been used to cause the expulsion of polypi, and even of interstitial fibroids from the uterus. In speaking of its administration in the latter class of tumors, Emmet* says : " It should never be given in large doses until after the uterine canal has been dilated, and until it is found that the tumor projects sufficiently to warrant the belief that it may become pedunculated by uterine contrac- tion." By neglecting these precautions he has seen peritonitis produced. It is best to administer it hypodermically in these cases. In subinvolution, especially when menorrhagia is present, ergot combined with potassium bromide is useful. From its action on unstriped muscular fibres it is much employed in hemor- rhage generally; in gonorrhoea; congestive dysmenorrhcea ; paralysis of the bladder, especially when due to over-distention ; purpura ; diabetes insipidus ; and lately, with marked success, in hypertrophy of the prostate ; by hypodermic injection, in the cure of aneurism and varix, and as a means of checking broncho- pulmonary hemorrhage. It is also used in renal, intestinal, and uterine hemorrhage. In hematemesis it may also be employed, but is inferior to other remedies. In paralysis dependent upon congestion of the spinal cord in spinal meningitis, and in acute myelitis, it is often of great service. Ergot exercises a dangerous sedative influence on the child during labor (owing to the inter- ference of the passage of blood from the placenta during violent uterine contraction), and its use may sometimes produce foetal death, if the obstetrician is not careful to listen frequently to the foetal heart, and deliver with the forceps should any sign of asphyxia be present (Spiegelberg). Administration. — Ergot may be given in labor, in the dose of gr. v-xx, in powder, every twenty minutes, till its effects are produced, or three doses are taken : in other diseases the dose is from gr. iij-x. It may be safely given, in chronic diseases, for a long period, without danger of ergotism ; the indication of the maximum dose having been reached in the female is the produc- * " Princip. and Practice of Gynaecol.," 3d ed., p. 567. 266 MATERIA MEDICA NEUROTICS. tion of uterine colic, when the quantity should be diminished. The fluid extract is the best preparation ; dose, ^v-f5j or more.* The extract is made by evaporation of 500 parts of fluid extract over a water-bath at a temperature not exceeding 122 F. until it is reduced to 100 parts; dose, gr. v-xv. The wine (vinum ergotce) contains powdered ergot, 15 parts, in 100 parts by weight of the preparation. Dose, foj-iv. The preparations used under the name of ergotin are of uncertain strength. USTILAGO. Ustilago maydis {Nat. Ord. Fungi), Corn Smut or Corn Ergot, is a fungoid growth upon the Zea Mays or Indian Corn (Nat. Ord. Graminaceae). It has been known to exist for more than one hundred years, having bden described by Pujol f in the last century. It is found in irregular masses in the Northern States, J during the middle and latter part of summer, growing most fre- quently upon the young ears and tassels, the leaves being usually exempt, and consisting of a blackish gelatinous membrane, inclosing numerous dark globular and nodular spores, which break up like a great puff-ball, discharging a cloud of brownish impalpable dust of narcotic odor. It has a disagreeable odor and taste, and contains a fixed oil, probably sclerotic acid, a. crys- talline principle \ etc. (Maisch). J. Mitchell § has investigated its action upon frogs with the following results : By injection it induces tremors and clonic spasms ; increased doses cause irregular respiration, weakened muscular movements, spasms, palsy and death, the latter due to paralysis of respiration ; the heart continues to beat after life is apparently extinct. Lethal amounts abolish all movements, suspend reflex action, and contract the pupils. The suspension of reflex action is due to paralysis of the sensory part of the cord ; the motor tracts, too, being depressed. We have seen no * For hypodermic use, the fluid extract should be reduced by evaporation to one- sixth of its weight, and sixty grains of this extract should be dissolved in four flui- drachms of water ; four minims of this aqueous solution represent one grain of extract and six grains of ergot; or the fluid extract may be carefully filtered, and used in doses of rr^x ; or the extract may be dissolved in water and filtered ; it is five times as strong as the fluid extract. f Journ. de Medecine, 1774, I, p. H5« % Therap. Gaz., 1881, p. 121. Prof. Spalding. \ Ibidem, 1886, p. 223. SPINANTS BARK OF COTTON ROOT. 267 statement of its action on muscular fibre of either kind, though Dr. Steel* noticed that cows when turned into fields to feed aborted unless the corn smut had been removed, which indicates an action of contraction upon the muscular structure of the uterus. Its effects resemble those of ergot, and it has been successfully used in the same class of cases. (Midwifery — Drs. Vernon f and RouseJ.) Dose of the fluid extract (unofficinal), gtt. x-xx. GOSSYPII RADICIS CORTEX BARK OF COTTON ROOT. Gossypium herbaceum (Nat. Ord. Malvaceae) is a native of Asia, cultivated extensively in tropical and semi-tropical coun- tries, and with great success in the South Atlantic and Gulf districts of the United States. By cultivation, different varieties of this plant have been produced. The root should be collected immediately after the cotton is harvested, and the root-bark should be of a yellowish-brown color externally, internally much lighter ; when chewed, it has a slightly sweetish, astringent taste. It contains cliromogene (when fresh), becoming a red resin, a yellow resinous coloring matter, fixed oil, gum, sugar, tannic acid, etc. It has long been recognized by southern physicians as possessing decided influence in exciting uterine contractions. Dr. J. C. Martin,§ from experiments on frogs, rabbits, and guinea-pigs, concludes that it has no action on the motor or sensory nerves, nor on the reflex functions ; that the circulation and muscles are uninfluenced by it, and that it possesses no oxytocic properties. The most recent investigations, however, show that in large doses it kills by paralysis of respiration, often preceded by clonic convulsions not prevented by section of the cord ; the reflex centres of the cord are depressed, but the motor and sensory nerves are not affected. The blood-pressure falls, from depression or paralysis of the vaso-motor centres, this fall being preceded by a rise in pressure if the dose be small. In large amounts it causes great venous congestion and tension, stimulates and then paralyzes the cardio-inhibitory apparatus and depresses the * Trans. Wisconsin State Med. Society, 1878, p. 127. f Chicago Med. Times, II, 1879-80, p. 434. % Therap. Gaz., 1886, p. 163. § Am. Journ. Med. Sciences, Jan., 1882. An investigation of the physiological effects of Gossypium herbaceum. 268 MATERIA MEDICA NEUROTICS. cardio-motor ganglia, thus at first retarding and then accelerating the pulse, which is always weakened. The pupil is always dilated. It stimulates muscular action, especially that of the unstriated variety. It often causes vomiting and purging. In cats and rabbits, gossypium causes, in small and repeated doses, intermit- tent rhythmical contractions of the gravid uterus, leading to com-, plete expulsion of its contents, and it has been seen to increase the uterine contractions when administered after their inception.* Prochovnik finds it an efficient substitute for ergot, although its expulsive power is not so great. He recommends it especially in hemorrhage after abortion, and in uterine myoma. The only officinal preparation is the fluid extract (which, when first prepared, is of a brownish-yellow color, changing, however, to a bright red) ; dose, foss. Gossypium {Cottojt), the well-known filamentous sub- stance separated from the seed of the varieties of gossypium, is a useful application to burns and parts affected with erysipelas and rheumatism, and is much used as dressing in various surgical affections, and after operations. Impregnated with iodoform, it may be packed in the vagina as a tampon, in various hemor- rhages from the uterus (as in threatened abortion, etc.), or to give support and correct displacement in cases of version of the uterus. It is particularly adapted to those cases where, from inflamma- tion or tenderness of the parts, an ordinary pessary could not be worn. It is also impregnated with carbolic, salicylic, boric acid, or corrosive sublimate, for use as a surgical dressing. DIGITALIS. Digitalis purpurea, or Purple Foxglove {Nat. Ord. Scrophu- lariaceae), is a biennial European plant, cultivated in our gardens, with an erect stem three or four feet high, large ovate-lanceolate, crenate, downy and veiny leaves, of a dull green color, and handsome bell-shaped crimson or purple flowers, arranged in a large terminal spike. The seeds and leaves are both active, but the latter only are employed, from plants of the second year's growth; and those from the European wild plants are preferred, as the cultivated variety is thought to be inferior in virtue. The * " Gossypium Herbaceum." Thesis by Thos. Harry Huzza, M.D., awarded the Medical News Prize at the Jefferson Medical College, of Philadelphia, 1887. SPINANTS DIGITALIS. 26q petioles are removed, and the leaves are then dried in baskets, in a dark place, in a drying-stove. When dried, they have a dull- green color, with a faint odor and a bitter, nauseous taste, and afford a fine deep-green powder. Both leaves and powder should be preserved in well-stoppered bottles, covered externally with dark-colored paper, and kept in a dark cupboard, and, as their medicinal activity is impaired by keeping, they should be renewed annually. They contain several glucosides termed digitalin, digitoxin, and digitalein, which possess properties similar to those Fig. 20. DIGITALIS PURPUREA. A, LEAF ; B, FLOWERS. of the leaves ; digitonin, which is said to resemble saponin, but which differs from it in its behavior to chemical reagents ; and also some inosit, pectin, resin, etc. Digitalin and digitoxin are the most active ingredients of the plant. Digitalin, when perfectly pure, occurs as fine, white, glittering hygroscopic needles, or groups of crystalline tufts, odorless, but of a very bitter taste ; readily soluble in alcohol, chloroform and warm acetic acid, but nearly insoluble in water and ether ; dose, from -^q to -^q of a grain. A dose above gr. -^ causes purging and 270 MATERIA MEDICA NEUROTICS. vomiting. According to Woodman and Tidy about gr. y^ would prove fatal, and a toxic amount rarely kills in less than 24 hours. Physiological Effects. — Though the action of digitalis is directed chiefly to the circulatory apparatus, yet in lethal quantity other phenomena are induced, as follows. Nervous system : in toxic doses, digitalis lowers reflex activity by exciting Setschenow's inhibitory reflex centre, and, after a time, paralyzing the spinal cord (A. Weil), causing prostration, muscular tremors and some- times convulsions. Circulation — Its action here has been inves- tigated by Vulpian, Pelikan, Homolle,* Gaskell f and others, with the following results, viz. : that it lessens the number of cardiac pulsations, prolonging the diastole, energizing the systole ', and finally paralyzing the heart in systole ; this is produced by direct stimu- lation J of the cardiac muscle, and possibly of the contained motor ganglia, as well as of the peripheral inhibitory fibres of the pneu- mogastric. Moderate doses cause a rise in the arterial pressure, probably by contracting the arterioles, through stimulation of the vaso-motor centres of the cord; after large doses the pulse becomes dicrotic from irregular ventricular contraction ; toxic doses, or, when the heart is much depressed, a sudden change from the recumbent to the erect position, may cause a frequent, weak and small pulse, with lowered blood-pressure. An entirely satisfactory explanation of the modus operandi of digitalis on the circulatory apparatus has not so far been made. The influence of digitalis over the pulse is more,marked in weak and debilitated persons than in those who are robust and plethoric. Its effects, too, in this particular are more easily obtained in the recumbent than in the erect posture, owing to the less force required in the former position to carry on the circulation. In the repeated use of small doses of this medicine, a cumulative effect is sometimes observed : its powers are not manifested for a certain time, and effects are suddenly produced, which are attributable to the whole amount administered, giving rise to dangerous and even * Arch. Gen. de Medecine, XVIII, p. 5. Exper. physiol. sur quelques preparat. de digitale. f The Journ. of Physiology, III, p. 48. On the Tonicity of the Heart and Blood Vessels. % Proc. of the Royal Med. and Surg. Soc, 1, 1882-5. Investigations into the Action of the Digitalis Group. Ringer and Sainsbury. SPINANTS DIGITALIS. 2J\ fatal syncope. In morbid conditions of the circulation, where it is irritable, abnormally quick or irregular, digitalis is consid- ered to exercise a primary medicinal effect in steadying the pulse and restoring its force and regularity, while it diminishes morbid frequency. Where the temperature of the body is abnormally increased, digitalis, in large doses, will diminish it. From its action on unstriated muscular fibres, digitalis has the property of stimulating the uterus to contraction. As regards its diuretic action, it is probably rather indirect than direct, and is most conspicuous where dropsical effusions are removed under its influence. Brunton has, however, shown that in dropsies it acts directly on the Malpighian tufts, independent of the blood- pressure. It increases the amount of solids eliminated in the urine, except that of urea and uric acid, which are diminished under its use. When too long continued, or taken in excessive doses, digitalis acts as an acro-narcotic poison, producing vomit- ing, purging, irregular, feeble and rapid cardiac action, severe abdominal pains, vertigo, disordered vision, dilated pupils, syn- cope, and finally delirium and stupor, death being usually pre- ceded by convulsions. In such cases, after evacuating the stomach, the diffusible stimuli, as brandy and ammonium car- bonate, should be administered. Opium, aconite, etc., antagonize to some extent the action of digitalis; the most complete antago- nism exists between digitalis and saponin, the active principle of Saponaria officinalis (Kohler). The quantity of digitalis, how- ever, that may be given, especially in disease, without destroying life, is considerable. Chemical analysis affords no certain tests of the presence of digitalis or its active principle, even Grandeau's method of isolating digitalin by dialysis being uncertain, and in cases of suspected poisoning the physiological test must be resorted to. This, however, is not proof positive of its presence, for Fagge and Stevenson* have shown that digitalis is only one of a small class of substances (as helleborus viridis and scilla) the action of which on the frog's heart appears to be identical. These they termed cardiac poisons. In every experiment they caused cardiac irregularity, followed by stoppage of its pulsa- * Proc. Royal Society, xiv, p. 270. On the Application of Physiological Tests for Certain Organic Poisons, especially Digitaline. 272 MATERIA MEDICA NEUROTICS. tions in rigid ventricidar contraction. In the celebrated Pomme- rais case, the criminal was condemned from the evidence derived from the administration of an extract obtained from the stomach and bowels of the deceased party, to small animals, in whom were produced vomiting and marked diminution of the number of heart-beats, with intermittent and irregular action. Medicinal Uses. — From its action on the circulation, digitalis has been used in adynamic fevers and inflammations, and in hemorrhages, especially in menorrhagia, metrorrhagia, and post- partum hemorrhages. In hectic fever, it is often combined with quinine, and if it do not disorder the digestion, it is generally of great value: 1^ Quininae sulphatis, gr. xxiv; pulveris digitalis, gr. viij ; pulveris opii, gr. yj. M. et ft. pil. xxiv. Sig. — Take one pill 3 or 4 times a day. In fevers accompanied by a high temperature, as scarlatina and typhoid fever, it is specially useful. In the treatment of diseases of the heart and great ves- sels, it is a remedy of the greatest value, but it is to be prescribed with discrimination. In dilatation of the heart, in fatty degenera- tion, and in irritability of heart-action generally, digitalis, by increasing the force of the cardiac contractions and by abating irregular movement, is always useful ; in uncomplicated hyper- trophy it is objectionable. In cases of sudden cardiac failure from any cause, a hypodermic injection of the tincture ig£x— xx, repeated, if necessary, in half an hour, may be advantageously administered. H. C. Wood states that he has never seen any severe local irritation follow this use of the tincture, which also accords with our observations in several cases (H. M.). In valv- ular, especially mitral, disease, as well as aortic constriction, if the heart's action be feeble, it is indicated. It is greatly esteemed in the treatment of dropsy ; and in the varieties of this disorder resulting from heart disease the infusion of digitalis is more employed than any other remedy, from its combined cardiac and diuretic influence. In these conditions it may often be advan- tageously combined with iron. 3^ Pulveris digitalis, gr. xv; ferri sulphatis exsiccati, gr. x; quininae sulphatis, gr. xx ; oleo- resinae capsici, gr. iij. M. et ft. pil. xx. Sig. — Take one pill three times a day ; or the infusion may be alternated with a mixture containing tincture of ferric chloride. It is a valuable remedy in acute desquamative nephritis, especially when dropsy is present, SPINANTS — ADONIDIN. 273 and also in granular degeneration of the kidney under like cir- cumstances. In delirium tremens, digitalis has been given in large doses, with excellent effect. It is thought that a physio- logical antagonism exists between digitalin and the alkaloids aconitine, delphinine and muscarine. Administration. — Digitalis may be given in powder, of which the dose is gr. j two or three times a day, to be gradually increased. The officinal preparations are the abstract, dose, gr. ss-j ; the infusion (powdered digitalis and cinnamon each 3 parts, macerated in 185 parts of boiling water for 2 hours, then strained and 15 parts of alcohol passed through the strainer, and water enough to make 200 parts), dose, f3ij-iv; the tincture, dose, ^v- foj ; the extract (alcoholic), dose, gr. J^, gradually increased; the fluid extract, dose, *xj to begin with. If digitalis produce wake- fulness, a little opium may be combined with it. ADONIDIN. Adonidin (not officinal) is a glucoside, obtained from the root of Adonis vernalis (Nat. Ord. Ranunculacese), a plant of central Europe. It was first isolated by Cervello,* and is an amorphous substance, odorless, colorless, but having an intensely bitter taste, soluble in alcohol, but slightly soluble in ether and waterf. Effects and Uses.-— Adonidin is almost identical in action with digitalis^, strengthening the cardiac energy, while diminishing its frequency by prolonging the diastole, thus allowing the engorged veins time to empty themselves, and at the same time raising the arterial tension by contracting the arterioles. It acts more quickly on the heart than does digitalis, and is not so apt to dis- order the stomach and bowels (Cervello ; Durand), although these effects are sometimes observed. According to most authorities it possesses considerable diu- retic powers, increasing both the water and the solids of the urine. It is rapidly eliminated, and has no cumulative action * Archiv fur Experiment. Pathol, und Pharmakol., 1882, p. 338. f " Poisons; their Effects and Detection," by Alexander Wynter Blyth. Am. Ed., p. 396. X V. Cervello, op. cit. and La Mid. Contemp., July and Aug., 1885. E. Durand, Journ. de Med., Dec, 1885 and These de Paris, 1886. Bubnow, Centralbl. fur die gesammte Therapie, 1885. Houchard, Gaz. J/ebdo/nadaire, ]a.n. 1st, 1886. 18 274 MATERIA MEDICA NEUROTICS. (Cervello). According to Hare,* in all doses it increases the arterial tension by stimulating the vaso-motor centres and increas- ing the force of the cardiac contractions ; large doses slow the heart by stimulating the vagus, which finally becomes paralyzed, the pulse rate being then accelerated. Adonidin may be used for the same purposes as digitalis, to which, however, it is inferior. When the latter is contra- indicated from some idiosyncrasy on the part of the patient, or when it disorders the stomach, or if its action be not sufficiently rapid, adonidin may be substituted with advantage. It may, too, be alternated with digitalis, giving either for a few weeks at a time. Dose, gr. y&—yi in compressed pill or capsule. STROPHANTUS. Strophantus (not officinal) is the seed of the Strophantus his- pidus {Nat. Ord. Apocynaceae), a plant distributed along the coast of Africa, between Senegambia and Lower Guinea. It is described by Blondel f as a branchy bush growing to the height of three or four metres, which gives off yellowish-white flowers, appearing in April or May, arranged in terminal cymes. The seeds are contained in a thin cylindrical pod, the length of which varies between 25 and 50 centimetres. They are from 10 to 14 millimetres in length and consist of a tiny tuft supported on a slender stalk. These seed, coarsely powdered and made into a paste, are used by the natives to poison their arrows, and are called Combe, Kombe, or Inee. From strophantus Dr. Thomas B. FraserJ has isolated a crystalline glucoside, which he calls strophantin, and to which the effects of the seeds are due. It is non-nitrogenous ; of a strongly-bitter taste and feebly-acid reaction, and is freely soluble in water and in rectified spirits, but not in ether. Effects and Uses — Pelikan in 1865 called attention to stro- phantus as a powerful cardiac poison, and his researches were confirmed by Fraser§, Corville||, and others. When introduced * Therap. Gaz.,Apv. 15th, 1886. f Bull. Gen. de Therap., Fevrier, 1888, p. 97. % Brit. Med. Jour., Nov. 14th, 1885. \ Op. cit.; also Proc. Royal Soc, 1879 ; Journ. Anat. and Phys., 1 872; Brit. Med. Jour., Jan. 22d, 1 887, and a monograph by Fraser " on the action of the digitalis group," containing a reprint of foregoing articles. || Med. Digest, Sec. 393; I, 1872. SPINANTS SPARTEINE. 2J^ into the system it increases the strength of the cardiac systole, while prolonging the diastole, and in over-doses arrests the heart in rigid systolic contraction. It is a muscle-poison, increasing the contractile power of all striated muscles, and renders their contractions more complete and prolonged, but the heart is easier influenced by it than are other muscles, and the dose may be so regulated that the cardiac effects are alone produced. It also contracts the arterioles somewhat, but not to the same extent as does digitalis. It produces a slight lowering of temperature and is a diuretic* It rarely causes vomiting and has no cumulative action. Strophantus, or strophantin has been used as a substitute for digitalis when the latter disagreed, or was objectionable from its effect in contracting the arterioles and thus throwing more work on an already overtaxed heart. A tincture (i to 20 parts by weight) is recommended by Prof. Fraser, of which the dose is f^j-xx, t. d. Of strophantin, gr. 1 ^ ^ may be given hypodermically. SPARTEINE. Sparteine (C 15 H 26 N 2 ) is an alkaloid obtained from Sarothamnus Scoparius, or Broom {Nat. Ord. Leguminosae), and occurs as a strongly alkaline, dense oily liquid, but slightly soluble in water, readily soluble in alcohol, ether and chloroform, having an intensely bitter taste and an aniline -like odor. It combines readily with acids to form salts, which are preferred for medi- cinal use because they are more readily soluble. Effects and Uses. — Like the other members of the digitalis group, sparteine is a cardiac tonic, acting through the central nervous system, increasing the intensity and persistence of the ventricular contractions and regulating cardiac rhythm. f In large doses it completely paralyzes the motor nerves and diminishes reflex action (Fick). It does not appear to affect muscular contractility. Sparteine is probably not the diuretic principle of Scoparius, and according to most observers has no effect on the urine, although Fick asserts that it increases diuresis. * Bull. Gen. de Therap., Aout 23d, 1888, Lemoine. -j- Archiv fur Experiment. Pathol, tmd Pharmakol., Fick. Band I, p. 397. Thise, Montpellier, 1887; " La Sparteine et ses Sels," par P. Dandrieu. Gaz. Hebdom., Nov. 27th, 1885, Germain See, et al. 276 MATERIA MEDICA NEUROTICS. It does not disorder the stomach, has no cumulative action, and acts on the heart more promptly than digitalis (See). In over- doses it is capable of causing a fatal result, death being due to paralysis of the respiratory centre, and preceded by a stage of excitement, quickly followed by collapse. Poisoning from spar- teine should be treated by artificial respiration and electricity applied over the vagi. When it has been taken by the mouth in the form of sulphate, potassic iodide should be administered, as in the presence of water this seems to form an almost insolu- ble salt (Dandrieu), and in any event elimination should be favored by diuretics and diluents. // has been used with success in cases of weak, feeble and irregular heart, particularly when the cardiac rhythm is disturbed. It has also been used as a substitute for digitalis in cardiac dropsy and in cardiac dyspnoea, but that it can fully replace digitalis in the treatment of heart affections is yet not fully established. As its action is more rapid than digitalis, it may be used when prompt results are required, and thus gain the time necessary for the influence of the digitalis to manifest itself. The sulphate is the salt usually preferred and may be given in doses of gr. ss-ij t. d., in pill, capsule or solution. It is also used hypodermically. CIMICIFUGA. Cimicifuga racemosa, Black Snakeroot, or Cohosh (Nat. Ord. Ranunculaceae), is a very common indigenous perennial plant, growing to the height of from four to eight feet, with ternate leaves, oblong-ovate, incised and toothed leaflets, and small white flowers disposed in a long raceme. The rhizome and rootlets are the parts employed. The rhizome is a rugged, blackish- brown caudex, from a third of an inch to an inch in thickness, often several inches in length, furnished with numerous slender rootlets. Internally its color is whitish ; it has a peculiar faint, disagreeable odor and a bitter, somewhat astringent, taste. It imparts its virtues to boiling water, and contains gum, starch, two resins, tannic and gallic acids, and a volatile oil. The active prin- ciple has not yet been isolated, nor has a crystalline proximate substance been found.* * " Lloyd's Drugs and Med. of North America," Vol. I, p. 266. SPINANTS CIMICIFUGA. 2/7 Effects cmd Uses. — The effects of cimicifuga are not very accu- rately known. After large doses, vertigo, dilated pupil, and often hypnotic and anodyne effects are seen. On the circulation its effects are similar to, but less powerful than, those of digi- talis, as it slows the cardiac beat, while increasing the strength Fig. CIMICIFUGA RACEMOSA. of its contraction, and raising the arterial tension. It is undoubt- edly an active stimulant of the secretions, particularly those of the skin, mucous membranes and kidneys. It acts also on the uterus and unstriped muscles like ergot, but less powerfully. It increases the sexual appetite of the male and promotes the 278 MATERIA MEDICA NEUROTICS. menstrual flow of the female. It has been prescribed with advantage as an expectorant in chronic bronchial affections, and even in caseous pneumonia and phthsis. In fatty heart it is safer than digitalis, and may be used in dilated heart, languid circulation and oppressed breathing. It has also been used as a diaphoretic in rheumatism and as a diuretic in dropsies. As an antispasmodic in chorea it enjoys a high reputation. In the relief of after-pains, and in menorrhagia it is frequently of service, and it is a good remedy in subinvolution of the uterus. Administration. — Dose, in powder, gr. xx-5j. Of the fluid extract or tincture the dose is f5ss-j or ij. DEPRESSO-MOTORS. CONIUM. Conium maculatum, or Hemlock {Nat. Ord. Umbelliferse), is a biennial European plant, naturalized in many parts of the Fig. 22 CONIUM MACULATUM. United States. Its stem is erect, from three to five feet high. The leaves are large and bright green ; the flowers are small, SPINANTS CONIUM. 279 white, and arranged in umbels. The whole plant is narcotic and virulent, and has a fetid, heavy odor. The full-grown fruit (gathered while yet green, and carefully dried) is the only portion used. It has a yellowish-gray color ; a feeble odor, and a bitterish taste ; it is roundish ovate, a line and a half in length by a line in breadth, and striated. The active principle of hemlock is an alkaloid termed conine (C 8 H 15 N), which exists in larger proportion in the seeds than in the leaves. It is a colorless, transparent, volatile, oily fluid, of a peculiar repulsive, suffocating, mouse-like odor and a bitterish taste, sparingly soluble in water, and freely so in alcohol, ether and chloroform, and undergoes decomposition upon exposure to the air. It is a highly energetic poison, even in very small quantity; the dose of it is gr. -^. Other alkaloids, termed conhydrine (C 8 H 17 NO) and methylconine (C 8 H 14 CH 3 N), have been isolated ; all probably exist as malates. Conine combines with acids to form salts and unites with water as a hydrate. Physiological Effects. — The following account is based on the investigations of Lautenbach * (chiefly) and Hubert-Valleroux.f Local action : conine applied to a part produces loss of function of the tissues with which it is brought in contact. Nervous system : hemlock has but little influence upon the cerebral hemi- spheres, for in cases of poisoning from it, consciousness has been preserved to the last. A full medicinal dose induces the following effects : a sense of muscular fatigue and feebleness of the legs is felt, the eyelids droop, and vision becomes impaired, accompanied by dilatation of the pupil. In lethal doses conium causes paralysis, which is due to a paralyzing influence on the terminal extremities of the motor nerves. It impairs the con- ductivity of the sensory nerves, while its action on the cord is one of progressive depression (Lautenbach). The circulation is at first accelerated, then retarded, but further investigation is here required. The arterial pressure is at first lowered, and then decidedly raised ; the respiratory movements are not altered unless a poisonous dose has been taken, when the respiratory * Trans. Acad. Nat. Sci., Phila., 1875, p. 367 ; The Phys. action of hemlock and its alkaloid. f Arch. Gen. de Medecine 6 e ser. t. xvi, p. 83. De la cigue at son action phys. et Therap. 280 MATERIA MEDICA NEUROTICS. centre is paralyzed and death ensues from asphyxia. Tempera- ture : some lowering of the animal heat has been noted ; but this, lately, has been denied by Lautenbach. Secretions : conium has no action on the glandular organs, except the salivary glands, the discharge from which it increases. Elimination : hemlock is eliminated in part by the urine, as it has been found there. Orfila detected it in the spleen, kidneys, and lungs. In large doses it causes nausea, vertigo, dimness of vision, relaxation of the muscles ; and in poisonous quantities, dilata- tion of the pupils, difficulty of speech, delirium or coma, paralysis, and finally convulsions (of cerebral origin) and death. It has no direct hypnotic effect. Like woorara, its characteristic physiological effect is the production of pure motor paralysis, begin- ning in the extremities and extending to the trunk, involving chiefly the terminal nerve-endings. In cases of poisoning, alco- holic stimuli are to be given, and as physiological antidotes, the tetanizing agents, as strychniue. Medicinal Uses. — It is employed as a general and topical ano- dyne, to relieve the pain of malignant tumors ; and, even if des- titute of the deobstruent powers which have been ascribed to it, it certainly exerts a remarkably palliative influence upon painful chronic indurations. It has also been recommended as an anti- spasmodic in whooping-cough, asthma, paralysis agitans, and as an anodyne in neuralgia ; as an adjuvant to other remedies in mania, and especially in melancholia; to moderate irritability of the sexual organs ; in diabetes ; to relieve the blepharospasm of many acute inflammations of the eye ; and it is used externally as a cataplasm to cancerous and irritable ulcers. Conium is quickly absorbed, and is eliminated with equal rapidity ; hence its effects are speedily induced, and are of brief duration. It is the cicuta of Hippocrates, Galen, and Pliny, and is supposed to have been the poison administered to Socrates and Phocion. Administration. — The dose of the powder, gr. ss-j. The extract {alcoholic) may be given in the same doses. An abstract is also officinal; dose, gr. %-). A tincture (dose f5ss-j) and a fluid extract are also used; of the flidd extract, in preparing which hydrochloric acid is employed to fix the alkaloid conine, the dose is i^iv-v, gradually increased until some effect is obtained. SPINANTS — PHYSOSTIGMA. 28 1 The preparations of conium are uncertain, from the fact that the active principle is very volatile and easily escapes. Probably the best preparation is the fluid extract. PHYSOSTIGMA. Physostigma or Calabar Bean is the seed of Physostigma venenosum (Nat. Ord. Leguminosae), a perennial climbing plant of the western coast of Africa. The seed is about the size of a large horse-bean, irregularly kidney-form in shape, with a hard, brittle integument, and of a dark chocolate-brown color. The inner kernel is by far the more active portion. Alcohol, but not water, extracts its medicinal virtues. It yields an active alkaloid, termed eserine or physostigmine (Q5H21N3O2) sparingly soluble in water, but more soluble in alcohol, ether, and chloroform ; and Fig. 2^. CALABAR BEAN. recently another alkaloid, termed calabarine, which is believed to be a tetanizing agent, has been found in it in variable amount. The Calabar bean has long been used among the negroes of western Africa as an ordeal to determine the guilt or innocence of accused individuals, whence its name, the ordeal bean of Calabar. Physiological Effects. — It has been found, in full medicinal doses, to produce giddiness, torpor, paleness and coolness of the surface, weak and irregular pulse, relaxation of the muscular system, and drowsiness, but not stupor. An interesting effect of its action is a remarkable power of contracting the pupil, whether taken internally or applied externally ; its seems probable that this is accomplished by a local peripheral action — i. e., paralysis of the sympathetic terminals and stimulation of the oculo- motor fibres in the iris ; and it also contracts the ciliary muscle, which regulates the accommodating power of the eye. Ner- 282 MATERIA MEDICA NEUROTICS. vous system : the brain is not directly affected by Calabar bean, the paralysis induced by it being due to a depressing action upon the spinal cord. In proof of this statement can be offered the fact that the muscular contractility and irritability of the motor and sensibility of the sensory nerves remains unimpaired in cases of poisoning by physostigma. The local application of a strong solution abolishes the functions of both kinds of. nerves (Fraser).* Lethal doses of physostigma cause total loss of reflex activity in the cord. Circulation : small doses of physos- tigma retard the heart's action by lengthening the diastolic pause, while toxic doses arrest it in diastole, but before the movements are extinguished there is a marked fall in blood pressure. The stoppage is probably due to paralysis of the cardiac ganglia. Respiration : toxic doses of physostigma cause slowing of these movements, and eventually they are abolished, death ensuing from asphyxia. Intestines : Calabar bean increases decidedly intestinal peristalsis. Increase of the salivary secretion has been observed. A poisonous dose of physostigma in man causes nausea, giddiness, muscular weakness and tremors, dimin- ished heart action, abolition of reflex action, slow respiration, myosis and motor-paralysis. It is allied in its effects to woorara and conium, but differs from them in its tendency to produce muscular twitchings, and contraction of the pupil. In cases of poisoning, after emptying the stomach, the hypodermic admin- istration of a solution of atropine is the best physiological antidote. Chloral mitigates the symptoms. Medicinal Uses. — Calabar bean has been found highly effica- cious in traumatic tetanus, but it must be given in doses large enough to attain decided effects. Fraser advises the exhibition of eserine hypodermically, in severe cases. It has been used also with success in chorea, in poisoning from strychnine, and in spasmodic cholera. In ophthalmic surgery its employment is obvious, either to produce contraction of the pupil or to increase the power of accommodating the eye to distances. The dose of the kernel is laid down as gr. ij-iij, to begin with, gradually increased. By exhausting the kernel with alco- * For an elaborate account of the action of Calabar bean, consult Dr. T. R. Fraser's Thesis, 1863. SPINANTS CHLORAL. 283 hol, and subsequent evaporation, an extract is obtained, of whfch the dose is gr. y&. A good form of administration is the tinc- ture (100 parts contain io parts of powder) ; dose, n^v-xv ; or a solution in glycerin may be used. Eserine itself, or as a salt, one part to a thousand in solution, may be applied to the eye ; dose, internally, gr. ^ ^ 2 . Physostigmince salicylas is officinal. It is the most stable salt of the alkaloid, but its slight solubility in water renders it of little value for hypodermic injection. Dose, gr. £ b ^ 2 (Stille and Maisch). Gelatin-disks are now much used in ophthalmic practice. CHLORAL. This interesting compound, although discovered by Liebig in 1832, has attracted attention as a therapeutic agent only since the statements of Liebreich, a physician of Prussia, pub- lished in May, 1869. It is prepared by passing dried chlorine gas through pure anhydrous alcohol, afterward gently heating, when the liquid separates into two layers, the lower of which is chloral ; this is agitated with sulphuric acid, and purified by distillation, first over sulphuric acid and then over quicklime ; the reaction, upon which the formation of chloral depends, in this process, is complicated, chloral and hydrochloric acids being the chief products. Anhydrous chloral (C 2 HC1 3 0) is a thin, limpid, oily, colorless liquid, greasy to the touch, with a fatty taste, and a strong pungent smell, producing lachryma- tion. Chemically, it is classed with the halogen aldehydes. It has a sp. gr. of 1.502, a boiling point of 203 F., and mixes in all proportions with water, alcohol, ether and chloroform. Mixed with one-eighth its weight of distilled water, it combines to form a so-called hydrate (C 2 HC1 3 0,H 2 0), for it contains an entire molecule of water, which crystallizes in a mass of snow- white needles, soluble in their own weight of water ; and, as pure chloral readily undergoes decomposition, the more stable hydrate is the form which is employed for medicinal use. It is incompatible with the alkalies, which decompose it into formic acid and chloroform. Chloral combines also with alcohol, forming a compound termed Chloral Alcoholate, which resembles the hydrate, but is 284 MATERIA MEDICA NEUROTICS. distinguishable by its insolubility in water and its solubility in cold chloroform. Effects and Uses. — Chloral has decided antiseptic properties, as pointed out by Keen ;* and it is also an irritant. Nervous system : in doses of 20 grains, chloral is a most reliable hypnotic, the sleep being usually quiet, natural, and refreshing.f Gener- ally, no unpleasant effects follow its employment, though occa- sionally headache and slight nausea supervene. According to Hammond, chloral causes cerebral anaemia, the brain being in this condition when chloral-sleep sets in. In medicinal doses, it is not a pain-relieving agent, in the way that opium is. In hypnotic doses, it slightly contracts the pupil. Da CostaJ states that it has no special action on the secretions, except some augmentation of the urine, and it is probably eliminated by the kidneys. When larger amounts are given, the sleep is deeper, and may pass into coma ; the respiration is slower ; the pulse is reduced in fullness and frequency, the arterial tension being lowered ; the temperature is reduced ; the muscular system is relaxed ; and both sensibility and reflex actioji are abolished, the latter being brought about by a direct action on the spinal cord, since chloral does not affect the motor nerves nor muscular con- tractility. Ringer§ found that it affected the cardiac tissues directly and ultimately stopped the heart in diastole, the contrac- tility of the muscle-substance being extinguished by it. Large amounts may be taken without fatal results, as 460 grains have been given without unpleasant effects, though gr. xx, in three cases, proved poisonous, and gr. xxx killed an adult female || ; The symptoms of poisoning are profound sleep, diminished fre- quency of the respiration and circulation, redness of the con- junctiva, contraction of the pupils, lividity of the lips, and falling of the jaw, with occasional eruptions of the skin. Death takes place probably from sudden failure of the heart's action, which stops in diastole, or from paralysis of the respiratory centre. * Amer. Jour. Med. Set., July, 1875. f Bull. Gen. de Tkerap., lxxvii, p. 307, Demarquay. % Am. Jour. Med. Set., April, 1870, p. 309. Clinical notes on chloral. \ Brit. Med. Jour., March 10th, 1883. Experimental investigation on the action of chloral, etc. || The Lancet, March 25th, 1871, 403. SPINANTS CHLORAL. 285 The treatment of chloral-poisoning is much the same as that pursued in opium-poisoning ; artificial respiration should always be resorted to before the respirations cease. Strychnine has been recommended to prevent cardiac failure, but according to Dr. Kobert, while chloral is the best antidote for poisoning by strychnine, their antagonism is not reciprocal, as the latter neither prevents the respiratory arrest, nor counteracts the de- pressing effect of chloral on the heart, nor prevents the lowering of the bodily heat. Atropine is probably the best antidote in cases of chloral-poisoning ; it should be given frequently, guided by the respiration, and the temperature of the body should be maintained by the application of dry heat. It was formerly asserted that chloral is decomposed in the blood by the liberation of chloroform ; but this is not the case, as Amory has proved,* for no chloroform could be detected in the breath or blood of a dog poisoned by chloral, but on introducing chloroform by enemas this drug was found in the blood and respired air at once. Chloral is a most valuable hypnotic remedy in all the forms of insomnia, in hysterical excitement, in acute mania, and in delirium tremens. As an antispasmodic, large doses are re- quired. It has been used with advantage in infantile convul- sions, and even in puerperal and uraemic convulsions, both by the mouth and hypodermically, and it is especially recommended in the relief of rigid os during labor. In sea-sickness it is highly recommended, though nothing is of much service in this com- plaint. In tetanus, much success has been obtained with chloral, in ten-grain doses every two hours. In whooping-cough, chorea, etc., it has also been employed with advantage, and as an antidote for strychnine. As an anodyne it is available, but only in narcotic amounts. The ordinary dose of chloral is 20 grains, which may be safely repeated every hour or two, till three doses have been taken or sleep occurs. An equal weight of chloral hydrate added to powdered camphor makes a valuable local anaesthetic liquid. Chloral is administered only in aqueous solution, and the addi- * N. Y. Med.Joum.yXV, 1872, 606 ; also Journal de Panatotnie et de laphysiologie, 1870-71, p. 570. 286 MATERIA MEDICA NEUROTICS. tion of mucilage or syrup, particularly of the syrup of orange- peel, will disguise its unpleasant taste. It is not well adapted to the hypodermic method, as painful phlegmons sometimes follow its repeated use. Locally, in dilution (gr. x to f§j of water), or as an ointment (5ss to §j), it is a good stimulant and deodorizing application to foul and fetid indolent ulcers ; as an injection in gonorrhoea (gr. xx to f§j of water), it answers well; and injected into subjects for the dissecting room (Keen, loc. cit.), and in the preservation of anatomical preparations, it has been also found useful (gr. xl to fSj of water). Croton-Chloral Hydrate (more correctly termed butyl- chloral hydrate) (C 4 H 5 C1 3 0.H 2 0) is made by the action of chlo- rine upon ethylic aldehyde, and, when pure, occurs in beautiful white, silvery crystals, with a sweetish melon flavor, only slightly soluble in water. Its action is similar to chloral, though thought to be feebler ; in addition it causes anaesthesia of the head. It is useful as an anodyne in neuralgia, and also in chronic cough, in doses of from gr. xv-xx, dissolved in glycerin and syrup. POTASSII BROMIDUM POTASSIUM BROMIDE. Potassium bromide (KBr) is prepared by adding a solution of pure potassium carbonate to a solution of ferrous bromide. The iron is precipitated, and the potassium bromide remains in solu- tion, from which it is obtained by evaporation. It occurs as a permanent, colorless, anhydrous, crystalline salt, of a pungent, saline taste, very soluble in water, and slightly so in alcohol. When mixed with starch, a yellow color is developed on the addition of chlorine. A bluish tint shows the presence of an iodide. The statement of the action of potassium bromide is based on the investigations of Amory,* Bill,f Nuneley,J Bartholow,§ Lasegue,|| Damourette et Pelvet.T Physiological Effects. — Local action : when applied locally to the pharyngeal mucous membrane, it is said to lessen the reflex * Pamphlet, 1869. " Exper. upon the Phys. Action of Bromide of Potassium, etc." f Am. J. Med. Sci., July, 1868. % The Practitioner, III, 347. \ Pamphlet, 16 pp. " Exp. Investigation into the Actions and Uses of the Bromide of Potassium." || Arch. Gen. de Medecine, t. VI, 6th Ser., p. 81. \ Bull. Gen. de Thirap., LXXin, pp. 241, 289. SPINANTS POTASSIUM BROMIDE. 287 irritability of the part. Nervous system : when applied locally to the motor nerves and spinal centres of the frog, potassium bromide destroys their functions. This action, however, is prob- ably due to the potassium which it contains (Ringer), and is shared by other potassium salts. When administered internally (in animals), the irritability of the brain is decreased, owing in great part to the anaemia caused by the action of the drug upon the vaso-motor nerves which govern the calibre of the vessels. Reflex irritability is diminished, partly on account of the para- lyzing influence exerted on the reflex functions of the cord, and in part from paralysis of the end-organs of the peripheral nerves ; on the latter account, also, cutaneous sensibility is lessened. It possesses a sedative action on the sympathetic system, giving rise to diminished cardiac action, decrease in the blood supply to various organs, and slight reduction in the temperature of the body. Circulation : topically applied to the heart (and volun- tary muscles), it destroys their functions, as in the case of the topical application to the nervous centres, and probably for the same reason. In very large doses it lessens the frequency and force of the cardiac contractions, shortening the systole, pro- longing the diastole, and, finally, paralyzing the heart in diastole. The tension of the arterial system is lowered. Respiration : it slows respiration and causes death by arrest of the respiratory centres (Ott). Temperature : in warm-blooded animals, toxic doses lower very decidedly the temperature, probably due to a direct checking of tissue changes. Secretion : at first the secre- tions and excretions are diminished, but, later, they are increased in amount. If a very large dose is taken, they are increased primarily. No lachrymation, salivation, or catarrh is produced, as after the administration of the iodides. After large doses, micturition is less frequent, because the vesical irritability is diminished, — not because the amount of urine is decreased. A very large dose may paralyze the sphincter and produce incon- tinence of urine. The amount of urea eliminated is diminished as is, also, the amount of carbonic acid exhaled from the lungs, and the perspiration is decreased. In man, the action of the bromides is similar to the action in animals ; the cerebral symptoms being, however, more marked, because of the greater development of the hemispheres. When 288 MATERIA MEDICA NEUROTICS. long continued, potassium bromide exerts a very marked depressing effect upon the sexual functions, enfeebling their vigor, and with it the sexual appetite. These symptoms pass away when the drug is withheld. When considerable doses are given for a long period, a train of symptoms is produced to which the name bromism is applied. These are mental weakness, great drowsiness, failure of memory, anaemia, malnutrition and depression of spirits, with, often, impaired sensibility of the mucous and cutaneous surfaces, diminution of the sexual func- tions, and an eruption on the skin (generally on the face and back), usually of acne, which rarely suppurates, occasionally of eczema, and, very rarely, rupial ulcers may be seen. Elimina- tion : potassium bromide is eliminated chiefly by the kidneys ; but also by the mucous membranes of the fauces, intestinal canal and bronchi, by the skin, and by the salivary glands. It is absorbed by the blood rapidly (Bartholow, lac. cit.) as traces may be found in the urine ten minutes after its administration, but elimination is slow. According to Amory (lac. cit), it passes out, when given in medicinal doses, undecomposed, by the skin and kidneys. No case of acute poisoning by potassium bromide has been reported. Antagonists and Incompatibles. — Acids, acidulous and metallic salts are incompatible with potassium bromide. It is antagonized in its physiological action by alcohol, ether, coffee, cold, digitalis, strychnine, belladonna, ergot, and other remedies which stimu- late the vaso-motor nerves and induce arterial congestion. It is aided in its action on the brain by cannabis indica, chloral, opium, and similar remedies ; the depressing effects on the cir- culation are enhanced by aconite, veratrum viride, gelsemium, etc. Medicinal Uses. — From its action on the nervous system, potassium bromide is much used to quiet cerebral excitement and for its sedative effect on the reflex centres of the cord. As a narcotic (by causing anaemia of the brain), it is much used in wakefulness due to cerebral hypersemia, or even when not more than the normal amount of blood is sent to the brain ; in wake- fulness and wandering during convalescence from acute diseases ; and in sleeplessness due to worry, grief, dyspepsia, and over- work ; also in cases of night-horror in children, where they SPINANTS POTASSIUM BROMIDE. 289 awake suddenly and scream with fright, often for a considerable time, small doses of this salt and a light supper will frequently effect a cure ; adults subject to nightmare will find relief, too, in the temporary use of potassium bromide ; to allay restlessness, remove delusions, calm delirium, and produce sleep in the early stages of delirium tremens, it is given in doses of gr. xx to xxx every two hours until sleep is produced. It is more efficient in the early stages, and can be relied on with more certainty in the first than in subsequent attacks. Potassium bromide is often combined with other narcotics, as opium, chloral, etc., to aid their action, and even to modify their disagreeable effects. It will generally prove beneficial in women suffering from nervousness ; great despondency, amounting to a feeling of approaching madness ; irritability ; lack of interest in their surroundings ; sleeplessness and harassing dreams, caused by overwork, want of change, grief, or worry. If the medicine does not succeed alone, it will when combined with a change of scene. In some cases of hysteria, potassium bromide is a valuable remedy. In all forms of convulsions (epilepsy, chorea, convulsions of Bright's disease, convulsions of children, etc.) it will prove beneficial, by diminishing the reflex function of the cord. In epilepsy the bromides are preeminently of service, lessening the frequency of the attacks, if not absolutely preventing their recurrence. It is stated by Trousseau and by Bartholow that it is less efficient in attacks of petit mal than in those of severer form ; but Dr. A. Hughes Bennett has recently published a number of cases of the lighter variety, in the majority of which the bromides proved successful. It should be given in doses sufficient to prevent reflex retching or nausea, when the fauces are tickled (Voisin), and must be continued for years, with an occasional intermission of a week or two. Potassium bromide has been successfully used in the treat- ment of strychnine-poisoning; it should be given in doses of 5ij, frequently repeated, as the case may require. It has also been successfully used in tetanus. It has been recommended during dentition, to allay irritability and restlessness and prevent convul- sions. In the reflex forms of vomiting, as the vomiting of preg- nancy and of sea-sickness, and in migraine or sick headache 19 29O MATERIA MEDICA NEUROTICS. (especially in the congestive forms), it is sometimes beneficial In the colic of infants, unaccompanied by diarrhoea, it is an excellent remedy, relieving pain and spasm, and producing sleep. It is used, too, in large doses, 5j or more, to obtund the sensibility of the fauces, before the exhibition of the laryngoscope, but this is going out of fashion since the introduction of cocaine. From its sedative influence on the organs of generation, it is used with success in nymphomania, spermatorrhoea and mastur- bation. It decreases the flow of blood in menorrhagia. The flushes of heat, followed by sweating and prostration, occurring at the menopause, are generally cured by the use of potassium bromide. Administration. — Dose, gr. v-5j or more. In epilepsy it is given in doses of gr. xx— xxx, thrice daily, and continued for a long period, with occasional intervals of a week or two. If bromism occur, stop the remedy for the time, and give tonics. The bromide rashes are easily cured by withdrawing the medicine, and giving liquor potassii arsenitis internally in small doses, and the local use of an ointment containing iodide of sulphur. Potassium bromide should be administered in solution, and preferably between meals. AMMONII BROMIDUM AMMONIUM BROMIDE. Ammonium bromide (NH 4 Br.) is prepared by mixing bromine with iron-wire in distilled water, agitating the mixture until the liquid assumes a greenish color, and then adding water of ammo- nia to the mixture, which precipitates the iron as ferrous hydrate, ammonium bromide remaining in solution. By filtration and evaporation, a white, granular salt is obtained, which, on exposure to the air, gradually becomes yellowish (in consequence of the liberation of hydrobromic acid), has a saline, pungent taste, is very soluble in water, and moderately so in alcohol. Physiological Effects. — The action of ammonium bromide lesembles, in many respects, that of the potassium salt. When applied locally to the motor nerves, spinal centres, heart, or voluntary muscles, it does not destroy their functions, and has less influence, when administered internally, on the circulation, respiration and temperature. Medicinal Uses. — It has been used for the same conditions in SPINANTS AMMONIUM BROMIDE. 29 1 which potassium bromide is given. Echeverrhia prefers fhe ammonium bromide in epileptic maniacal excitement, but states that it will fail unless combined with chloral, cannabis indica, or other narcotic, or, better still, with ergot. The combined use of ammonium and potassium bromide has been recommended by Brown-Sequard. Da Costa highly recommends its use in acute rheumatism. It has also been used with advantage in pertussis. Administration. — It is given in doses of gr. v-xxx, thrice daily, and is best administered in some bitter infusion. Sodii Bromidum {Sodium Bromide) (NaBr) may be prepared in a similar manner to potassium bromide. In its physiological effects it resembles potassium bromide, but is much feebler. It is used in the same diseases and in the same doses as is the potassium salt. Lithii Bromidum {Lithium Bromide) (LiBr) has been recom- mended as the most efficacious of the bromides. S. Weir Mitchell has found it efficient in gr. x-xx doses, in some cases of epilepsy, after potassium bromide had failed. It has been used in gout, but not with much success. It contains a larger per cent, of bromine than do the other salts, and is very soluble. Calcii Bromidum {Calcium Bromide) (CaBr 2 ) has been em- ployed for the same purposes and in the same doses as potas- sium bromide. Zinci Bromidum {Zinc Bromide) (ZnBr 2 ) has been employed in the treatment of epilepsy, but its use is not general. Ham- mond * has obtained beneficial results with the salt in arresting the epileptic paroxysms where the other bromides had failed, and it has the advantage of not causing bromism or a cutaneous eruption. Dose, gr. ij-xx, in syrup and water. Acidum Hydrobromicum Dilutum {Diluted Hydrobromic Acid) is a clear, colorless liquid, without odor, but having a strongly acid taste, which consists of 10 per cent, of absolute Hydro- bromic acid (HBr), and 90 per cent, of water. It has a sp. gr. of 1.077. Effects and Uses. — This acid does not differ materially. in its * " A Treatise on Diseases of the Nervous System," 1888, p. 716. 292 MATERIA MEDICA NEUROTICS. action from potassium bromide, and has been used as a substi- tute for it in epilepsy, alcoholism, congestive headache, vertigo, chorea, insomnia, hysteria, post-hemiplegic disturbances, etc. It has been recommended to combine it with quinine as a pre- ventive of cinchonism. Its value does not seem to be very firmly established. Dose of the diluted acid, f5ss— ij, TABACUM TOBACCO. Nicotiana Tabacum, or Virginia Tobacco (Nat. Ord. Solana- ceae), is a native of the warm countries of America. . It is an annual plant, growing to the height of from three to six feet, with large oblong, pointed, hairy, pale-green leaves, and light-greenish, funnel-shaped flowers. The dried leaves are the portion used. They have a yellowish-brown color, a strong, peculiar, narcotic odor, and a bitter, nauseous taste. The darker-colored leaves are the strongest. The virtues of tobacco are imparted to alcohol and water, and depend on the presence of an alkaloid called nicotine (C 10 H 14 N 2 ) (as a malate), which is found in all parts of the plant, but not in tobacco-smoke. It is a colorless, oily, volatilizable, alkaline liquid, highly soluble in water, alcohol, ether, chloroform, the fixed oils, and oil of turpentine, of a feeble odor when cold, but irritant when heated, of an acrid, burning taste, and is a most energetic poison, ranking after prussic acid. From the dried leaves are also obtained a concrete volatile oil, termed nicotianin, which is probably the odorous principle of the plant, and an empyreumatic oil, which gives the peculiar smell to old tobacco pipes. Both of these principles are poisonous. Tobacco-smoke * has been found " to contain numerous basic substances of the picolinic series, and ceded to caustic potash, hydrocyanic acid, sulphuretted hydrogen," with fatty acids, phenol and creasote. Physiological Effects. — Local action: applied to the skin tobacco is readily absorbed. On persons unaccustomed to its use, tobacco, in small doses, produces nausea, depression, and a feel- ing of wretchedness. Nervous system : tobacco expends its action on the spinal cord, and not upon the brain, and nicotine, in full doses, acts as a tetanizing agent on man. Nicotine con- *" Pharmacographia," 2d ed., p. 468. SPINANTS TOBACCO. 293 tracts the pupil either locally or internally. The conductivity of the motor nerves is more or less abolished, and lastly that of the spinal cord, while the voluntary muscles remain unaffected. These remarks apply to lethal doses of the drug. Circulation : the red globules of the blood of a person under the influence of tobacco present a crenated appearance. Tobacco is not a cardiac poison, since the application of nicotine to the cut-out heart will not stop its beats ; nevertheless it slows the cardiac action and tem- porarily reduces the blood pressure. It causes death by paralyz- ing the muscles of respiration. Intestines : tobacco has a relax- ing influence upon this tract, and the injection of nicotine induces intestinal peristalsis. Nicotine is probably eliminated by the kidneys. In larger doses, it induces vomiting and purging, a sensation of sinking at the pit of the stomach, giddiness, disorder of vision, contraction of the pupils, depression of the circulation, great relaxation of the muscular system, coldness of the surface, and other symptoms of prostration ; and, when excessive doses have been taken, these symptoms become more violent, and are followed by clonic convulsions, paralysis and death. Woodman and Tidy * have collected a number of fatal cases from the use of tobacco-infusion by clyster and injection, so that it is a remedy, even locally, to be employed with caution. Cases of poisoning are to be treated with the diffusible stimuli, after washing out the stomach, and strychnine is to be used hypoderm- ically; dry heat should also be applied, and, if these means fail, artificial respiration should be resorted to. The habitual use of tobacco as an exhilarant is well known. When taken to excess, it frequently develops disorders of the stomach, heart and nervous system. Medicinal Uses. — Tobacco is employed in medicine chiefly with a view to its action on the muscular system — its anodyne properties being relatively feeble. In various spasmodic diseases, particularly in colic, ileus, strangulated hernia, constipation from spasmodic constriction, tetanus, spasm of the neck of the bladder and the glottis, and asthma, it was formerly considered a remedy of great value, but more efficacious ones have superseded it. Internally, tobacco is to be employed with caution, as it occasion- *" Forensic Medicine, etc.," 1882, p. 381. 294 MATERIA MEDICA NEUROTICS. ally acts with dangerous energy. It is now rarely used medici- nally. Administration. — Tobacco is not given by the stomach, owing to its emetic properties. It is usually administered by the rec- tum, in the form of infusion, or tobacco-smoke may be introduced into the rectum. It may also be smoked for medicinal effect, or applied locally in the form of cataplasm. The oil is sometimes mixed with ointments. LOBELIA. Lobelia inflata, or Indian tobacco {Nat. Ord. Lobeliaceae), is a very common annual or biennial indigenous plant, growing to the height of from six inches to two feet, an erect, hairy stem, ovate, serrated leaves, pale-blue flowers, and ovoid, inflated cap- sules. All parts of it are active, but the leaves and tops only are officinal. Water and alcohol extract the virtues of lobelia, which contains a partly volatile alkaloid, lobeline, lobelic acid, fixed and volatile oil, gum, chlorophyll, etc. Lloyd* regards the alkaloid as a fixed one ; he also isolated a substance termed inflatin. Lobeline is a yellowish liquid, lighter than water, of an aromatic odor, an acrid taste, soluble in water, but more so in alcohol and ether. Pliysiological Effects. — Lobelia produces effects on the system analogous to those of tobacco, acting in small doses as a sedative, nauseant and diaphoretic. According to Ott's f investigations, the alkaloid produced in the rabbit curious alterations of blood- pressure, viz. : first a fall, followed generally by a rise, and lastly a very decided fall ; also slower respiration, paralysis, reduction of temperature, and death from asphyxia. Lobelia, like tobacco, retards the heart's action, is said to increase the urinary flow, and, in an unexplained way, relieves bronchial spasm. There are on record numerous cases of death from large doses of lobelia. Complete investigations of its action have not yet been made. In large doses it is an energetic emetic ; and in still larger doses destroys life by paralyzing the respiratory centre in the medulla oblongata, the pupil being contracted. It was employed by the aborigines, and has always been a popular empirical remedy. *" Drugs and Medicines of North America," Vol. II, p. 75. + Boston Med. and Surg. Jour., 1875. SPINANTS LOBELIA. 295 Medicinal Uses. — Lobelia is sometimes classed among emetics, but its action in this particular is too violent for its safe adminis- tration. It is chiefly employed, by regular practitioners, in virtue of its bronchial antispasmodic properties for the relief of asthma, angina pectoris, and cardiac dyspnoea, and is given in small doses, Fig. 24. LOBELIA INFLATA. gradually increased until headache or nausea ensues. In asthma, Ringer advises lobelia to be given in large doses, viz., f5j of the tincture every hour, or even every half-hour. The chief draw- back to its use is its uncertainty and the nausea and depression induced by it. In asthma it possesses no curative power, seeming 296 MATERIA MEDICA NEUROTICS. to be beneficial by reason of its antispasmodic and expectorant properties. It may also be used as an enema, to fulfill the same indications as tobacco. Administration. — Lobelia is given in substance, tincture, and infusion. The dose of the powder as an antispasmodic is gr. j-iij ; as an emetic, gr. v-xx. The best form, particularly in asthma, is the tincture (20 per cent., in diluted alcohol), which may be given in the quantity of foss— j, to be repeated as occasion may require A fluid extract is also officinal ; dose, ^j— xxx. Acetum LoBELiiE (Vinegar of Lobelia), made with diluted acetic acid, is a good preparation, in which the alkaloid is fixed by the acetic acid; it contains 10 per cent, of lobelia. Dose, as an expectorant, f5ss-j ; as an antispasmodic and nauseant, f5j-ij. ACIDUM HYDROCYANICUM DILUTUM DILUTED HYDROCYANIC ACID. Hydrocyanic acid, known also as cyanhydric acid and prussic acid, is derived from a variety of vegetable substances, as the bitter almond, peach kernels and leaves, wild cherry, cherry laurel, etc. It is employed in medicine only in a state of ex- treme dilution ; and the diluted acid is obtained by the action of sulphuric acid and water on potassium ferrocyanide, or when wanted for immediate use, by the action of hydrochloric acid and water on silver cyanide. Diluted hydrocyanic acid is a colorless, volatile liquid, with a peculiar odor and a cooling, somewhat irritating taste. It under- goes decomposition if exposed to the light, and should be kept in bottles covered with black paint or paper ; but it is not a stable preparation. It contains two per cent, of the anhydrous or concentrated acid. The anhydrous acid(HCy or HNC) is a colorless, feebly acid, transparent, very volatile and decomposable liquid, with a pow- erful, peculiar odor, and a cooling, afterward burning taste. Both water and alcohol dissolve it readily. Its presence in a suspected mixture may be detected by the addition of a solution of silver nitrate, which throws down a white, curdy precipitate of silver cyanide, distinguishable by its giving off, when dried and heated in a test tube, cyanogen gas which will burn with a rose-colored flame (the silver test is the most delicate, when applied to prussic acid in the state of vapor) ; or, by adding to SPINANTS DILUTED HYDROCYANIC ACID. 297 the suspected solution a little liquid potassae, and then a mixed solution of ferrous and ferric sulphate, a dirty greenish-blue precipitate is thrown down, which, on the addition of a few drops of pure hydrochloric acid becomes Prussian blue (the best liquid test). Physiological Effects. — Locally: hydrocyanic acid applied directly to the skin exerts a benumbing influence, and may be absorbed with the aid of friction ; to a mucous membrane or wound it is readily taken up. Nervous system : in small doses it produces no symptoms beyond a calming effect. Full doses cause giddiness, confusion of mind, and muscular feebleness. Whether large doses act on brain, vagus, or peripheral nerves is disputed. The convulsions which it produces are cerebral, for they do not occur in parts cut off from the cord. In the frog, Kolliker* finds that the direct application of hydrocyanic acid paralyzes the motor nerve trunks, and destroys the irrita- bility of muscle, and upon the peripheral sensory nerves acts as a paralyzant. Since hydrocyanic acid produces asphyxia most rapidly in the form of vapor, Preyer concludes that it acts directly on the pulmonary ends of the vagi. That it acts directly on the nerve centres is supported by the experiment of Jones, f in which the application of the acid to the medulla of an alligator caused quickly collapse of the lung. Circulation : prussic acid in small doses has a sedative action on the heart ; large doses arrest it in diastole (Lecorche et MeuriotJ). When applied directly to the heart it suspends its movements. Under prussic acid a temporary increase of the arterial pressure, fol- lowed by a permanent reduction, has been observed. But this is not in accordance with Lecorche and Meuriot's (loc. cit.) inves- tigations. It is only in lethal doses that opinion is unanimous as to a decided reduction of blood-pressure. Respiration : nothing short of 10-15 min. disturbs this act, this amount rendering it labored and irregular. Large doses destroy life so quickly that the respirations cannot be counted. Prussic acid has no influence on temperature, nor on secretion, save a slight * Arch, fur Pathol. Anat., Bd. x, p. 272. \ N. Y. Med. Record, II, 1867, 456. % Arch. Gen. de Medecine, 6 ser., x i, p. 529. Etude Phys. et Therap. sur l'acide cyanhydrique. 298 MATERIA MEDICA NEUROTICS. augmentation of saliva. Elimination is rapid, taking place by the saliva, kidneys and lungs. Opinions as to the action of prussic acid on the blood are contradictory. During life, under hydrocyanic acid, the venous blood is found to have an arterial hue ; while in man and mammals, after death this fluid is dark colored, probably from deficient abstraction of carbon dioxide. Outside of the economy the addition of hydrocyanic acid to the blood produces a new body, formed from HCy and hemoglobin, called cyanohemoglobin (Hoppe-Seyler *), which has no ozonizing power, and it seems probable that the forma- tion of this substance, if it take place during life in the blood, may be one of the main factors in causing death. In a poison- ous dose, hydrocyanic acid arrests life with fearful rapidity, and is one of the most energetic poisons known, one or two drops of the pure acid being sufficient to destroy a dog in a few seconds, and gr. -^ f of the anhydrous acid killed an adult in twenty minutes. When not immediately fatal, it produces great and sudden prostration, difficult and spasmodic respiration, dila- tation and immobility, and sometimes contraction of the pupils, feeble pulse, diminution of temperature in the extremities, rise of temperature in the trunk at first, but afterward fall of tem- perature, and involuntary evacuations. It acts on both the voluntary and involuntary muscles, decreasing or arresting entirely their property of contractility ; both the sympathetic and cerebro-spinal nervous systems appear to be affected. The best antidotes are inhalations of ammonia or its carbonate, and (if the patient can swallow) alcoholic stimuli are to be employed, and at the same time cold and hot affusions and artificial respira- tion must also be resorted to. The subcutaneous injection of atropine sulphate has been proposed as a physiological antidote, but its rate of diffusion is too slow to be of service, while Boehm % states that it is not antagonistic at all. Medicinal Uses. — Hydrocyanic acid is a valuable agent in allaying spasm, pain and nervous irritability, in a variety of dis- orders, and is much used to relieve cough, particularly in phthisis pulmonalis, and for its antispasmodic virtues in asthma and * Virchows Archives, xxxvni, p. 435. " Ueber die Ursache der Giftigkeit der Blausaure." f " Taylor's Med. Jurisprudence," 3d Am. ed., 142. % Practitioner, XIII, p. 168. SPIN ANTS DILUTED HYDROCYANIC ACID. 299 whooping-cough. It is, moreover, a most efficacious remedy, in gastrodynia and in neuralgic affections of the bowels, and also in chronic vomiting. Topically, it is employed as an anodyne in neuralgia, and in various forms of cutaneous disease (fSj—iij to water Oj-iss), notably urticaria and prurigo. The dose of the officinal acid is gtt. i-ij, to be repeated and gradually increased by a drop till some effect is perceptible. When it is taken for a length of time, care should be observed to have the medicine, as renewed, of uniform strength ; and it is best, in using a fresh sample, to return to the minimum dose. Potassii Cyanidum (Potassium Cyanide, KCN), is used as a substitute for hydrocyanic acid, and has the advantage of being a more uniform chemical product, and less liable to undergo decomposition. It is made by heating together potassium ferro- cyanide and potassium carbonate, and occurs in white, opaque, amorphous pieces, having a sharp, somewhat alkaline and bitter- almond taste, and an alkaline reaction ; its solution yields the odor of hydrocyanic acid when exposed to the air. It is deli- quescent, very soluble in water, and sparingly so in alcohol. Its medicinal and poisonous effects are the same as those of hydro- cyanic acid. Dose, gr. \ in f§ss of distilled water, to be repeated and in- creased. The addition of a few drops of some vegetable acid frees the hydrocyanic acid, and the same effect is produced by the acids of the stomach. Lethal effects may be obtained by prolonged contact with the skin. It is also irritant, and will produce an eschar. As much as gr. iij have been taken by an adult without fatal results (Taylor *). Oleum Amygdala Amar^e (Oil of Bitter Almond') contains hydrocyanic acid, and may be used for the same purposes. It is obtained by distillation from the kernel of the fruit of Amygdalus communis, variety Amara (Nat. Ord. Rosacea^), and is of a yellowish color, with a bitter, acrid, burning taste, and the peculiar odor of the bitter almond, which is different from that of hydrocyanic acid. It is heavier than water, slightly soluble in it, and soluble in alcohol and ether. It contains benzoic aldehyde and hydrocyanic acid, which are developed from a * Guy's Hospital Reports, xiil, 1868. 300 MATERIA MEDICA NEUROTICS. principle termed amygdalin, and water, under the influence of an albuminous ferment termed emulsin : thus, amygdalin (C 20 H 17 - NOn) + water (2H 2 0) = benzoic aldehyde :C 7 H 5 OH) + HCN + glucose (2C 6 H 12 6 ). The effects of this oil upon the system are closely analogous to those of hydrocyanic acid, and its strength is about four times that of the diluted officinal acid. Dose, for internal use, gtt. J— } in emulsion ; as an external application, gtt. j to a f§j of menstruum. Bitter Almond Water (aqua amygdalae amarse) is used as a vehicle for narcotic medi- cines containing one part of the oil dissolved in 999 parts of dis- tilled water. Dose, fgss. Syrupus Amygdala {Syrup of Almond), made from both the sweet and bitter almonds, is slightly impregnated with the virtues of hydrocyanic acid, and is a pleasant vehicle for cough mixtures. AMYL NITRIS AMYL NITRITE. Amyl nitrite (C 5 H n N0 2 ) is prepared by heating one part of strong nitric acid with two parts of rectified fusel oil (amylic alcohol or amyl hydrate — C 5 H n HO) until it approaches boiling, when the fire is removed. After the violent reaction has sub- sided, heat is again carefully applied. The distillate obtained below 212 F. is rectified over potassium carbonate, with the precaution to collect only that portion distilling between 202 and 206 F. It is a clear amber-colored, volatile, inflammable liquid, of sp. gr. 0.872 to 0.874, boiling at about 205 ° F., giving off an orange-colored vapor. It has an odor and taste like that of ripe pears. It is insoluble in water, but soluble in all propor- tions in alcohol, ether and chloroform. Amyl nitrite should be kept in small glass-stoppered bottles, in a dark and cool place. Effects and Uses. — The following account is based on the inves- tigations of H. C. Wood,* Amez-Drozand,f and Lauder Brun- ton{. When amyl nitrite is inhaled, it causes flushing of the head and face, a feeling of oppression in the head, with vertigo, excited cardiac action, diminished blood pressure, marked dilatation of the arterial system, from paresis of the muscular coat * Am. J. Med. Set., July, 187 1, p. 39. f Arch, de Phys. Norm, et Pathol., v, 1863, 467. \ Journ. of Anat. and Physiol., V, p. 92. SPINANTS AMYL NITRITE. 3OI of the vessels, due to direct action of the drug (Lauder Brunton, loc. cit), lowering of temperature, retarded respiratory move- ments, which tend to become slower as the administration is pushed, and eventually are extinguished, from a paralyzing influ- ence on the respiratory centre. At the same time there is com- plete motor paralysis. Consciousness is not destroyed, unless a condition approaching death is produced. The violent action of the heart is due, probably, to depression of the cardiac inhibitory nerves. On the reflex function and spinal motor centres, amyl nitrite acts as a powerful paralyzer. It also lessens the functional activity of the muscles and nerves. Dilatation of the vessels of the retina has been observed by the ophthalmoscope. Amyl nitrite has the property of diminishing the oxidizing function of the red blood-corpuscles, uniting with them to form a new compound, methemoglobin, which is not as readily deoxidized as hemoglobin, but which may be again con- verted into the latter by reducing agents. Whether inhaled or administered internally, amyl nitrite increases to a marked degree both the quantity of urine passed and the amount of' uric acid and urea eliminated (Mya). Sugar has been found in the urine of rabbits to which the drug had been administered by hypoder- mic injection. It has been employed to rouse the system in cases of syncope and prostration, as an antidote to chloroform poisoning, and has been found efficacious in relieving the pain of angina pectoris, eclampsia parturientium, and other convulsive diseases, and Frazer* has recently called attention to the value of the inhala- tion of amyl nitrite to relieve the dyspnoea of asthma. In uraemic asthma especially are the good effects of an inhalation of the drug seen, the relief being very speedy, the quantity of urine much augmented, and the amount of albumen lessened, at the same time the cedema decidedly subsides (Ringwood ; Rossbach ; Mya). In dyspnoea due to cardiac failure, it is also beneficial. In dysmenorrhea of the so-called congestive form, it often proves serviceable. The inhalation of the vapor of the nitrite has also been found efficacious in arresting epileptic seizures, when their approach is indicated by the aura epileptica; and also in tetanus, * Am. J. M. Sci., Oct., 1887, p. 393. 302 MATERIA MEDICA NEUROTICS. nausea marina, and strychnine poisoning. Dr. Macdonald* re- commends its use in gout, on account of the rapid elimination of uric acid which it causes. It is indicated in all conditions where there is a high degree of tension of the arterioles. The following drugs, although not officinal, are deserving of notice in connection with amyl nitrite. N itroglycerinum {Nitroglycerin — Trinitroglycerin — Glonoin (C ;i H 5 (N0 3 )3) is made by the action of sulphuric and nitric acids on glycerin, and occurs as a colorless or pale yellowish, oily liquid, with a sp. gr. 1.600 ; it crystallizes in long needles if kept for some time at the temperature of 32 F.; is nearly insoluble in water, but readily soluble in alcohol and ether. It is without odor. Nitroglycerin forms the basis of various explosives, as dynamite, giant powder, etc., and will itself explode with great violence if heated in a closed vessel or if forcibly percussed. Hayf has made some experiments which seem to show that nitroglycerin is a nitrate of glyceryl. Physiological Effects. — The effects of nitroglycerin resemble those of amyl nitrite and the other nitrites, but are more per- sistent. Hay (loc. cit) considers their similarity of action to be due to the nitrous radical contained in each, which is the view expressed by a recent experimenter (Armstrong J) and it appears to be substantially correct. When inhaled it causes flushing of the face and headache. Given internally, in small doses § (gr. yto)> ^ causes very great acceleration of the pulse and respiration, diminished blood-pressure, flushed face, a feeling of tension and throbbing, and severe headache, pharyngeal con- striction, diaphoresis, all lasting some hours. After larger doses all these symptoms are present to a greater degree ; there is gradual paralysis of reflex and voluntary motions, loss of sen- sation, and finally death from paralysis of respiration. Injected into cats Brunton || found that it produced paralysis without * Brit, Med. Journ., 1885, p. 1039. j- The Practitioner, xxx, p. 422. %Med. Times, Feb., 1888, p. 260. $ British Med. Journal, March, 1880, vol. 1, p. 406, article on nitro-glycerine. ■J St. Bartholomew's Hospital Reports, xii, 1 876, p. 140. SPINANTS AMYL NITRITE. 3O3 tetanus, and in addition it poisoned the muscles. On the motor nerves its action is uncertain. It paralyzed the cord before the ganglia at the base of the brain ; slowed the action of the heart directly, and reduced the blood-pressure. It is decomposed by the alkalies in the blood, the greater portion of the nitric acid of the compound being converted into nitrous acid and com- bining with alkaline bases, forming nitrites which lessen the oxidizing power of the red corpuscles and cause both arterial and venous blood to assume a dark chocolate hue. Nitroglycerin is a muscle poison, and when applied directly to the heart of the frog causes paralysis of that organ. Prof. Rossbach, of Jena, finds that it greatly increases both the quantity of urine and the amount of uric acid and urea present. Three fatal cases * are recorded, but the amount is not given. Medicinal Uses. — Nitroglycerin is used to relieve the tension of the vessels, as in angina pectoris, in which disease pre- eminently there is a high arterial tension. If taken at the beginning of an attack of asthma (especially if due to emphy- sema), it will frequently give good results (Korczynski). In uraemic asthma it is often useful, but if the symptoms are urgent, it is best to let the patient inhale amyl nitrite until the danger is abated, after which nitroglycerin should be administered. In puerperal eclampsia it has been of great service, and has also been recommended in cardiac dyspnoea, due to cardiac failure, and in weak heart, or where fatty degeneration of the cardiac muscle is taking place ; although many prefer the use of amyl or other nitrite in these cases. It is also useful in Bright's disease, both in the acute and chronic forms. It sometimes affords relief in neuralgias, in gastralgia and in hepatic colic, and has been found useful to arrest vomiting in sea-sickness. It has also been used with success in the cold stage of intermittent fevers, as by dilating the vessels it will frequently abort or cut short the attack. It is best given in a one per cent, solution in alcohol, of which the dose is t^ss-x. It is best to begin with a small dose and gradually increase it. Potassium Nitrite and Sodium Nitrite have been introduced into practice as similar in effects and uses to amyl nitrite and * Woodman and Tidy, 1882, p. 464. 304 MATERIA MEDICA NEUROTICS. nitroglycerin, and this similarity has recently been corroborated by Armstrong (loc. cit.) and Reichert * in some experiments on the pharmacology of the nitrites. Dr. Matthew Hayf believes the sodium salt to be as active and reliable in angina pectoris as either of the above drugs, and prefers it, because when used in medicinal doses, it does not cause the headache, giddiness or even partial collapse, which are sometimes seen after their use. Dose, gr. iij-v or more, in aqueous solution. GELSEMIUM. Gelsemium sempervirens, Yellow or Carolina Jasmine {Nat. Ord. Loganiaceae), is a beautiful climbing plant of our southern States, with a twining, smooth, and shining stem, perennial, dark- green leaves, and beautiful, very fragrant flowers, of a deep-yellow color. The rhizome and rootlets are officinal. The true root Fig. 25. GELSEMIUM SEMrERVIRENS. is hard and woody, slightly undulated in outline, sparingly branched, externally of a pale-brown color, smooth, and fur- nished with a thin scurfy cuticle, slightly cracked longitudinally. The stem is rougher externally, and is distinguished from the root by a small central cavity, representing the pith. The stem should be rejected. The root has a bitter and pleasant flavor, and an odor somewhat between that of senega and green tea. * Am. Jour. Med. Sci., Vol. 80, p. 158. I Practitioner, March, 1 883. SPINANTS GELSEMIUM. 305 It contains an alkaloid termed gelsemine, combined with an add called gelseminic, both discovered by Wormley* (not identical with aesculin), a volatile oil, an acrid resin, etc. The alkaloid, which represents chiefly the physiological action of the drug, though Ottf has shown gelseminic acid, gr. j— *4 injected into cats to be a fatal tetanizer, is a powerful poison, an amount of gelsemium estimated to contain gr. ^ of gelsemine having proved fatal to an adult woman. Effects and Uses. — The action of gelsemium has been investi- gated and described by the following observers, viz., Bartholow,J Ott (loc. cit), Ringer and Murrell§ and Holmes,|| as follows : Gel- semium in moderate doses, causes languor, dizziness, disordered vision and frontal pain, but hardly affects the circulation. Large doses diminish the pulse and blood-pressure by direct action on the heart, the temperature of the body, lessen respiration, and dilate the pupils, with little or no nauseating or purgative effect, nor does it exhibit any characteristic influence upon the brain. Ott's (loc. cit.) conclusions are these, viz., that gelsemine has no action on the motor or sensory nerves, nor on muscular contractility, which is in accord with those of Bartholow (loc. cit.) ; the last observer concludes that its paralyzing influence is due to a direct action on the motor and sensory centres of the cord. It appears to slow the heart by direct action, and it destroys life by paralysis of respiration. By summing up its action, after examining the effects of lethal doses, and the results of experiments, we can deduce the fact that gelsemium is a powerful depressant, not only of the motor, but also of the sensory centres, in the spinal cord. In overdoses, it has rapidly produced death, with great mus- cular relaxation, want of coordination in the movements, difficulty of speech, double vision, dilatation of the pupils, failure of the pulse and respiration, coldness of the surface, and finally unconsciousness preceding death. Ott^f has collected six cases of fatal poisoning by Gelsemium, the minimum dose being f$j of the fluid extract. * Am. Journ. of Pharm., Jan., 1870, and July, 1882. | Phila. Med. Times, V. July, 1875, and March 31, 1887. % The Practitioner, v, p. 200. || Annuaire de Therap., 1877, p. 41. \ The Lancet, Jan. 15th, 1876. \ Phila. Med. Times, Vol. v, p. 689. 20 306 materia medica NEUROTICS. It has been used in fevers, inflammations, essential spasmodic affections, as tetanus, and as a hypnotic in delirium tremens and other forms of morbid wakefulness, and as an anodyne in odontalgia and trifacial neuralgia. As a calmative in acute mania it has been given in full doses. Bartholow recommends gelsemium in acute inflammations of the lungs and pleura, espe- cially in pneumonia and pleurisy. He gives the fluid extract ^v-x every two hours " to maintain a constant effect within the limits of safety." Bulkley * advises the internal use of tincture of gelsemium gtt. x, repeated, to relieve the itching of eczema and prurigo. The tincture of gelsemium is the form which has been heretofore employed, in the dose of r^v-xx; but the fluid extract should be preferred, dose, t^v-x; f5j of this has proved fatal. WOORARA. This solution, termed also woorari, woorali, and curare, has long been known as a powerful poison prepared by the Indians, in South America, and of late years has been employed as a medicine. Its source is unsettled, but it is generally considered to be an extract from the bark of Strychnos toxifera and other species of Strychnos. It is brought from the banks of the Ori- noco, and occurs in the form of dark-brown or grayish lumps or powder, of an intensely bitter taste, and, when triturated, of a powerful odor. An alkaloid termed curarine (C 18 H 35 N) has been extracted from woorara, which is said to exist as a sul- phate (Sachs). Recently (1886) another alkaloid termed curine has been discovered by Bohm. Effects and Uses. — Woorara, topically applied, is an irritant. It is ranked with the motor depressants, and is considered to destroy life by paralysis, more or less rapid, of the respiratory muscles. A peculiarity of its action is that it is comparatively innocuous when taken by the stomach, being either not absorbed at all in this viscus, or so slowly as to allow of its elimination by the kidneys before dangerous accumulation in the blood. According to Lauder Brunton, on introduction into the stomach the absence of poisonous effects of curare is due, probably, to its being passed round the entero-hepatic circulation. Hence, * A 7 ". Y. Med.Journ., Jan., 1881. SPINANTS VIBURNUM. 307 for therapeutic purposes, it must be employed either enderniic- ally to a blistered surface or by hypodermic injection. Woorara kills the intra-muscular motor nerve-endings without affecting the muscular irritability, and destroys the reflex function of the spinal cord : in other words, the paralysis induced by it is peripheral and not centric ; eventually, however, the paralyzing action of woorara extends to the nerve-trunks and centres. The cerebrum is only secondarily involved. Artificial respiration retards the poisonous effects of the drug. Woorara stimulates and then paralyzes the accelerator cardiac nerves. Other effects of woorara are elevation of temperature, increased nasal, salivary and intestinal secretions, and diabetic urine (in animals). The elimination of curarine has been distinctly shown to take place, in part, by the kidneys. Woorara, or curarine, is only applicable to the treatment of those affections which therapeutically require motor depress- ants to antagonize the disease process. Among the most promi- nent of these are tetanus and hydrophobia. In tetanus good results have been obtained from its use in large doses, while from hydrophobia there are two reported cases of recovery. It has also been employed in chorea and epilepsy. The dose of woorara is from y 1 ^- to |- of a grain. Of curarine, from gr. yj-g- to y^-Q, hypodermically. Caution must be enjoined, as the samples vary. VIBURNUM. Viburnum is the bark of Viburnum prunifolium, commonly known as the Sloe or Black Haw {Nat. Ord. Caprifoliaceae), a small tree growing in thickets in the southern and western States, with opposite, oval, obovate, sharply serrulate leaves about two inches long, and short, slightly marginal petioles. It has small white flowers in terminal cymes, appearing in May ; and small blue-black edible drupes containing a flatfish, smooth putamen. The bark is in thin pieces or quills of a purplish- brown color, with scattered warts and minute black dots ; col- lected from the old wood it is a grayish-brown, the thin corky layer easily removed from the green layer ; the inner surface is whitish and smooth ; it breaks with a short fracture ; is without smell, and of a bitter, astringent taste (Stille and Maisch ; 308 MATERIA MEDICA NEUROTICS. Maisch). It contains valerianic acid, a brown bitter resin, a greenish-yellow bitter principle {vibumin), tannin, etc. Effects and Uses. — The physiological effects of viburnum are not understood. It probably acts as a sedative to the spinal centres, especially those governing the uterine functions ; whether it influences the circulation or the blood supply to the uterus, or what action, if any, it has on the sympathetic gan- glionic system are questions for the future to determine. It is said that no disagreeable after-effects attend its use. Viburnum is highly recommended as a sedative in cases of threatened abortion,* whether accidental or due to the action of drugs, and is said to be especially serviceable where a tendency to abortion exists from habit. In these cases 5j may be given every two or three hours as long as the abortion is threatening. It is also recommended to allay the severity of after-pains, and is one of the numerous remedies which have been used for the relief of the vomiting of pregnancy. It has also been used with success in menorrhagia and metrorrhagia, depending on anaemia, debility or other systemic cause, and in menorrhagia accompanied with nervous symptoms appearing at the climacteric period. It has been given, too, in dysmenorrhceaf with profuse discharge, accompanied by a feeling of weight in the pelvis, and may be combined with other remedies in the treatment of neuralgic dys- menorrhcea. The fluid extract is officinal, the dose of which is f3ss-j. GRINDELIA. Grindelia is the leaves and flowering tops of the Grindelia robusta [Nat. Ord. Composite), an herbaceous perennial plant growing to the height of one or two feet, indigenous to the Pacific coast. It resembles the common sunflower in its general appearance, and contains vegetable wax, fixed and volatile oils, a greenish, soft, acid resin having the odor of the drug, an acid saponin-like body (grindelin), a trace of tannin, but no alkaloid (W. H. Clark J). Effects and Uses. — In large' doses, grindelia has a decided * Liverpool Med. and Surg. Journal, 1875, p. 41, J. H. Wilson. f " New Preparations," 1879, P- l 37- J American Jour, oj Pharmacy, Sept., 1888. SPINANTS SUMBUL. 3O9 hypnotic effect, during which the pupils are dilated and reflex action, motion, and sensation are depressed. Buffington's* inves- tigations give the following results : the cardiac action is slowed by grindelia, through stimulation of its inhibitory centre while the local blood pressure is raised. The statement as to the slowing of the heart and reduction of blood pressure are con- firmed by Dobroklonsky.f The respiratory movements are increased in frequency by an action of the drug on that centre. It is eliminated by the kidneys, inducing a marked increase in the urinary flow and to a certain extent by the lungs. The state- ment in regard to its diuretic action is not confirmed by Dobrok- lonsky (loc. cit.), who affirms that it is feebler in this respect than digitalis. Grindelia is not actively toxic, though a lethal dose will destroy life by arrest of respiration. Grindelia is very serviceable in the treatment of asthma, espe- cially in the uncomplicated spasmodic form, but has also proved useful when complicated with bronchitis, etc. In many cases of hay asthma and hay fever it has proved of much benefit. It is useful in pertussis, and is also recommended in acute and chronic bronchitis and pneumonia. Dr. H. M. Fiske recommends its internal and local use in iritis. It has been used as an injection in vaginitis and as a local application in poisoning by rhus toxicodendron, the latter with varying results. The fluid extract is officinal, the dose of which is ^x-f5j. SUMBUL. * Sumbul is the root of the Ferula Sumbul {Nat. Ord. Umbelli- ferae), a perennial plant, growing to the height of eight feet, with large triangular, tripinnate radical leaves and a few small cauline leaves. It is a native of Turkestan and eastern Siberia. The root reaches us through Russia, and is met with in transverse slices from one to five inches in diameter and three-quarters to two inches thick. It is light, spongy, annulated, with a thin brownish bark and a whitish interior, with numerous dots of brown-yellow resin and irregular, easily separated fibres ; of a strong musk-like odor and a bitter balsamic taste. The root of * Am. Joitrn. Med. Sci., Jan., 1886. f These de St. Petersburg. Quoted by Bull. Gen. de Therap., cxi, 277. 3IO MATERIA MEDICA ECCRITICS. the Dorema ammoniacum is sometimes flavored with sumbul, but may be distinguished from it by being firmer, denser, and of a yellow or reddish tint (Stille and Maisch). Sumbul root contains a volatile oil, a soft resin, angelic and valerianic acids (Maisch). The soft oleo-resin is soluble in ether, exists in the proportion of 9 to 1 00, and imparts to water the odor of musk (Remsch).* Effects and Uses. — The physiological effects of sumbul are not accurately known. It probably acts as a sedative to the brain and spinal cord. It was originally introduced into Russia as a remedy for cholera, and is still used there in asthenic dysentery and diarrhoea. In England it has been used in dysmenorrhea, hysteria, epilepsy, and various allied nervous disorders. Mr. Murawieff recommends it in chronic bronchitis in old and debili- tated patients, in humid asthma, atonic dyspepsia, hypochon- driasis and hysteria, and Phillips has seen it prove useful in chronic bronchitis and in certain stages of phthisis. He also recommends it in severe cases of facial, sciatic, or ovarian neu- ralgia, and in the restlessness of pregnancy. Boehm (Ziemssen's Cyclopedia) speaks favorably of it in delirium tremens. It is not much used in this country. The tincture may be given in doses of t%x-f5j. CLASS II. — ECCRITICS. ORDER I. EMETICS. Emetics (from 's/jJoj, I vomit) are medicines which are employed to promote vomiting ; when they are used merely to excite nausea, they are termed nauseants. When an emetic is administered, usually within fifteen or twenty minutes afterward a feeling of distress, relaxation and faintness is experienced, with coolness and moisture of the skin and a small, feeble, irregular pulse. These symptoms increase till the contents of the stomach are ejected. During the act of vomiting, the face becomes flushed, the pulse is full and frequent, and the temperature of the body is increased. After vomiting is over, the skin is moist, the pulse * Journ. de Pharm. et de Chimie, 4.ieme S er., 1 87 1, p. 320. EMETICS. 311 soft and feeble, the patient becomes languid and drowsy, and, under peculiar circumstances, alarming and even fatal syncope has been induced. Emetics act either directly on the centres of the medulla which govern the act of vomiting, or by the local irritation they produce, which, being conveyed to the centre by filaments of the pneumogastric nerve, produces vomiting in a reflex manner. In the former case, vomiting is produced by the drug, no matter in what manner it enters the system, and it is therefore called a systemic emetic ; in the latter, vomiting is only produced by the introduction of the substance into the stomach, and it is hence called a local emetic. Dr. Marshall Hall gives the following summary of the mechanism of vomiting: " During the act of vomiting, 1, the larynx is closed ; 2, the cardia is opened ; and 3, all the muscles of expiration are called into action ; but, 4, actual expiration being prevented by the closure of the larynx, the force of the effort is expended upon the stomach, the cardia being open, and vomiting is effected." Susceptibility to the action of emetics differs in different indi- viduals and in different diseases. In fevers, and where gastric irritation is present, their influence is increased; and, on the other hand, when the brain is oppressed by disease or by narcotic medi- cines, the stomach is exceedingly insensible to their action. Emetics are employed therapeutically — 1, to evacuate the stomach, for the purpose of removing poisons, undigested food, etc. ; and, with this view, the emetics should be selected which occasion least nausea and distress ; 2, to expel foreign bodies lodged in the throat or oesophagus ; 3, to excite nausea, and thereby depress the vascular and muscular systems ; 4, to relieve spasm, as in' spasmodic croup; 5, to promote secretion and excretion, etc. ; and, 6, sometimes to break up a train of morbid associations, by giving a shock to the system, as in the forming stages of certain fevers, as typhus and scarlatina, and of delirium tremens. They are improper where the effort of vomiting is liable to increase any existing pathological conditions, as in congestion of the brain, pregnancy, hernia, etc., or where such debility is present that the depressing effects might prove fatal, as in the last stages of membranous croup. The act of emesis is promoted by the free use of tepid drinks ; excessive vomiting may be checked by demulcents, opiates, counter-irritation to the stomach, etc. 312 MATERIA MEDICA ECCRITICS. VEGETABLE EMETICS. IPECACUANHA IPECAC. Ipecacuanha is the root of Cephaelis Ipecacuanha (Nat. Ord. Rubiaceae), a small shrubby perennial plant of Brazil, where it grows to the height of about five or six inches. The roots, as met with in the shops, are in pieces about the size of a quill, several inches long, of an irregular, twisted, contorted shape, with numerous circular Fig. 26. CEPHAELIS IPECACUANHA. , each pill contains rhubarb gr. ij, aloes gr. iss, myrrh gr. j, oil of peppermint gr. -^; compound powder of rhubarb (containing 25 parts of rhubarb, 65 parts of magnesia, and 10 parts of ginger); syrup contains also cinnamon, potassium carbonate, sugar, and water; aromatic syrup (contains aromatic tincture, 10 parts, syrup, 90 parts — much used in infantile cases under the name of spiced syrup of rhubarb) — dose, for an infant, f.3j ; and wine contains rhubarb, 10 per cent., and calamus, 1 per cent, in stronger white wine — dose, f5j— f Sss. Roasting impairs the cathartic power of rhubarb, and is said to increase its astringency. Juglans. The inner bark of the root of Juglans cinerea, or Butternut (Nat. Ord. Juglandaceae), an indigenous forest tree, found throughout New England, the middle and western States and Canada, possesses cathartic properties resembling those of rhubarb. It is of a fibrous texture, a white color, gradually changing to a dark-brown, a feeble odor, and a bitter, somewhat acrid, taste. It contains nucin, C 36 H 12 O 10 (composed of juglandic acid and juglone), some tannic acid, fixed and volatile oils, resin, etc. It is not given in substance ; the extract is officinal, of which the dose is gr. v-x as a laxative, and gr. x-xxx as a decided cathartic. aloe — aloes. Aloes is the inspissated juice of the leaves of Aloe soco- trina {Nat. Ord. Liliaceae), a succulent herbaceous plant grow- ing in warm countries. Aloes obtained from other varieties of aloe is used, but the Pharmacopoeia only recognizes Aloe soco- 338 MATERIA MEDICA ECCRITICS. trina as the source of officinal aloes. The finest kinds are obtained by exudation ; those prepared by expression and by boiling are inferior. Three principal varieties are known in commerce : Cape, Socotrine, and Barbadoes aloes, the first two of which are the most used in the United States. 1. Cape aloes (Aloe capensis), which is much the most common, is obtained from the Cape of Good Hope, where it is collected indiscrimi- nately from A. spicata and other species. Its powder is green- ish-yellow; its odor is strong and disagreeable, but not nau- seous. 2. Socotrine aloes (Aloe socotrind), when genuine, is the choicest variety. It is produced in the island of Socotra, on the eastern coast of Africa, from A. socotrina, and occurs in pieces of a yellowish or reddish-brown color., becoming darker on expo- sure to the air, with a smooth and conchoidal fracture, the interior being lighter-colored than the exterior. Its powder is golden-yellow ; its odor peculiar, but not unpleasant, and its taste bitter and disagreeable, but aromatic. Hepatic aloes is probably an inferior variety of Socotrine, and is seldom met with in our shops. 3. Barbadoes aloes (Aloe barbadensis) comes from the West Indies, the product chiefly of A. vulgaris ; it is imported in gourds. The taste of all the varieties of aloes is intensely bitter and very tenacious ; their odor, disagreeable. Aloes yields its virtues to water and alcohol. A neutral crys- talline principle, termed aloin, has been extracted from it, which is supposed to be the cathartic principle, and which has been used as a purgative in doses of gr. y 1 — ij ; that from Socotrine aloes is termed socalotn (C 15 H 16 7 ), of Barbadoes, barbalo'in (C 17 H 20 O 7 ), and of Natal, nataloin (C 16 H 18 7 ). The resin of aloes, when exhausted of aloin, possesses no purgative properties. Effects and Uses. — Aloes, in small doses, is tonic, and in large doses, purgative. As a cathartic, it is remarkable for the slow- ness of its operation and its special action on the large intestine and the pelvic viscera generally. Hence it is objectionable in cases of disease of the genito-urinary apparatus, pregnancy, etc.; and, on the other hand, is useful in amenorrhcea. It also stimu- lates the hepatic secretion. It is principally employed in cases of dyspepsia accompanied by costiveness, dependent on a torpid condition of the large intestine or liver. In chronic constipation, combined with belladonna and CATHARTICS SENNA. 339 nux vomica and continued for some time in small doses, it often proves advantageous. 3^ Alo'in, gr. -^ ; extracti nucis vomicae, gr. J- ; extracti belladonnas, gr. -j^. M. ft. pill. Sig. — One pill t. d. after meals, to be reduced to two per diem if it cause more than one daily evacuation. Active exercise, massage and regular habits add greatly to the efficiency of this treatment. It is also useful as a mild revulsive in cerebral affections, and has proved efficacious as an anthelmintic. It was once thought that it was objectionable in hemorrhoids, but this affection being now con- sidered to depend upon relaxation of the veins of the rectum, aloes has been administered in it upon theoretical views, and with very good results. As a purgative it holds an intermediate rank between rhubarb and senna. Administration. — Dose, gr. v or x-xx, in pill ; it is usually given in combination with other cathartics. Aloes is so often mixed with impurities that, for medicinal use, it is best employed under the form of aloe purijicata {purified aloes), which is pre- pared by straining and evaporating an alcoholic solution of Soco- trine aloes. The officinal preparations are : Pills of aloes, con- sisting of equal parts of aloes and soap, one pill containing aloes gr. ij ; pills of aloes and mastic, 4 parts of aloes to 1 part of mastic and red rose, each (the Lady Webster pill, each containing aloes gr. ij); pills of aloes and asafoetida (one pill contains of aloes, asafoetida, and soap, ]\ gr. each), useful in flatulent consti- pation ; pills of aloes and myrrh, or Rufus's pills, aloes 4 parts, myrrh 2 parts, and aromatic powder I part, made into pills with syrup ; employed in amenorrhcea, each pill containing aloes gr. ij - pills of aloes and iron, equal parts of aloes, dried iron sulphate and aromatic powder, made into pills with confection of rose ; each pill contains aloes gr. j ; very useful in amenorrhcea ; aqueous extract of aloes (extractum aloes aquosum), dose, gr. j-v ; tincture (aloes and extract of glycyrrhiza, of each 10 per cent., in diluted alcohol), dose, foj to fSss ; tincture of aloes and myrrJi{z\oz$ and myrrh, each 10 per cent., in alcohol) ; wine of aloes (aloes 6 per cent., cardamom and ginger each 1 per cent, in stronger white wine). SENNA. Senna consists of the leaflets of several species of Cassia {Nat. Ord. Leguminosae), small shrubs which grow in the trop- 34-0 MATERIA MEDICA ECCRITICS. ical regions of Asia and Africa. The species recognized as officinal are C. acutifolia and C. elongata ; and besides these, C. obovata, C. lanceolata, and C. aethiopica are also generally received as sources of the drug. The commercial varieties of senna which are found in the United States are the Alexandria, the Tripoli, the India and the Mecca senna. I. Alexandria semia, which comes from the port of this name in Egypt, is made up chiefly of the leaflets of C. acutifolia (which are yellowish-green, acute in shape, and less than an inch in length), intermingled with the pods, leafstalks, flowers, etc., of this plant. 2. Tripoli senna consists of the leaflets of C. sethiopica, which are shorter, less acute, thinner and more fragile than those of C. acutifolia, and are generally much broken up. 3, India senna is produced in Arabia and consists of the leaflets, intermixed with the leaf- stalks and pods, of C. elongata, and is readily recognized by the long, narrow, pike-like shape and dark hue of the leaflets. A Fig. 28. Fig. 29. ALEXANDRIAN SENNA. INDIAN SENNA. finer variety of India senna, cultivated at Tinnevelly ', in Hindostan, has been known for some years past, which is distinguishable from the common sort of India senna by the bright-green color of the leaflets. 4. Mecca senna consists of leaflets, intermediate in length between those of C. acutifolia and C. elongata, and has in mass a yellowish, tawny hue. It is probably the product of C. lanceolata. Cassia obovata has been lately found growing wild in abundance in Jamaica. Commercial senna is prepared for use by separating the leaflets from the stalks, adulterations, etc. ; the pods possess cathartic properties, but are less active than the leaves. The odor of senna is faint and sickly ; its taste bitter, sweetish and nauseous. It imparts its virtues to water and alcohol, its infusion being of a reddish-brown color. The chemical composition of senna has long been an unsettled point. By the latest analysis it has been found to contain a glucoside, cathartic acid, which is insoluble in water, stronger alcohol and ether, but which enters readily into watery CATHARTICS LEPTANDRA. 34 1 solution with alkaline and earthy bases, in which state it exists in senna ; this is actively cathartic. Catharto-mannit {sennit), sennacrol and chrysophan have been also obtained ; and there is probably another purgative principle which has not been isolated. Effects and Uses. — Senna is a prompt, efficient and safe catliar- tic, well adapted to febrile and inflammatory cases ; it operates on the entire tract of the intestinal ca?tal, and produces watery, feculent discharges. Prof. Rutherford found that senna was a mild hepatic stimulant, and rendered the bile more watery. Its tendency to gripe may in a great measure be counteracted by combining aromatics or neutral salts with it ; the addition of bitters promotes its cathartic activity. Administration. — The dose in powder is 5ss-ij ; Confectio senna (made with senna, coriander, sugar, figs and pulp of prunes, tama- rinds and purging cassia) is an excellent mild cathartic, much used for pregnant women ; dose, 5ij. Of the fluid extract the dose is f 5j-iv ; the compound infusion (black draught) contains senna, manna, magnesium sulphate and fennel ; dose, f§ss— j or more. Syrup of senna contains senna, sugar, alcohol and oil of coriander; dose, f5j. Pulvis glycyrrhizcz compositus {compound powder of glycyrrhizd) consists of senna, glycyrrhiza, fennel, washed sulphur and sugar. It is an excellent purgative ; dose, a teaspoonful of the powder in half a glass of water at bedtime. LEPTANDRA. The rhizome and rootlets of Leptandra virginica, Culver's Root, or Culver's Physic {Nat. Ord. Scrophulariaceae), an herb- aceous perennial plant, three or four feet high, with leaves in whorls, and a long spike of white flowers, are ranked as a chola- gogue cathartic. It consists of a dark-brown rhizome, from two to four lines in thickness, several inches in length, with numer- ous long, slender radicals. The odor is feeble and disagreeable, the taste bitterish and somewhat nauseous and acrid. Water and alcohol extract its virtues, which depend on leptandrin. It also contains resin, saponin, tannin, mannit, etc. It is only a feeble stimulant to the liver and intestinal glands, according to the investigations of Rutherford. Adolphus * states that it acts on the small intestines, pancreas, and liver, while Dutcherf * Boston Med. and Surg. Reporter, 1868, p. 23. \ Ibid., 1868, p. 275. 342 MATERIA MEDICA ECCRITICS. thinks it stimulates the intestinal glands only, but they offer no evidence to prove their statements. Dose of the powdered root, gr. xx to 5j ; of an impure resin misnamed leptandrin (made by precipitating a tincture of the root with water), gr. ij-iv ; an extract (dose, gr. ij— iv) and fluid extract (dose, f 5ss-j) also have been used. FRANGULA. The bark of Rhamnus Frangula,* or Alder Buckthorn {Nat. Ord. Rhamnaceas) is a mild purgative of some value. Fran- gula is a shrub growing to the height of ten feet or more, found in wet places along the northern coast of Africa, throughout Europe, and in Siberia. It has alternate oval leaves, slightly pointed at the apex, greenish flowers in axillary clusters and small red berries, which finally become black and contain two or three roundish-angular seeds. The bark comes in small quills, grayish or blackish-brown externally, and marked with numer- ous small, whitish, transversely elongated warts ; the inner sur- face is smooth, pale, brownish-yellow. It has no smell and a sweet and bitterish taste. It contains frangulin (C 2 oH2o0 10 ), einodin, resin, tannin, etc. When fresh the bark is an active emetic and hydragogue cathar- tic, possessing irritant qualities, but it loses much of its acridity in drying, and it is therefore recommended by the Pharmaco- poeia to be collected at least a year before it is used. When dried it is a mild acrid cathartic, proving also somewhat diuretic. It is also an anthelmintic of considerable value. The fluid extract may be given in doses of f 5ss— j. CASCARA SAGRADA. Cascara sagrada * or Chittem bark (unofBcinal) is the bark of Rhamnus purshiana {Nat. Ord. Rhamnaceae), a small tree found on the Pacific slope, growing to the height of ten to twenty feet, with elliptic denticulate leaves, rather large white flowers in umbellate clusters, and three-lobed, three-seeded black drupes. The bark comes in thin quills, with a grayish periderm, under- neath which it is of a reddish-brown color ; the inner surface is smooth and yellowish. It is without smell, but has a bitter taste. * Med. Times, Dec. 5th, 1887, on " R. Frangula and Purshiana," Rusby. CATHARTICS JALAP. 343 It contains three resins, viz., a brown, red, and yellow, which are probably the purgative principles, and recently a ferment, glucose, and traces of ammonia have been isdlated.* Effects and Uses. — From experiments on dogs in the labora- tory of Prof. S. P. Botkin, Dr. M. M. Tcheltzoff deduces the following resultsf : — Administered internally the fluid extract (4-10 c.c.) increases the secretion of the gastric and pancreatic juices and also of the bile, augmenting the water of the latter. It did not affect the salivary secretion, nor did it lead to any rapid and considerable evacuations from the bowels. He concludes that as a prompt laxative, cascara is useless, but recommends it for its effects on the digestive fluids, and as a cholagogue, ranks it next in effi- ciency to rhubarb. Cascara bark is a good and efficient cathartic and is highly useful in habitual constipation. As a cathartic, Dujardin-Beau- metz \ rates it between podophyllum and rhubarb. Dose of the fluid extract, t^x-xxx, beginning with the smallest dose three times a day and gradually increasing until a free morning evacua- tion is produced, after which the quantity should be carefully decreased, giving just sufficient to produce the necessary morning evacuation. According to Cullimore,§ cascara is well combined with capsicum in obstinate constipation, which obviates the griping and aids the action of the former. As great difference in action is found in many preparations of the drug, it is well to begin with a smaller dose on procuring a new supply. DRASTIC CATHARTICS. JALAPA JALAP. Jalap is the tuber of Exogonium Purga (Nat. Ord. Convol- vulacese), a climbing plant of Mexico, which derives its name from the city of Jalapa, near Vera Cruz. The tubers are im- ported usually entire, but sometimes in slices. . When entire, they vary in size and shape from a walnut to a large pear, are * Am. Journ. of Pharm., Feb., 1888. " An Exam, of Cascara Sagrada," by Meier and Webber. f Ejewed. Klin. Gaz., No. 35, 1884, p. 545; No. 21, 1886, pp. 418-23; No. 22, 1886, pp. 444-51. \ " Les Nouvelles Medications," 1886, p. 60. \ London Lancet, March, 1885, p. 502. 344 MATERIA MEDICA ECCRITICS. hard and heavy — externally, brown and wrinkled, and inter- nally, grayish, with brown concentric rings ; they are often furrowed with vertical incisions, made to promote drying. They have a heavy, rather nauseous smell, and a sweetish, subacrid, disagreeable taste. They yield their virtues partly to water, partly to alcohol, and completely' to diluted alcohol. In the shops jalap is kept in the state of powder, which is of a yellow- ish-gray color. Its active principle is a resin, which consists of two portions, both of which are cathartic ; one is soft and soluble in ether, the remainder is the glucoside convolvulin (C 62 H 100 O 3 2), insoluble in ether ; it contains also gum and starch, which is apt to be attacked by worms, the worm-eaten pieces becoming thus the most active. Effects and Uses. — jalap is a powerful hydragogue cathartic, operating with great promptness, and often causing much pain. Rutherford found that jalap was an energetic hepatic stimulant, augmenting the flow of bile, which at the same time was rendered more watery. It also increases the secretion of the intestinal glands to a marked degree. In overdoses, it may produce dan- gerous hypercatharsis. Orfila * ascertained experimentally that 5ij by the mouth is the fatal amount for a dog. We have met with no fatal cases in man. It is employed as a hydragogue in dropsy of cardiac or renal origin, when it is often combined with cream of tartar; as a revulsive in cerebral and other affections, and to increase the activity of calomel in bilious fever. Dose, gr. xv-xxx ; in combination, gr. x. Of the abstract, gr. j-v. The compound powder of jalap (pulvis jalapcz compositus) contains 35 parts of jalap and 65 parts of cream of tartar; dose, gr. x-5j. The resin is extracted by solution in alcohol, and afterward precipi- tated from the tincture by water; dose, gr. iv— viij. BRYONIA BRYONY. Bryonia is the root of Bryonia alba and B. dioica {Nat. Ord. Cucurbitaceae), climbing perennial vines, growing in the thickets and hedges in various parts of Europe, with rough, five-lobed, toothed, alternate leaves and cymes of three or four small green- ish flowers, and black or red berries containing six large spotted * " Toxicologic Generale," t. I, p. 683. CATHARTICS PODOPHYLLUM. 345 seeds. The root is found in the shops in transverse sections about two inches in diameter, with a grayish-brown, rough, thin bark, the central portion being whitish, with small woody bundles arranged in circles, and projecting, radiating lines. It is without smell, but has a bitter taste. The active principle is probably bryonin (C 48 H 80 Oi 9 ), a bitter glucoside. Effects and Uses. — Bryonia is a powerful hydragogue cathartic, resembling jalap in its action, but much more violent. It also acts on the kidneys, increasing their secretion. In large doses it has produced fatal gastro-intestinal inflammation. Christison * records a fatal case following the swallowing of two glasses of an infusion (strength not stated), which was characterized by violent tormina and purging. Should symptoms of its irritant action appear, the drug should be discontinued and opiates and stimu- lants administered. In dropsies it may be used as a drastic cathartic, with a view of also acting on the kidneys. Phillips recommends it in the stage of effusions in pleuritis and pericar- ditis, in pleuro-pneumonia, and where the joints are stiff and painful from rheumatic affections. The tincture is the only offi- cinal preparation ; dose, f 5ss-j or more. PODOPHYLLUM. Podophyllum peltatum, May-apple or Mandrake {Nat. Ord. Berberidaceae), is a very common indigenous herbaceous plant, with a long, creeping, perennial root, and an upright stem about a foot high, separating at the top into two petioles, each support- ing a large peltate leaf, divided into five or six lobes. At the fork of the petioles it bears a single flower, which appears in May, the fruit ripening in September. The rhizome and root- lets are the parts used. The rhizome is found in the shops in wrinkled, jointed, cylindrical pieces, about two lines in diameter, of a brown color externally, and yellowish within, having a tuft of about ten nearly simple fragile rootlets on its under surface. The powder is yellowish-gray, and has a sweetish smell ; its taste is at first sweetish, afterward bitter, acrid and nauseous. Diluted alcohol is the best solvent of podophyllum, which has been found to contain two resinous cathartic principles ; one * " A Treatise on Poisons," 4th edition, p. 594. 346 MATERIA MEDICA ECCRITICS. neutral, the other acid in reaction (podophyllinic acid). Accord- ing to V. Podwissotzki, of Dorpat, podophyllum and podophyllin both contain a resinous, bitter, amorphous substance, which is very active and which he calls podophyllotoxin. This consists of two principles, picropodophyllin (crystalline, bitter) and podo- phyllinic acid (inert). Power * has shown that the rhizome con- Fig. 30. PODOPHYLLUM PELTATUM. tains no berberine nor any other alkaloid, and his investigations have been confirmed by Maisch. Effects and Uses. — Podophyllum is therefore an active hydra- gogue cathartic, with an especial determination to the upper * Proceedings Am. Pharm. Assoc, 1 87 7, p. 420. " On the Resin of Podophyllum Peltatum." CATHARTICS CHELIDONIUM. 347 portion of the alimentary canal, and a pretty decided cholagogue action which, according to Rutherford, is due to stimulation of the hepatic secreting apparatus, and is greater when purgation is not profuse, and vice versa. He also concludes that purgation is due to intestinal irritation, which is essentially the conclusion reached by Anstie.* As a cholagogue and purgative, one of the following pills may be given at bedtime : Jfy Resinae podophylli, gr. ij ; extracti colocynthidis compositi, gr. xxiv; extracti bella- donnas, gr. iij. M. Ft. pil. xij. It is an ingredient in several cathartic nostrums. Dose, in powder, gr. xx ; of the abstract, gr. \-) ; of the fluid extract, t^x-xx; of the extract (alcoholic), gr. v-xv ; of the resin, gr. \-]. Podwissotzki found that the effects of podophyllum depended upon picropodophyllin, small doses of which caused purging while large doses produced vomiting. As this is very expensive when pure, he recommends a I per cent, solution of podopliyllotoxin in alcohol, which he gives in doses of gtt. xxx in wine. He uses it in chronic constipation from sluggishness or atony of the muscular fibres, and in catarrhal jaundice. When podo- phyllotoxin is given internally, a cathartic effect is produced in about four hours ; if given hypodermically, in about two hours. Dose, for a child, gr. x \ ^ ; for an adult, gr. \-\, once or twice a day ; eight or ten hours should elapse before the second dose is taken. CHELIDONIUM Chelidonium majus, known also as Celandine or Tetterwort (Nat. Ord. Papaveraceae), is a perennial herb growing in waste places, indigenous to Europe, but naturalized in North America. The stem is about two feet high, and hairy; the leaves are alternate, the upper ones sessile, light-green above and glaucous beneath, lyrately pinnatifid, the pinnae ovate-oblong, obtuse, coarsely crenate or incised. The flowers appear from May to September, are of a bright golden-yellow color, and arranged in small axillary umbels on long peduncles. Chelidonium contains * Med. Times and Gazette; Vol. I, pp. 326,487; "Report on the Phys. Action of Podophyllin." 348 MATERIA MEDICA ECCRITICS. two alkaloids, chelerythrine (Ci 9 H 17 N0 4 , not identical* with san- guinarine) and chelidonine (C ]9 H 17 N 3 03), combined with chelidoninic acid, which is identical f with succinic acid. Effects and Uses. — The physiological action of this drug has not been investigated. It has been used as a hydragogue cathartic, and is said to possess narcotic properties. Binz and Phillips both believe that it has a stimulating effect upon the hepatic secretions, and class it with podophyllum and iris. Dose of the powder, gr. x-5j ; or it may be given in extract or infusion. There are no officinal preparations. IRIS. The rhizome and rootlets of Iris versicolor, or Blue-flag {Nat. Ord. Iridaceae), are used as a powerful hepatic stimulant. The Blue-flag is found in the swampy meadows of North Amer- ica, having sword-shaped leaves and a stout stem, bearing a few blue flowers, appearing late in the spring. The rhizome is horizontal and jointed ; is long and cylindrical in its lower half, broad near its upper extremity/and terminated by a circular scar, annulated from the leaf-sheaths, of a grayish-brown color, with long: rootlets crowded near the broad end. It has a slight odor and a nauseous, acrid taste (Maisch). It contains a resin, to which probably its medicinal qualities are due. Effects and Uses. — In large doses the fresh plant causes violent vomiting and purging, with much depression : in smaller doses it is a cholagogue and diuretic (Phillips). The qualities are impaired by drying. Rutherford found that iridin (an impure oleo-resin) was a powerful hepatic stimulant, producing less intestinal irrita- tion than podophyllin, but greater purgation than euonymin. It was also a decided stimulant to the intestinal glands. It is highly recommended in jaundice of malarial origin, and may be given with advantage in torpidity of the liver, dropsy and intestinal disorders. The fluid extract (extractum iridis flidduni) may be given in doses of ^xx-f 5j. An extract is also officinal. EUONYMUS. Euonymus or Wahoo is the bark of Euonymus atropurpureus {Nat. Ord. Celastracece), a handsome shrub of the northern and * Pharm. Zeitung, Berlin. 1886, p. 577 ; also Journ. de Med. de Chir. et de Pharm., Bruxelles, 1868, p. 268. f Per. der. deutsch. chem. Ges., 1886, xv, p. 704. CATHARTICS SCAMMONY. 349 middle portions of the United States, found in shady woods. " Its branches are slightly quadrangular ; the leaves opposite, petioled, elliptic-ovate, serrate, and pointed ; the flowers dark- purple, in loose cymes of three to six, and appear in June." The fruit matures in autumn, and consists of pendulous capsules of a bright crimson color. The bark, as seen in the shops, is of a grayish color, mottled with blackish patches on its outer sur- face, which is detached in thin and small scales ; inner surface tawny and smooth. It is without smell, and has at first a sweet- ish taste, which afterward becomes bitter and acrid. It contains a bitter principle, euonymin, resins, euonic acid, etc. Effects and Uses. — Euonymus is an excellent cathartic, increas- ing the intestinal secretions to some extent, and acting as a powerful hepatic stimulant. It may be advantageously used in cases of torpor of the liver and intestines. The extract is the only officinal preparation ; dose, gr. iij-v. SCAMMONIUM SCAMMONY. Scammony is a resinous exudation from the root of Con- volvulus Scammonia (Nat. Ord. Convolvulaceae), a twining plant of Syria. The finest kind is the product of exudation from the sliced root; but most of the drug which reaches us is probably obtained by expression, or by evaporation of a decoction of the root. It comes from the Levant. Genuine scammony, termed Virgin Scammony, occurs in light, irregular, friable pieces, of various shades of color, from dark-ash to dark-olive, covered with a whitish-gray powder, and breaking with a bright-greenish fracture ; they should not effervesce with an acid. The scam- mony of the shops, which is always more or less adulterated, is in hard, heavy, saucer-shaped cakes, from four to six inches in diameter (sometimes broken into pieces), of a dark -ash or slate color. The powder is light-gray ; the smell disagreeable, like that of old cheese, the taste at first feeble, afterward bitterish and acrid. Scammony is a gum-resin, the resin constituting from 80 to 90 per cent, of the weight of good scammony, and called scammonin (C 34 H 56 16 ). It is a colorless and tasteless substance, having a peculiar faint, sweetish smell, and being soluble in alcohol and ether. A factitious scammony made in France, and known as Mont- 350 MATERIA MEDICA ECCRITICS. pettier Scammony, is occasionally imported into the United States. It is blacker than the genuine article, has a feeble balsamic odor and a very bitter, nauseous taste. Effects and Uses. — Scammony is an energetic Jiydragogue cathartic, operating sometimes with great violence, and seldom given except in combination with other cathartics. We have seen no recorded fatal cases of poisoning by scammony ; Orfila* ascertained that so much as 5iv in dogs only produced diarrhoea. Dose, gr. v-xv of the pure drug, gr. x-xxx of the drug of the shops ; of the resin, gr. iv-viij. Scammony resin is of pleasanter smell and taste than jalap resin, produces less griping, and is less apt to cause vomiting. It is much used in the form of compound extract of colocynth. COLOCYNTHIS — COLOCYNTH. Colocynth is the fruit (deprived of its rind) of Citrullus Colo- cynthis or Bitter Cucumber (Nat. Ord. Cucurbitaceae), an annual plant of the south of Europe and parts of Asia and Africa, resembling the common watermelon. The fruit has a thin but hard rind, but is peeled and dried for exportation, and comes to Fig. 31. COLOCYNTH (PEELED). us from the Levant. It consists of light, whitish, spongy balls, about the size of a small orange, filled with numerous seed. For medicinal use the pulp only is employed, and the seed, which are inactive, are rejected. The pulp has a feeble odor and a nause- ous, intensely bitter taste. It yields its virtues to both water and alcohol, and contains a peculiar glucoside termed colocynthin (C 56 H 84 023), resin, colocynthitin, etc. *" Toxicologie Generale," Vol. I, p. 758. CATHARTICS GAMBOGE. 35 I Effects and Uses. — Colocynth is a hepatic stimulant, increasing the amount of the biliary constituents as well as rendering the bile more watery and at the same time stimulating the intestinal glands (Rutherford). It is a violent hydragogue cathartic, acting sometimes very harshly even in small doses, and in overdoses producing dangerous, and occasionally fatal, enteric inflammation. Christison * describes a case in which a teaspoonful and a half of the powder killed a man, while Husemanf mentions an instance in which 5^ proved fatal to a woman, and of recovery after swallowing 5"j. Its chief use is to unload the bowels in obsti- nate constipation. The dose is gr. v-x. It is seldom, however, administered alone. The extract (alcoholic) is used chiefly in the preparation of the compound extract, which contains also aloes, resin of scammony, cardamom and soap ; this is a favorite prescription, but it is apt to gripe, and it is well to combine some aromatic with it, as a little oil of cloves or capsicum ; dose, gr. v-x. CAMBOGIA GAMBOGE. Gamboge is a gum-resin procured from Garcinia Hanburii (Nat. Ord. Guttiferae), a tree of Siam and Cochin- China. The juice is collected in a bamboo joint as it exudes from a spiral incision in the bark, extending nearly round the tree, and is afterward reduced to a solid consistence by the aid of heat. The sap exudes slowly for several months, and the tree is not injured by the process. It is imported from Canton and Calcutta, and occurs in cylindrical rolls from one to three inches in diam- eter, of an orange color, known as pipe gamboge, or in irregular masses (which are less pure), weighing two to three pounds or more, called cake or lump gamboge. Good gamboge is opaque, brittle, inodorous, nearly insipid, and breaks with a vitreous fracture; its powder is bright-yellow. It is a gum-resin, forming a yellow, opaque solution with water and a golden yellow solu- tion with alcohol ; it contains from 20 to 25 per cent, of gum and from 75 to 80 per cent, of a resin termed cambogic acid (C20H23O4). Effects and Uses. — Gamboge is a powerful hydragogue, and in * " A Treatise on Poisons," 4th ed., p. 595. •j- " Handbuch der Toxicologic," p. 625. 352 MATERIA MEDICA ECCRITICS. overdoses has proved fatal. Sometimes it causes vomiting, and in large amounts has produced death merely from depression. Christison * mentions a case in which 5j proved fatal, the symp- toms being excessive vomiting, purging and faintness. It is employed in obstinate constipation ; in dropsies, combined with cream of tartar or jalap ; and has been given to destroy taenia. Dose, gr. ij-vj. It is usually prescribed with other and milder cathartics, to promote and accelerate their action. Compound cathartic pills (pilulce catharticce compositce) are made by mixing compound extract of colocynth (gr. 130), extract of jalap and calomel (of each, gr. ico), and gamboge (gr. 25), with water, forming a pilular mass, to be divided into 100 pills. Three of the pills, containing gr. io|-§- of the mass, represent gr. 3.9 of compound extract of colocynth, gr. 3 of extract of jalap and calomel each, and gr. ^ of gamboge. ELATERINUM ELATERIN. Elaterin (CaoH^Os) is a neutral principle extracted from elaterium, a substance deposited by the juice of the fruit of Ecballium Elaterium, or Squirting Cucumber (Nat. Ord. Cucur- bitacese), an annual vine of the south of Europe, now cultivated in England. The fruit has the shape of a small oval cucumber, and, when fully ripe, separates from the peduncle, and throws out its juice and seeds with considerable force, through an open- ing in the base. Pure elaterium is obtained by slicing the fruit and allowing the juice to drain through a sieve. The juice deposits a sediment, which dries in very light, thin, nearly flat, pulverulent, greenish-gray cakes, and is the genuine elaterium. It is almost inodorous, and has a bitter, acrid taste. The com- mercial elaterium, which is obtained chiefly from England, is made by expression. The drug is to be considered inferior when it is dark-colored, much curled, and hard. Elaterium yields its virtues to alcohol and not to water. Elaterin, its active principle, crystallizes in beautiful colorless, needle-shaped crystals, without smell, but of a bitter, sharp taste, insoluble in water, but readily soluble in alcohol. Effects and Uses. — Elaterium is a hydragogue cathartic of great * "A Treatise on Poisons," 4th ed., p. 603. CATHARTICS CROTON OIL. 353 violence of operation, possessing some diuretic action, and irt overdoses has frequently proved fatal. Beck * mentions a case in which extract of elaterium, gr. ij J-, with gr. xvj of rhubarb caused death, the chief symptoms being incessant vomiting and purging. It is a very efficient remedy in the treatment of dropsies, and is also a useful revulsive in cerebral affections ; but in administering it, considerable caution is required. Elaterin proves powerfully cathartic in doses of gr. xo~rV- Trituration of elaterin (trituratio elatermi) consists of elaterin IO parts and sugar of milk 90 parts, thoroughly triturated ; dose, gr. J-j. It is safest to begin with the smaller dose. OLEUM TIGLII CROTON OIL. Croton oil is a fixed oil obtained from the seeds of Croton Tiglium (Nat. Ord. Euphorbiaceae), a small tree of the East Indies. The croton seeds resemble the castor seed in shape and size, and consist of a blackish shell, sometimes covered with a yellowish- brown epidermis, and inclosing a yellowish oily kernel. They are highly irritant and cathartic, but are not imported into this country. They contain a volatile oil, a fixed oil, resin, acetic, butyric, and valerianic acids, together with an acid termed tiglinic (C 5 H 8 2 ). The croton oil of the shops is obtained by expres- sion, and is a mixture of the fixed oil proper, the resin and tiglinic acid. According to Senierf the vesicating principle resides in the non-volatile fatty acids, or in that part of the oil soluble in alcohol. The oil is made in both India and England, the Indian oil being of a pale straw color, and the English reddish-brown ; the latter is the variety now found in the shops. It has a viscid con- sistence, which is increased by age, a faint, peculiar odor and an extremely acrid, pungent taste ; it is soluble in ether and the volatile and fixed oils, and partially so in alcohol. The drastic principle has been found by Senier {loc. eit.) to exist in that por- tion of the oil insoluble in alcohol, which he styles the " Alcohol non-soluble, non-vesicating oil." This he determined experi- mentally to be purgative in "^ tV~2> ms work being confirmed by Dr. Meek (same article as Senier's). There are no exact * " Med. Jurisprudence," 6th ed., 11, p. 578. f The Pharm. Journ. and Trans., 1883, p. 446. 23 354 MATERIA MEDICA ECCRITICS. chemical tests by which croton oil can be recognized in medico- legal cases. Physiological Effects. — Croton oil, taken internally, is a powerful hydragogue purgative, occasionally increasing also the secretion from the kidneys. Gtt. j-ij are usually sufficient to produce active catharsis, but sometimes as much as gtt. viij-x may be taken without affecting the bowels. It operates very speedily, often causing evacuations in half an hour, and is apt to produce considerable sedation of the vascular system. In overdoses it has frequently proved fatal, destroying life rather by its depress- ing influence on the functions of organic life through the nervous system than by a local irritant action. The fatal quantity varies widely, since ^ iij killed a child aged 13 months,* while recovery has followed after swallowing f5j (a child f), and in adults f5j,t f 5ij % (without purging) and f §j.§ Rubbed on the skin, croton oil causes rubefaction and a pustular or vesicular eruption; and rubbed over the abdomen it will sometimes purge. Medicinal Uses. — Croton oil, from the smallness of the dose required and the speediness of its action, is an extremely valuable purgative in obstinate constipation, and in cerebral disorders, par- ticularly apoplexy. As a counter-irritant, it has been employed in pulmonary and laryngeal affections, diseases of the joints, etc. Dose, gtt. j-ij, made into pill with bread-crumb. For external use, it may be diluted with one or two parts of olive oil or oil of turpentine. MERCURIAL CATHARTICS. The preparations of mercury employed as cathartics are calo- mel and blue pill. Their purgative effects depend partly on the increased flow of bile which they occasion, and partly on the stimulus which they give to secretion from the mucous follicles of the intestinal canal and from the pancreas. They probably do not increase the amount of bile secreted, but by irritation of the orifice of the duct, cause reflex contraction of the ducts and the gall-bladder, and consequently expulsion of that already secreted. * Med. Times and Gazette, 1870, I. ff" Handbuch der Toxicologie," Huseman, p. 443. % Am. J. Med. Sci., April, 1874, p. 416. \ Boston Med. and Surg. Journ., 1868, p. 294. CATHARTICS ENEMATA. 355 They are rarely employed alone, owing to the slowness and uncertainty of their action, but are usually combined with or followed by other cathartics (as jalap, senna, rhubarb, compound extract of colocynth, or some of the saline preparations). The mercurial cathartics are usually administered with a view of com- bining a purgative action with an effect on the secretions, partic- ularly that of the liver; also as anthelmintics and as revulsives in cerebral and other affections. They are well adapted to infantile cases, from the facility of their administration, and are especially beneficial in the ephemeral febrile attacks to which children are subject ; they, moreover, rarely produce salivation in children. Hydrargyri Chloridum Mite {Mild Chloride of Mercury, or Calomel). (Noticed at length under the head of Alteratives)) Dose, as a cathartic, gr. j-xij, in pill or in powder, with syrup or molasses ; to be followed, in from four to six hours, by some other cathartic. Sometimes, when it is exhibited with a view to a full action on the liver, gr. J^-ij may be given every hour or two, until the whole purgative dose is taken ; or it may be admin- istered at bedtime, with an aperient draught the next morning. For children, larger doses are required in proportion than for adults : gr. %-v] may be given to a child from three to six years old. Calomel occasionally causes griping pain in the bowels, with bilious vomiting ; this is attributable, not to any irritant qualities in the medicine, but to the acrid character of the bile secreted. Calomel is an ingredient of the compound cathartic pills. Massa Hydrargyri (Mass of Mercury), commonly called blue pill or blue mass (see Alteratives), is analogous in its cathartic action to calomel, but milder and less certain. It is given in about the same doses and in the same combinations, etc. ENEMATA. In cases of irritability of the stomach— or with the view of hastening the action of cathartics taken by the mouth — or to remove feculent accumulations in the lower bowels — 'or to relieve tympanites — or for the purpose of revulsion, or the removal of ascarides, cathartic enemata are frequently administered, When it is desired simply to open the bowels mechanically, tepid water, flaxseed tea, or other demulcent infusion may be employed. The common laxative enema consists of a table- $6 MATERIA MEDICA ECCRITICS. spoonful of common salt, molasses and lard or olive oil, each, In two-thirds of a pint of warm water ; castor oil or Epsom salt may be added to increase the cathartic effect. Senna tea or some other cathartic infusion is often employed. Glycerin, f5ss- j, with an equal quantity of water, injected into the rectum, will produce, in a few minutes, an evacuation, usually normal in consistence. To relieve flatulency, oil of turpentine (foss— j, in emulsion), or milk of asa- fcetida (f 5ij-iv) may be given. The latter is a suitable preparation in infantile cases. For the removal of ascarides infusion of quassia makes an excellent enema. In some cases, as invagination of the intestines, or even in hernia, much good may be accomplished by the gradual distention of the bowel by means of forced enemata of warm water. This is accomplished by means of a long flexible rubber tube, one end of which is armed with a rectal tube having a blunt conical point and several large openings to admit of the free passage of the water. The other end of the flexible tube is attached to a large funnel, and the tube has a stop-cock upon it. By elevating the funnel and filling it with water, a continual stream can be thrown into the bowel, the force being regulated by the height at which the funnel is held and by the stop-cock. In this way from five to ten pints of water can be thrown into the bowel, filling the large intestine and even passing the ileo-caecal valve. The injection should be conducted slazvly and carefully. Several cases of invagination have been reported where the symptoms subsided under this treatment, the invaginated portion of the intestine having slipped back to its proper place during the distention. This method should not be resorted to when there is reason to think that sphacelus of the bowel is taking place, as it might result in a rupture. ORDER III. DIAPHORETICS. Diaphoretics (from diawoplw, I transpire), called also sudorifics*. are medicines which promote transpiration from the skin. The action of the cutaneous exhalants may be increased by various means. The mere introduction of a large quantity of fluid into the system will produce sweating, if the system be kept warm. Exercise, and a warm temperature, by determining a flow of blood to the cutaneous vessels, act in the same way. Nau- • DIAPHORETICS PILOCARPUS. 357 seants occasion diaphoresis by relaxing the orifices of the cuta- neous vessels ; stimulants, by exciting them to increased secretion. Diaphoretics are employed therapeutically for their evacuant, revulsive and alterative effects, and to promote absorption. Dif- ferent classes of diaphoretics are required for different morbid conditions. i. Nauseating Diaphoretics. — Most of the emetics, in nauseating doses, produce a powerfully relaxing diaphoretic action, and are much employed, with this view, in inflammatory cases, when not contra-indicated by the presence of gastric irritability. The Pre- parations of Antimony (see p. 241) and Ipecac (see p. 312) are chiefly resorted to as nauseating diaphoretics. Ipecac is often given as a diaphoretic, in combination with opium, in the form of Dover's Powder (see p. 82). 2. Refrigerant Diaphoretics. — The saline and ethereal prepara- tions classed as refrigerants (see p. 247), produce a gentle relax- ing diaphoretic action, unattended with nausea. They are used to allay febrile excitement and reduce the temperature of the body. 3. Stimulating Diaphoretics. — This group includes the diffu- sible stimulants, aromatic substances generally, of every class, and many narcotics, particularly opium and camphor. They are contra-indicated in high inflammation, but are very serviceable in rheumatic and pulmonary affections, after vascular excitement has been reduced, and in all diseases where the surface of the body is cold. Opium, in the form of Dover's Powder, may be employed in inflammatory cases, where other stimulating dia- phoretics are inadmissible, and is given with advantage in an early stage of acute rheumatism, dysentery and catarrh of the air passages, unless the action of the pulse, be very strong, when this should be previously moderated. The operation of the diaphoretic stimulants is promoted by the free use of warm diluent drinks, and warm covering to the body. PILOCARPUS. Pilocarpus is the leaflets of Pilocarpus pennatifolius (Nat. Ord. Rutaceae), a shrub of some of the northern provinces of Brazil, growing to the height of about five feet, with a long cylindrical root, about three-quarters of an inch in thickness, 35» MATERIA MEDICA — ECCRITICS. and imparipinnate leaves (with anastomosing veins near the mar- gin) about nine inches long, with from three to five pairs of opposite, oblong-lanceolated, grayish-green leaflets, with an odd terminal one, which are dotted with a number of pellucid glands. There are several plants known in South America under the name of Jaborandi, and the variety brought here is from Per- nambuco. The leaflets have a characteristic odor (resembling a mixture of Indian hemp, matico and cubeb) and a warm, sharp, aromatic taste. They yield pilocarpine (C n H 16 N 2 2 ), an alka- loid of a bitter, nauseous, astringent taste, soluble in water, alco- hol, ether, chloroform and diluted acids, and an amorphous Fig. PILOCARPUS PBNNATIFOLIUS. A, LEAF; B, C, FLOWERS. alkaloid termed Jaborine* — probably a derivative of pilocarpine — has been isolated, which resembles atropine in action ; they con- tain also a volatile oil (chiefly pilocarpine, C 10 H ]6 ). Recently MM. Hardy and Calmelsf have obtained pilocarpine synthetically from a derivation of pyridin, which is stated to be identical in action with the natural base. Physiological Effects. — The action of pilocarpus and of its alkaloid (upon which its effects depend) has been studied by * Arch.filr exper. Pathol, u. Pharmakol., XII, p. 366 ; Harnack und Meyer, f Compt. Rend. CII, quoted in Dublin M. J., Dec, 1887. DIAPHORETICS PILOCARPUS. 359 Ringer,* Murrell, Langley,f Harnack and Meyer {loc. cit), and many others, with the following results. It paralyzes the vaso- motor nervous system, and rapidly excites the circulation, but the pulse is soon slowed and the arterial tension is greatly increased. According to Ringer (loc. cit.), it paralyzes the ven- tricles separated from the auricles by a direct action. The tem- perature, as a rule, rises at first, but coincident with the profuse sweating, is lowered. It is a powerful diaphoretic, augmenting both the watery and solid ingredients of the sweat enormously, probably by a direct action on the peripheral endings of the nerves. The amount of urea eliminated by the skin is especially heightened. The sweat is said to be acid at first, becoming neutral and, finally, alkaline. It also causes salivation, which is some- times very profuse, in which case the diaphoretic effect is less marked, and vice versa. The sialagogue effect probably depends on a direct action of the drug upon the glands. The gastric and bronchial secretions are also increased. These effects continue for from three to six hours. Disturbance of the vision, con- tracted pupils, uneasiness of the head, and after a time vomiting, generally accompany these eccritic results, often followed by drowsiness. In much of its action, especially on the secretions, an antagonism exists between pilocarpus and belladonna (Lang- ley, loc. cit.). Pilocarpus appears to stimulate the nutrition of the hair, and in one case, Prentiss,J under its use, noticed a change in the color of the hair from blonde to black. Gale- zowski § found that an aqueous solution of pilocarpine nitrate applied to the conjunctiva contracted the pupil. It is eliminated by the secretions on which it acts. Medicinal Uses. — Pilocarpus should not be given in affections of the gastro-intestinal mucous membrane, nor in weak heart due to disease of the cardiac muscle or ganglia, or of the valves. In cases of pleuritic effusion, especially after the subsidence of the inflammatory symptoms, pilocarpus or its alkaloid often quickly removes the transudation. In renal dropsy and in uraemia it is often invaluable on account of its diaphoretic effects and because * Practitioner, 26, 1 88 1, p. 5. f Journ. of Physiology, 1878, p. 339. \ Phila. Med. Times, July 2d, 1 88 1. \ " Compte Rendus de la Societe de biologie," 4, 1877, p. 401. 360 MATERIA MEDICA ECCRITICS. it increases the elimination of urea by the skin. It has also been used with success in puerperal convulsions due to kidney dis- ease, in humid asthma and bronchorrhcea, in some cases of paro- titis, in chronic enlargement of the cervical glands, in adenitis of the inguinal glands, and as an agent to increase the secretion of milk. Pilocarpine has been found useful in arresting severe and prolonged hiccough, in doses of gr. J hypo^dermically employed. It is recommmended in polyuria and in squamous affections of the skin, and has been used locally and hypodermically with success in alopecia. In diphtheria it has been used with varying success, but on the whole the evidence can scarcely be con- sidered in favor of its employment. Dose of the fluid extract, f5ss— j ; of pilocarpine hydrochlorate, gr. J-ss. Children bear pro- portionally large doses. ALTERATIVE DIAPHORETICS. Under this head are comprised a class of diaphoretic medicines which produce a gradual and nearly insensible increase of the cutaneous secretion, and are supposed to promote the elimination of noxious matters from the blood through the vessels of the skin. They are employed chiefly in chronic rheumatic and cutaneous affections, and in secondary syphilis. SARSAPARILLA. The name of Sarsaparilla is applied to the root of Smilax officinalis, S. medica and other species of Smilax {Nat. Ord. Smilaceae), twining prickly shrubs of Mexico, Guatemala and the warm countries of South America. The roots consist of numer- ous wrinkled, slender pieces, of the average thickness of a writing quill, several feet long, springing from a common head or rhi- zome, and are frequently found in the shops with portions of the stem attached. Several varieties are known : I. Honduras sar- saparilla, the most common variety in the United States, is com- posed of several long, thin roots, folded lengthwise, of a dirty grayish or reddish-brown color. 2. Jamaica sarsaparilla, which comes in shorter bundles, and is known by the red color of the epidermis. 3. Vera Cruz sarsaparilla consists of a head with numerous long radicals. 4. Brazilian or Rio Negro sarsaparilla is found in cylindrical bundles, with fewer rootlets than the Hon- DIAPHORETICS SARSAPARILLA. 36 1 duras variety ; it is distinguished by the amylaceous character of its interior structure. 5. Guatemala sarsaparilla resembles the Brazilian. Sarsaparilla roots are several feet in length, about the thick- ness of a goose-quill, cylindrical, more or less wrinkled longi- tudinally, and consist of a whitish-brown or pink cortical portion covered with a thin, gray, brown or red epidermis, and inclosing a layer of whitish ligneous fibre and a central pith. The cortical portion is more active than the inferior portion ; the central medulla contains a good deal of starch. Sarsaparilla, in the dried state, is nearly inodorous, but its decoction has a strong smell. It has a mucilaginous, slightly bitter taste, and when chewed for some time produces a persistent acrid impression on the mouth ; this acridity of taste is the criterion of good sarsa- parilla. Water and diluted alcohol extract its virtues. It con- tains a glucoside, resembling saponin, called smilacin or parallin, a volatile oil, starch, mucilage, resin, extractive, etc. The Vera Cruz and Jamaica varieties contain the most smilacin, and are there- fore the best for medical purposes. Effects and Uses. — The physiological effects of sarsaparilla, beyond a slight diaphoretic action, are not very obvious ; in large doses it occasionally produces nausea and vomiting. Its efficacy in eradicating various morbid symptoms is believed in by some, though denied by others; and its mode of action, though obscure, is popularly attributed to a purifying influence on the blood through the function of the skin. It is employed in tertiary syphilis, particularly where the disease resists or is aggravated by the use of mercury ; also in chronic rheumatism, skin dis- eases, and cachectic conditions of the system generally. Administration. — Dose, of the powder, 5ss three or four times a day — never used, however, in this form. The compomid decoc- tion is made by boiling sarsaparilla 10 parts, sassafras, guaiacum wood and liquorice root each 2 parts, and mezereon 1 part, in IOO parts of water, then macerating, and, after straining, adding water enough to make the decoction measure 100 parts ; dose, f5iv-vj t. d. The compound syrup (which contains also guaiacum wood, pale rose, senna, glycyrrhiza, sassafras, anise, and gaulthe- ria) is a favorite preparation ; corrosive sublimate should riot be given with it, as it is decomposed into calomel. Dose, f §ss. Of 362 MATERIA MEDICA — ECCRITICS. the fluid extract \ the dose is f5ss. The compound fluid extract contains the ingredients of the compound decoction, except the guaiacum ; dose, f 5j, repeated. GUATACI LIGNUM— GUAIACUM WOOD. GUAIACI RESINA GUAIAC. Guaiacum Wood, or Lignum Vitcz, and Guaiac are products of Guaiacum officinale and G. sanctum {Nat. Ord. Zygophyllaceae), large evergreen trees of South America and the West Indies. The wood, which is remarkable for its hardness and density, is imported in logs or billets, covered with a thick gray bark ; the outer portion or sap-wood is of a pale-yellow color, the inner of an olive-brown. The heart- wood is the officinal portion ; it is usually kept in the shops in the state of shavings or raspings ; they are inodorous unless heated, and when chewed for some time they have a bitterish pungent taste. Guaiacum wood yields its virtues to alcohol, and partially to water ; they depend on the guaiac contained in the wood. Guaiac is a peculiar resin, obtained from Guaiacum officinale by spontaneous exudation, by incision, by dry heat, or by decoc- tion of the comminuted wood. It comes in large, irregular, semi-transparent, brittle pieces, of varying size — externally of a deep green or olive color, and internally red. It has a slight balsamic odor, which is rendered stronger by heat, and though at first nearly tasteless, leaves a hot, acrid sensation in the mouth and throat. Water dissolves it partially, alcohol completely. It contains guaiaconic and guaiaretic acids, guaiac beta-resin, gum, ash, guaiacic acid, coloring matter, etc. (Hadelich *). Most oxidizing agents, as nitric and chromic acids, etc., produce a blue, then green, and finally a brown color, with tincture of guaiacum. Effects and Uses. — Guaiacum wood and guaiac are stimulant diaphoretics, also increasing the secretion of bronchial mucus, and in large doses cathartic. They are principally used for their alterative virtues in chronic rheumatism and skin diseases ; guaiac has been used as a laxative. In tonsillitis the tincture, f5/^, repeated every three or four hours, is extremely useful. * " Pharmacographia," 2d ed., p. 104, quoted. DIAPHORETICS MEZEREUM. 363 They are considered also to possess emmenagogue properties, and are employed in amenorrhcea and dysmenorrhcea. Administration. — Gitaiacnm wood is used only as an ingredient in the compound decoction and syrup of sarsaparilla. Dose of guaiac, gr. x-xxx, in pill or emulsion, sometimes combined with alkalies. The tincture (20 parts in 100 parts of the tincture) and ammoniated tincture (20 parts to ar. sp. of ammonia q. s. to make 100 parts) are much used in chronic rheumatism ; the former is given also in amenorrhcea ; dose, f 5j t. d. They are decomposed by water, and should be administered in mucilage, syrup or milk. MEZEREUM. Mezereon is the bark of Daphne mezereum and other species of Daphne {Nat. Ord. Thymelaceae), European shrubs which grow to the height of four or five feet. The root-bark is the part employed in Great Britain, but the bark of our shops, which is brought from Germany, is the stem-bark. It comes in strips from two to four feet long and an inch or less in breadth, folded in bundles or wrapped in the shape of balls. It has a thin, grayish or reddish-brown, wrinkled epidermis and a tough, pliable, whitish inner bark. When fresh it has a faint, nauseous smell, but when dry it is nearly inodorous. Its taste is at first sweetish, afterward highly acrid. It yields its virtues to water and alcohol, and contains a neutral crystalline bitter glucoside, called daphnin (C 31 H340 19 ), and a resin, to which it owes its acridity. Effects and Uses. — The topical action of mezereon is irritant and vesicant. When swallowed in large quantities it is highly acrid ; in medicinal doses it promotes the action of the secreting and exhaling organs, particularly of the skin and kidneys. Christison* records a case of fatal poisoning in a child of 8 years by mezereon, but the quantity taken is not mentioned. It is employed chiefly in conjunction with sarsaparilla (in the compound decoction, etc.) as an alterative diaphoretic in rheumatic, syphilitic and cutaneous affections. As a masticatory, it has been chewed for the relief of paralysis of the muscles of deglutition. The fluid extract is the best preparation for internal administration ; dose, f^x. An extract * "A Treatise on Poisons," 4th ed., p. 601. 364 MATERIA MEDIC A ECCRITICS. is also officinal, and is used as an addendum to rubefacient lini- ments and ointments. The ointment is also used as a stimulating application to blistered surfaces and indolent ulcers. MENISPERMUM. Menispermum is the rhizome and rootlets of Menispermum canadense, Yellow Parilla or Canada Moonseed (Nat. Ord. Meni- spermaceae), a climbing plant of North America. The rhizome contains berberine, starch, etc. It is supposed to be a diaphoretic, diuretic, tonic and alterative, and to possess virtues similar to those of sarsaparilla, and it maybe given in corresponding doses. According to the experiments of Rutherford, it is an intestinal, but not a hepatic, stimulant. There are no officinal preparations. CALENDULA. Calendula is the fresh flowering herb of Calendula offici- nalis, or Marigold {Nat. Ord. Compositae), a European plant, cultivated in our gardens. It contains a volatile oil, a bitter prin- ciple, calendidin, etc. It is supposed to be a stimulant, alterative, diaphoretic and diuretic. It is said to be efficacious in certain forms of chronic vomiting, and externally, to promote resolution of ulcers, wounds and contusions. It may be given in doses of gr. viij-5j. Of the tincture, the dose is foss-j. It may be used externally, diluted with water 20 parts. SASSAFRAS. This is the bark of the root of Sassafras officinale (Nat. Ord. Lauraceae), an indigenous tree of middling size. The bark is found in the shops in small, irregular pieces, of a cinnamon color, sometimes invested with a brownish epidermis. It has a highly fragrant odor and a sweetish, aromatic taste. Its virtues are extracted by water and alcohol, and it contains a little tannic acid and a volatile oil (oleum sassafras). Effects and Uses. — Sassafras bark is a mild stimulant alterative diaphoretic, used chiefly in combination with sarsaparilla. Its principal virtues are probably aromatic. Dose of the oil, gtt. ij-x. (For Sassafras Pith, see Demulcents^) DIURETICS. 365 STILLINGIA. The root of Stillingia sylvatica (Nat. Ord. Euphorbiaceae), commonly called Queen's Delight, a perennial plant, growing to the height of two feet in our south Atlantic States, is highly esteemed by southern physicians as an alterative diaphoretic in secondary syphilis, scrofula, cutaneous affections and chronic rheumatism. Dose of the powder, gr. xv-xxx. The fluid extract may be given in the dose of f 5'ss. A decoction and tincture are extemporaneously prepared. ORDER IV. DIURETICS. Diuretics (from did, thoroughly ,'and oupia>„ I make water) are medicines which excite the secretion of urine. The flow of urine may be promoted indirectly by increasing the quantity of fluid taken into the stomach, or by the removal of causes which check its secretion, or by mental emotion, a cool temperature, etc. It is promoted directly by the use of medicinal agents which specific- ally affect the kidneys ; they are termed diuretics. A large pro- portion of diuretic medicines are found among the agents which influence other, secretions, particularly diaphoretics. The func- tions of transpiration and urination are to some extent vicarious, and the same articles will prove diaphoretic or diuretic, as their action may be directed to the skin or kidneys. External warmth and warm drinks determine the action of such medicines to the skin ; and, on the other hand, if the skin be kept cool, and cool diluents freely administered, the secretion from the kidneys is promoted. . Blennorrheas, or medicines which have a special action on the mucous membranes, exert also a diuretic influence — probably the result of the stimulating impression which they make- on the mucous membrane of the urinary passages. When the action of the kidneys is obstructed by diseases of the heart, sedatives prove diuretic, by their tranquilizing influence on the action of the heart. In cases of obstruction of the portal system, mercurials increase the efficacy of the diuretics proper ; and also cathartics y by stimu- lating the flow of bile and the pancreatic juice. The principal therapeutic employment of diuretics is to promote the absorption of dropsical effusions. They are also useful in 366 MATERIA MEDICA — ECCRITICS. nephritic disorders attended with obstructed secretion ; to wash out calculi from the pelvis of the kidneys, ureters and bladder ; in gravel, with the view of rendering the urine more dilute ; and they may be resorted to as evacuants, to reduce inflammation. As diuretics act by becoming absorbed, they should be admin- istered in a very diluted state, to prevent a cathartic effect. The following groups of medicines, noticed under other heads, are employed also as diuretics : — 1. The Saline and Ethereal Refrigerants (see p. 247). 2. The Alkaline Carbonates (see Antacids); and the Alkaline Salts which contain a vegetable acid, as the acetates, citrates and tartrates. The acid potassium tartrate, or cream of tartar (see p. 334), is a very active diuretic. Potassii Acetas {Potassium ' 'Acetate). This salt (KC 2 H 3 2 ), formerly termed sal diureticus from its decided diuretic action, is made by saturating acetic acid with potassium bicarbonate. It occurs, when pure, as a white, foliaceous, satiny mass, of a warm pungent taste, very deliquescent, and wholly soluble in water and alcohol. The physiological effects of the potassium compounds have already been fully considered (see p. 244). In small doses it is diuretic, and in larger doses gently cathartic. It is a good deal employed as a diuretic in dropsies, as an antacid in acute rheumatism, as a preventive of the formation of urid acid calculi, and it has also been found useful as an alterative in cutaneous affections. As is the case with all the alkaline salts containing vegetable acids, the acid of this salt is decomposed in the system into carbonic acid. Although increasing the flow of urine, potas- sium acetate diminishes the amount both of uric acid and of urea in the secretion. Hence, it is valuable in gout, and, like colchicum, it may perhaps check the actual formation of uric acid in the system. Dose, gr. xx-3j, repeated. Sodii Acetas {Sodium Acetate) (NaC 2 H 3 02,3H 2 0), is prepared from crude pyroligneous acid, which is saturated with cream of lime, and the solution of calcium acetate thus formed is decom- posed by sodium sulphate ; repeated solution and crystallization, with fusion, furnish a pure salt in the form of white or colorless striated prisms, which effloresce in dry air, are wholly soluble in water, tolerably soluble in alcohol, and have a sharp, bitterish, not disagreeable taste. Its effects and uses are analogous to those DIURETICS — SQUILL. 367 of potassium acetate, over which it has the advantage of not being deliquescent. Dose, gr. xx-5j, p. r. n. 3. Sedatives (see p. 226) ; and Digitalis (see p. 268), which is very much employed in cardiac dropsies in combination with squill. 4. Blennorrhetics (see p. 378), particularly the oleo-resins. 5. Most of the Stimulating Diaphoretics. special diuretics. scilla squill. Squill is the sliced bulb of Urginea Scilla {Nat. Ord. Liliaceae), a perennial plant which grows on the shores of the Mediterranean. It has fibrous roots attached to a roundish-ovate bulb, from which both the leaves and flower-stem spring directly, the latter ap- Fig. 33. URGINEA SCILLA, BULB. pearing first ; the leaves are broad-lanceolate, and from twelve to eighteen inches long ; the stem is about two feet high, and bears pale yellowish-green flowers. The fresh bulb is pyriform, of the size of the fist to that of a child's head, and consists of thick, fleshy, concentric scales, attenuated at their edges, and attached to a rudimentary stem ; the outer scales are very thin and papery. Two kinds of squill bulbs are met with, the white and the red, which differ only in the color of their scales, and are identical in medicinal virtues. 368 MATERIA MEDICA ECCRITICS. Both abound in a viscid, acrid juice, which is very much dimin- ished by drying, with little loss of medicinal power. For im- portation, squill is usually sliced and dried, and is found in the shops in white or yellowish-white pieces, which when dry are brittle, but when moist, flexible. They absorb moisture readily, and. should be kept in well-stoppered bottles. They have a feeble odor, a bitter, nauseous, acrid taste, and yield their virtues to water, alcohol and vinegar. The active principles found in squill are scillipicrin, scillitoxin, and scillin. The first two are said to act on the heart like digitalis, slowing the pulse by stimulat- ing the end-organs of the par vagum, and the last to produce numbness and vomiting. A principle termed scillain is described by Jarmersted,* which he ascertained to be poisonous to the heart-muscle. Physiological Effects. — In small doses, squill promotes secre- tion from the mucous membranes and the kidneys — its diuretic effect being much the most marked and constant. Hammond f found that, in addition to its diuretic action, it increased also the proportion of inorganic solids. Husemann states that the diu- retic effects of squill are due to its influence on the blood-pressure, which it increases ; but clinical experience teaches that it stimu- lates the kidneys. In larger doses it excites nausea, vomiting, and occasionally purging ; and in excessive doses it acts as an acro-narcotic poison, gr. xxiv J having proved fatal. The symp- toms are violent vomiting and purging, abdominal pains, bloody or suppressed urine, reduction of the pulse, with collapse ; or death may be preceded by convulsions. Christison § describes an instance in which a teaspoonful of the root killed a woman, the main symptoms being gastric pain and convulsions. The stomach was found to be inflamed everywhere, and partly eroded. After evacuation of the stomach, opiates and demulcents are to be administered, and, if syncope or collapse occur, alcoholic stimuli should be given. Medicinal Uses. — Squill is employed principally in the treat- ment of dropsy ; it should not be used, however, in cases compli- * Arch, fur exper. Pathol, u. Phai'??iak., XI, p. 22. f Am. Journ. Med. Set., 1859, p. 275. I " Handbuch der Toxicologic," p. 413. § " A Treatise on Poisons," 4th ed., p. 879. DIURETICS COLCHICUM. 369 cated with degeneration of the kidneys or inflammation of the bladder. Digitalis is much prescribed in combination with squill in the treatment of cardiac dropsies, and calomel is often added with a view to its action on the absorbents. As a blen- norrhetic expectorant, squill is an excellent remedy in chronic and subacute bronchial affections ; it is, however, improper in the early stages of inflammatory cases. As an emetic, squill is too dangerous for general use ; but it forms an ingredient in some emetic preparations administered in croup. Administration. — Dose, as a diuretic or expectorant, gr. j, repeated and gradually increased till nausea supervenes. Gr. vj-xij will vomit. Of the vinegar (acetum scillce, containing 10 per cent, by weight of the powder), the dose is ^xv to f 5ij ; of the flidd extract, ^j ; of the syrup, f 3j ; of the compound syrup, known as hive syrup (which contains a solution of senega and squill in diluted alcohol and water, and tartar emetic, gr. j in every ounce of the syrup), i^v-fSj, according to the age; of the tincture, ^v-xxx. COLCHICUM. Colchici Radix, Colchicum Root ; Colchici Semen, Colchicum Seed. Colchicum autumnale, or Meadow-Saffron {Nat. Ord. Melan- thaceae), is a small biennial, bulbous plant, which grows wild, in moist meadows, in England and other temperate parts of Europe. The bulb, or corm, appears in midsummer as the lateral offset from the corm of the preceding year, and sends up the flower- stem in the autumn — the leaves and fruit following in the succeeding spring. The leaves are broadly lanceolate, about five inches long ; the flowers, of a lilac or light-purple color ; and the fruit, oblong, elliptical and three-celled. The corm and seed are the portions used medicinally. The corms are gathered in July, just before the sprouting of the flower from the young corm. They are somewhat like tulip- bulbs in appearance, but solid, and not composed of scales. They are covered by an external brown membrane and an inner reddish-yellow one, and are an inch and a half to two and a half inches in length, with a longitudinal groove. Internally they are white, fleshy and solid, and contain an acrid, bitter, milky juice. As found in the shops they are in the dried state, sometimes whole, but usually cut into transverse slices, about an 24 37o MATERIA MEDICA ECCRITICS. eighth of an inch thick, with a notch on one side, and deprived of the outer brown membrane. They have a hircine odor and a bitter, hot and acrid taste. The seed are brown, about the size of black-mustard seed, inodorous, and have a bitter, acrid taste ; they are less apt to be injured by drying than the corm. Colchicum corm and seed yield their virtues to vinegar and alcohol ; they both contain an alkaloid, soluble in water, readily so in alcohol, but insoluble in ether, termed colchicine (C23H27NO7, Laborde et Houde), on which the medicinal activity depends. Colchiceine (C^H^NO^) is a crystalline substance, of feeble acid Fig. 34. COLCHICUM AUTUMNALE, BULB. reaction, which does not preexist in the plant, but is formed by the action of the mineral acids upon colchicine. Colchicine makes with concentrated nitric acid a play of colors, beginning with yellow, then green, afterward crimson, and finally violet ; with concentrated sulphuric acid, to which has been added a fragment of potassium nitrate, it produces an intensely yellow color termi- nating in light violet. Physiological Effects. — Colchicum is a local irritant. Colchicine is undoubtedly the active ingredient of meadow-saffron (Huse- man*), and when introduced by the stomach diffuses into the *"Die Pflanzenstoffe," 1871,^?. 497. DIURETICS COLCHICUM. 37 I blood, since it has been found in the heart, lungs, liver, kidneys and blood by Aschoff.* Other observers, however (Laborde et Houdef) failed to detect it there or in the heart, even after intra- venous injection, but found the largest quantity inside the stomach and intestines. It seems to expend its force on the alimentary tract, though not entirely by a local action, for both LewinsJ and Roy§ found these parts to be much inflamed after the subcuta- neous administration of the drug. Taken internally, in small doses, it stimulates the secretions generally ; in larger doses it produces nausea, vomiting,|| and repeated purging, and primarily acceleration, followed by a reduction in the frequency of the pulse ; in excessive doses it is an intestinal irritant poison, inducing emesis, uncontrollable diarrhcea, collapse, and finally producing death by paralysis of respiration, the heart beating for a short time after the cessation of this act, the cerebral functions usually remaining unaffected, though Toulmouche {loc. at.) states that there is decided cerebral excitement. According to the recent investigations of Laborde et Houde (loc. cit) colchicine is without action on the centres of intelligence or volition, and there is an entire absence of paralysis, either motor or sensory, of central origin. The temperature falls during the period of emeto- catharsis; and when injected into dogs there is a marked fail in the blood pressure. The amount of urea and uric acid excreted in the urine is much increased after the adminis- tration of colchicum. Lewins {loc. cit) found the urea to be almost doubled. Hammond^f experimentally ascertained that it heightened the urinary flow and the proportion of solids, but as his results were based on only three analyses they can scarcely be accepted as conclusive. It increases the secretion of bile, which at the same time is rendered very watery. Fatal Quantity. — Dr. Major** reports 17 cases of poisoning by the wine of colchicum seeds, seven of which were fatal, the * "Die Pflanzenstoffe," 1871, p. 499, quoted. f Pamphlet, 1887. " Le Colehique et la Colchicine." % Edinburgh Med. and Surg. Jour., lvi, p. 185. \ Arch, de physiol. Norm, et Pathologique, t. V, p. 648. || Arch. Gin. de Midecine, t. xviil, p. 37, par. A. Toulmouche. ^ Amer. Journ. Med. Set., 1859, p. 275. ** Canada Med. and Surg. Jour., 1 874, p. 24. 372 MATERIA MEDICA ECCRITICS. quantity ingested ranging from fSiij-viij ; in two, there were con- vulsions. Dr. G. B. Wood* states that f 5iiss of the wine of the root proved fatal, and in another instance f oiss")* of the wine of the bulb killed a man. Vomiting and purging are the chief symptoms of colchicum poisoning, convulsions being infrequent, while the brain escapes till the approach of death. After death, in Roy's {loc. cit) experiments upon dogs, the post-mortem appear- ances were those of enteritis. Tannic acid is a partial antidote (forms a white precipitate with colchicine) ; opiates, demulcents and stimulants are to be given. Although placed among the diuretics, colchicum does not evince a more decided action on the kidneys than on other secretions, as those of the skin, liver and mucous membranes. Medicinal Uses. — Colchicum has long enjoyed a high reputa- tion in the treatment of gout ; and, although its modus medendi is obscure, it is universally admitted to possess a more decided control over the disease than any other remedy. It is usually administered in repeated doses till an effect is produced on the bowels, though purging does not promote its curative effect. Epsom salts and magnesia are often combined with it, as in the celebrated Scudamore's draught {magnesia, gr. xv-xx ; magne- sium sulphate j 5j-ij ; wine of colchicum seed, f5j-ij, in any pleasant vehicle). An excellent combination in the. treatment of gout is colchicum {wine of the seed, f§j), with potassium iodide (5ij), dissolved in cinnamon water (f§viij) ; dose, f 5ss t. d. until purgation is produced. Quinine and digitalis are also often given advantageously, with colchicum, in gout.J When it is desired to act on the kidneys and skin rather than the bowels, opiates are sometimes added. It is better to reserve colchicum for the treatment of the acute paroxysms of gout, giving a little opium (as in Dover's powder) at night, particularly to relieve the pain and procure sleep, enjoining perfect rest and quiet and using warm applications locally. In chronic gout and in lithaemia colchicum is not as useful, and these conditions are better treated by a * '•• U. S. Dispensatory," 15th ed., p. 1534. f Edinburgh Med. and Surg. Journ., XIV, p. 262. % Lartigue's celebrated gout-pills are : acetic extract of colchicum root, 2 grains; extract of digitalis, I grain ; compound extract of colocynth, 20 grains, to be mixed and divided into five pills— one to be taken at night. DIURETICS OIL OF ERIGERON. 373 properly regulated diet, avoidance of stimulants, exercise in the open air and the administration of the alkalies, particularly of the lithium salts. In rheumatism it is also employed, but it has little control over this disease. Dr. Woodbury,* however, has recently reported cases where hypodermic injections of ^v of a solution of colchicine (y 1 ^ per cent.) gave speedy and permanent relief in acute rheumatism, after the salicylates had failed. It has been occasionally resorted to as a diuretic in dropsy, as a sedative in febrile and inflammatory diseases, as an anthel- mintic and as an expectorant. Administration. — Dose of the corm or seed, in powder, gr. ij- viij ; the seeds are to be preferred. The liquid preparations, which are more generally used than the powder, are : the wine of the root (vinum colchici radicis), ""£ x-xxx ; wine of the seed (vinum colchici seminis), dose, f5ss-j; tincture (of the seed), dose, f5ss— j. An extract of the root (acetic) is also employed — dose, gr. j-ij ; and a fluid extract of the seed and also of the root — doses, gtt. iv-xij. The alkaloid colchicine (not officinal) has been recommended as the best form of administration in doses of gr. -^ in pill, or somewhat less by hypodermic injection. OLEUM ERIGERONTIS OIL OF ERIGERON. The oil distilled from the fresh flowering herb of Erigeron canadense, or Canada Fleabane (Nat. Ord. Composite), an herba- ceous indigenous plant, two or three feet high, with ovate or lanceolate toothed leaves, and white, blue or purple flowers. The oil by distillation yields resin and turpene (C 10 H 16 — Powerf). It possesses diuretic and hemostatic properties, and has been used in hemorrhagic dysentery and uterine hemorrhage. It has also been used in gonorrhoea with success, Stark % stating that in the majority of cases it stopped the discharge in from two to six days. Prettyman § reports unvarying success with it in 50 cases, affirming that it cures in from six to eight days, but as he omits the details of treatment, his statement cannot be accepted as proven. Dose, gtt. v-xx, on sugar, or in capsule. * Phila. Med. Times, Dec. 2d, 1882. f" Pharm. Rundschau," Sept., 1887, p. 201. % London Med. Record, June 15th, 1886, quoted. . \Amer. Jour. Med. Scu, 1886, p. 117. 374 MATERIA MEDICA ECCRITICS. APOCYNUM. Apocynum cannabinum, or Canadian Hemp [Nat Ord. Apocy- nacese), is an indigenous herbaceous plant growing to the height of two or three feet, with oblong-ovate leaves and small greenish, campanulate flowers. ,The root is the officinal portion ; it is of a yellowish-brown color when young, and of a dark-chestnut Fig. 35. APOCYNUM CANNABINUM. when old, has no odor, but a nauseous, acrid, bitter taste. The fresh root, when wounded, pours out a milky juice, whence the plant is sometimes termed milk-weed. It yields its virtues to water and alcohol, and contains gallic and tannic acids, gum, resin, apocynin, apocynein y bitter extractive, etc. Although the entire root DIURETICS TARAXACUM. 375 is officinal, the bark of the root is probably alone active. A. androsaemifolium, or Dogsbane, is possessed of much the same properties as A. cannabinum. Effects and Uses. — Canadian Hemp is diuretic, diaphoretic, seda- tive, and, in continued doses, emeto-cathartic. It is chiefly em- ployed in the treatment of dropsy, in which its action is often powerfully efficacious. It should be given in amounts just suffi- cient to produce diuresis, when a cathartic effect is not desirable. The best form of exhibition is an infusion (3ss to boiling water Oj, or the same amount may be dissolved in gin Oj) ; dose, f 5ij-iv three or four times a day. TARAXACUM. Taraxacum Dens-leonis, or Dandelion [Nat. Ord. Composite), is a small herbaceous, perennial plant, common to most parts of the world, and found abundantly throughout the United States. Fig. 36. TARAXACUM DENS-LEONIS. It has a fusiform root, which sends up numerous long, sinuated, bright-green leaves, and flower-stems about six inches high, bearing golden-yellow flowers. The root is the officinal portion, and should be gathered in the autumn. In the fresh state it is several inches long, branched, fleshy, of a light-brown color externally, whitish within, and abounds in a milky juice ; the fresh root is preferable for use. When dried it is shrunken, wrinkled and brittle. It is without smell, but has a bitter taste Boiling water extracts its virtues, which probably depend on a peculiar 376 MATERIA MEDICA ECCRITICS. bitter crystallizable principle termed taraxacin, soluble in water and alcohol. It also contains taraxacerin, resin, and Dragendorff* found inulin and some sugar. Effects and Uses. — Taraxacum is diuretic and slightly aperient, with some tonic action, and a slight determination to the liver- It is useful in hepatic dropsies, and is also employed in dyspepsia accompanied by derangement of the liver. It may be given in the form of infusion — dose, ff>ij t. d. ; extract (an inspissated juice, w r hich should not be kept above a year) — dose, gr. xx-5j t. d. ; fluid extract — dose, f 5j-ij t. d. TRITICUM — COUCHGRASS. The rhizome of Triticum repens or Couchgrass {Nat. Ord. Graminaceae), a perennial weed, native of Europe and North America, growing in fields and in waste places, with a long, stiff, pale-yellow rhizome, which should be gathered in the spring, and is found in the shops, freed from the rootlets, cut into short lengths and dried, without odor, but having a slightly sweetish taste (Fluckiger and Hanbury), contains triticin (which resembles inulin), and several sugars, and appears to be a feeble diuretic. According to Sir H. Thompson,f couchgrass exercises a bene- ficial influence in cystitis. He directs the decoction to be made by boiling 5ij-iv in water Oij until reduced to Oj ; the strained liquor to be taken in four doses in 24 hours. Whitla, too, advises it to allay irritation of the urinary passages. Fluid extract may be given in doses of f5ss-j. JUNIPERUS JUNIPER. The fruit or berries of Juniperus communis {Nat. Ord. Co- niferse), an evergreen European shrub, naturalized in the United States, are used as adjuvants to the more active diuretics, and in large doses produce strangury and bloody urine, and prove em- menagogue. When dried they are about the size of a pea, of a blackish-purple color and a sweetish, terebinthinate, aromatic taste ; they are given in infusion. Their virtues depend on a volatile oil (oleum juniperi) (C 10 H 16 ), the dose of which is gtt. * " Pharmacographia," 2d ed., p. 394, quoted. I "Diseases of the Urinary Organs," 7th edition, p. 152. DIURETICS CANTHARIDES. 2>77 v-xv two or thres times a day. Hammond * found that juniper increased the flow of urine, the proportion of solids being only slightly altered (three experiments). The compound spirit (con- taining also the oils of caraway and fennel, dissolved in alcohol and water) is a pleasant addition to stimulating diuretic and blen- norrhetic combinations, and a good stomachic and carminative ; dose, f5j-ij. The spirit is made by dissolving 3 parts of the oil in 97 parts of alcohol; dose, f5]-ij. An active diuretic mixture is : 1^ Potassii bitartratis, §ij ; seminis juniperi, Sj ; aquae (tepid), Oiv. M. Sig. — All to be taken in 24 hours. SCOPARIUS. Sarothamus Scoparius, or Broom {Nat. Ord. Leguminosae), is a common European shrub, cultivated in the United States, from three to five feet high, with numerous bright-yellow flowers. The tops of the branches are the officinal portion, but the seeds are also used. The twigs are pentangular (with small oblong, downy leaves), of a bright-green color, a strong, peculiar odor when bruised, and a bitter, nauseous taste. Two principles are found in broom-tops — scoparin (C21H22O10), a neutral, crystalliz- able body, supposed to be the diuretic constituent, and a volatile alkaloid, sparteine (C 15 H 2 6N 2 ), (vide p. 275); it also contains volatile oil, tannin, etc. Effects and Uses. — Broom is an efficient diuretic, in large doses producing free purging. It is a valuable and reliable remedy in dropsy, best given in decoction, half an ounce to a pint of water, boiled down to half a pint, of which an ounce may be given every hour or two till the bowels are disturbed. A fluid extract is used in doses of f 3ss-j. CANTHARIS CANTHARIDES. The properties, etc., of cantharides will be noted fully under the head of Irritants (subdivision Epispastics). Taken internally, they sometimes prove diuretic, and generally excite irritation of the genito-urinary passages, as strangury, priapism, etc. ; and in overdoses act as an acro-narcotic poison. They are em- ployed in dropsies, incontinence of urine, amenorrhcea, seminal * Amer. Journ. Med. Sci., 1859, p. 275. 378 MATERIA MEDICA ECCRITICS. weakness, impotence, etc. Dose, gr. j-ij twice a day, in pill. They are most commonly administered in tincture (5 per cent.) ; dose, gtt. x or more three or four times a day till signs of strangury supervene. ORDER V. BLENNORRHETICS. Blennorrhetics (from pXiwa, mucus, and piw, I flow) are medi- cines which promote the secretion of the mucous membranes. They are employed therapeutically in morbid conditions of those membranes, with a view to the restoration of healthy action in cases of deficient, abnormal or excessive secretion. When administered with the object of stimulating the secretion of mucus from the bronchial or laryngeal membrane, this class of agents is termed expectorants. They are prescribed in the subacute and chronic forms of bronchitis and laryngitis, and in the declining stages of the acute forms of those affections and pneumonia. In the early or inflammatory stages of acute bronchitis and laryngitis the stimulating expectorants are inadmissible until expectoration has been established. The blennorrhetics are less employed in gastro-enteric affections than in those of other mucous membranes, owing to their tendency to produce catharsis. Several of the oleo-resins are, however, used with advantage in certain forms of chronic diar- rhoea, and the oil of turpentine is highly esteemed in the treatment of the diarrhoea of typhoid fever. The oleo-resinous articles of this group are extensively employed in diseases of the urino-genital mucous membranes — gonorrhoea, gleet, leucorrhcea, incontinence of urine and cystitis. The following are the articles chiefly resorted to for their influence on the mucous membranes : — SENEGA. Polygala Senega, or Senega Snakeroot {Nat. Ord. Polygalaceae), is a small indigenous plant, found in all parts of the United States, but most abundantly in the South and West. It has a perennial branching root, several erect annual stems about a foot in height, alternate lanceolate leaves, and small whitish flowers arranged in a terminal spike. The root is the officinal portion. It occurs in BLENNORRHETICS SENEGA. 379 the shops in twisted pieces, varying in thickness from the size of a pill to that of the little finger, attached to a knotty head, and marked with a ridge along their whole length and numerous annular protuberances. The cortical portion is hard, resinous, of a yellowish-brown color, and contains the active qualities of the root. The central ligneous portion is white and inert. The odor of senega is peculiar and disagreeable, but faint in the dried root ; the taste is at first mucilaginous and sweetish, but afterward becomes acrid and very irritating. Fig. 37. POLYGALA SENEGA. The virtues of senega are extracted by cold and hot water and alcohol. It contains polygalic acid (senegin), on which its activity chiefly depends ; this is identical with saponin, a glucoside found in soapwort and other plants (Huseman*). Effects and Uses. — Senega, in small doses, is an active excitant of the mucous membranes and secretions generally, and in large doses proves emetic and cathartic. It is prescribed chiefly as a stimulating expectorant in chronic and subacute bronchial affec- Die Pflanzenstoffe," 1 871, p. 750. 380 MATERIA MEDICA ECCRITICS. tions, and in the latter stages of acute bronchitis and pneumonia. As an ingredient in the compound syrup of squill it is much em- ployed in the treatment of croup, but, except in some such com- bination with tartar emetic or other emetic nauseant, it is scarcely admissible in the early stages of this disease. Senega is thought also to possess emmenagogue properties, and is highly extolled by many practitioners in the treatment of amenorrhcea. It has been occasionally used as a diuretic in dropsies, and in emeto- cathartic doses has been found useful in rheumatism. Administration. — Dose, in powder, gr. x-xx ; but the abstract is to be preferred ; dose, gr. v-xx. The fluid extract is given in the dose of ^x-xx; and syrup is also used, in the dose of f5j-ij- QUILLAIA. Quillaia, or Soap-bark, is the bark of the Quillaia Saponaria {Nat. Ord. Rosaceae), a tree of South America. The bark is found in the shops in large flat pieces, brownish-white, with small patches of brownish cork on the outer surface, but other- wise smooth ; without smell, but having a very acrid taste ; the powder is sternutatory (Maisch). It contains saponin (C 13 H 30 O 10 , a glucoside), which in watery infusion foams like soap, and is identical with polygalic acid (senegin). The following statement concerning saponin is based on the investigations of Lhomme * and Kobert \. According to the latter observer, saponin consists of at least four organic sub- stances, viz., of pure saponin (C 13 H 30 Oio, inert), lactosin (inert), quillaiac acid and sapotoxin — the last two, powerfully poisonous. The principle experimentally used by Lhomme seems to have been a mixture of these substances. Locally, it is a protoplasmic poison, and applied to the skin with friction is irritant, and if it be continued, will cause suppuration. It abolishes instantly the excitability of the striated muscles and nerves when in contact with them. Applied directly to the heart it rapidly stops it in diastole, and antagonizes the effect of digitalis upon it. Kobert ascertained, and his experiments were made with quillaiac acid, that when injected into the veins of dogs, and also by the * Pamphlet, " Etude exper. sur Taction physiol. de la saponine." "j: Arch.f. exper. Pathol, u. Pharmak., 1 887. BLENNORRHETICS GARLIC. 38 I stomach, it expended much of its force upon the alimentary canal, which was found to be in a highly inflamed condition. , Both he and Lhomme found that when introduced into the veins in sufficient quantity it paralyzed voluntary motion, abolished the reflex excitability of the cord, lowered the blood-pressure, and gradually stopped the heart's beats. Lhomme observed, without making exact experiments, that the urinary and dermal secretions were considerably diminished in frogs, rabbits and rats. Schroff noticed an increase of the bronchial mucus. Quillaia is rarely employed medicinally, nor are its exact thera- peutical uses yet placed on a scientific basis. As an expectorant in chronic bronchitis, emphysema and dilatation of the bronchi, it has recently been highly recommended (Kobert *). It is contra- indicated where a disposition to hemoptysis is present (A. Mas- lovskif), and in inflammatory conditions of the alimentary tract. It is chiefly useful from the property which it possesses of emul- sifying oils. A fluid extract mixed with glycerin forms an admirable local application to some cases of acne (Piffard). Dose, gr. xv-xxx in infusion t. d. ALLIUM GARLIC. Allium sativum {Nat. Ord. Liliaceae) is a small perennial, bulbous plant, which grows wild in the south of Europe, and is cultivated in all parts of the world. The bulb is the portion used. As found in the shops, it is somewhat spherical in form, about an inch in diameter, with the portion of the stem attached, covered with a white, membranous envelope, and consists of five or six smaller bulbs, of a curved, oblong shape, called cloves of garlic. They have a strong, irritating, characteristic odor and a bitter, acrid taste. Water, alcohol and vinegar extract their virtues, which depend on an essential oil, which is of a yellow color, very volatile and irritating; it consists of allyl (C 3 H 5 ) oxide and sulphide. Effects and Uses. — Garlic is a local irritant and rubefacient, and, taken internally, quickens the circulation and stimulates the secre- tions generally. It is a good deal employed as an expectorant * Central./. Klin. Med., No. 30, 1885. f Russ. Meditz., No. 36, 1886, p. 599. 382 MATERIA MEDICA ECCRITICS. in chronic and subacute bronchial catarrh, particularly in infan- tile cases, and occasionally as a stomachic in flatulence, and as a diuretic in dropsies. Externally it is used as a revulsive rube- facient to the feet, as a resolvent of indolent tumors, and as a liniment in infantile convulsions. Administration. — A clove may be swallowed entire, or cut into small pieces. Dose of the fresh bulbs, 5j-ij, in pill; of the juice, f5ss, mixed with sugar; of the syrup, f5j, for children. SCILLA' — SQUILL. Squill, already noticed among Diuretics, is one of the most powerful and valuable stimulating expectorants in the Materia Medica. (For properties, doses, preparations, etc., see p. 367.) TEREBINTHINA — TURPENTINE. The term turpentine is applied to liquid or concrete vegetable juices, consisting of resin combined with a peculiar essential oil, called oil of turpentine. Two kinds of turpentine are recog- nized by the U. S. Pharmacopoeia : 1. The common American white turpentine, which is procured chiefly from. Pinus australis (Nat. Ord. Coniferae), a large indigenous evergreen tree of our southern States, where it is called Long-leaved Pine, Yellow Pine, and Pitch Pine ; and in part also from Pinus tasda, found in Virginia, and other species of Pinus. 2. Canada turpentine (Tere- binthina canadensis), kept in the shops under the name of Canada balsam or balsam of fir, the product of Abies balsamea, the Amer- ican Silver Fir or Balm of Gilead Tree (Nat. Ord. Coniferae), a handsome tree about forty feet in height, inhabiting the northern portions of North America. Many other varieties of turpentine are known in commerce, as Bordeaux turpentine, Venice turpentine, CJiian turpenti?ie, etc. White turpentine comes from North Carolina and other south- ern States, and is collected from excavations (called technically " boxes "*) made in the trunks of the trees, from March to Novem- ber, into which the turpentine runs in the mild weather. It is yellowish-white and somewhat translucent, semi-fluid in summer, firm and hard in winter, but becoming permanently hard by * " Our Slave States," 1856, p. 339, F. L. Olmsted. BLENNORRHETICS TURPENTINE 383 exposure to the air, and has a peculiar aromatic odor and a warm, pungent, bitterish taste. Canada turpentine comes from , Canada and Maine. It is procured by breaking the vesicles which are found between the bark and wood of the trees and collecting the liquid contents in a bottle. When fresh it has the consistence of honey, but gradually solidifies by age. It is yellow, transparent, tenacious, of a peculiar pleasant, terebin- thinate odor and a slightly bitter, acrid taste. Chemical Constituents. — The turpentines yield, by distillation, a volatile oil, known as oil of turpentine, and leave a residue con- sisting exclusively of resin. Both the oil and resin are officinal. The turpentines are inflammable, nearly insoluble in water, but almost wholly soluble in alcohol and ether. Physiological Effects. — The local operation of the terebinthi- nates is irritant. When applied to the skin they produce a rube- facient effect, and when swallowed in large doses, promote the peristaltic motion of the intestines. Taken internally, in small doses, they are absorbed, and prove excitant to the vascular system and the secretions generally, especially the mucous mem- branes ; they communicate an odor of violets to the urine. In large doses they cause pain in the loins, strangury and bloody urine. The activity of the terebinthinates depends on their vola- tile oil. Medicinal Uses. — Turpentine is employed chiefly in diseases of the various mucous membranes, as gonorrhoea, gleet, leucorrhoea cystorrhcea, chronic bronchitis, and chronic mucous diarrhoea. It is also used in rheumatic complaints, and in iritis and sclero- titis ; and, in cathartic doses, in cases of ascarides, constipation, and colic. Administration. — Dose, as a blennorrhetic , gr. xx-5j, in ////, emidsioji, or electuary ; as an anthelmintic or cathartic, Sss-j in emulsion. The white turpentine is generally used in this country. Chian Turpentine is derived from Pistacia Terebinthus {Nat. Ord. Anacardiacese), and is collected chiefly in the island of Scio, during the summer months, the juice flowing spontaneously from incisions made in the bark. It is " greenish-yellow or brownish, hardens to a transparent mass, and has a fennel-like terebinthi- nate odor, and a mild, bitterish taste " (Maisch). It is very expensive, and but little of it comes to this country. It has been 384 MATERIA MEDICA ECCRITICS. extolled in the treatment of uterine cancer, but sound observers* now agree that it is utterly valueless as a curative agent. Dose, gr. v, increased to gr. xxv, in emulsion. Oleum Terebinthin^e {Oil of Turpentine) (C 10 H 16 ), commonly called spirit of turpentine, is the active principle of turpentine, obtained by distillation. It is a limpid, colorless, volatile and inflammable liquid, of a strong, penetrating, peculiar odor and a hot, pungent, bitterish taste ; very slightly soluble in water, less soluble in alcohol than the volatile oils generally, and wholly soluble in ether ; exposed to the air it absorbs oxygen, with the formation of resin. Its effects and medicinal uses are the same as those of turpentine, for which it is usually substituted in practice. Locally, it acts as a rubefacient. When sivallowed in large doses, as f 5J-ij, it commonly passes off by the bowels ; taken in small doses, it is absorbed and, according to the recent investigations of Hare,f it increases the number of the cardiac beats, due to direct action on the heart; large doses decidedly slow the pulse by stimulation of the vagus inhibitory centre. Its influence, either in large or small amounts, is indifferent upon the vaso-motor centre, though this statement, is not in accord with that of Kobert.J Small doses increase reflex action, while large decrease it; the first being due to stimulation, and the latter to depression of the cord and afferent nerves. Toxic amounts destroy life by causing cardiac failure. Respiration is at first increased, but afterward diminished as to frequency. Secretion : when given in moderate doses it stimulates the kidneys, increas- ing the urinary flow. In large amounts (fSj-ij), the urine is diminished, often bloody and sometimes suppressed. Toxic quantities provoke constant efforts at micturition, strangury, and often priapism. Gastro-intestinal tract : in large quantities it causes vomiting and purging, with abdominal pain and a sense of heat. Elimination : by the broncho-pulmonary mucous mem- brane and kidneys (chiefly). The lethal dose is not determined, but poisonous effects from the oil of turpentine are rare, as it generally passes off by the bowels ; * Lancet, Dec. 4th, 1880. Mr. Henry Morris. f Med. News, Phila , 18S7, II, p. 593. % Arch, fur Anat. u. Physiol., 1886 — quoted. BLENNORRHETICS TURPENTINE. 385 it may, however, produce severe vomiting and purging, bloody or suppressed urine, intense irritation of the urino-genital organs., unconsciousness, with dilated pupils, and even death. • (An in- fant* swallowed f&}4, and recovered after convulsions.) Oil of turpentine is contra-indicated in cardiac hypertrophy, atheroma of the vessels, and acute inflammatory diseases of the kidneys. It is incompatible with cardiac depressants. Its action is aided by the alcoholic and diffusible stimuli. In large doses it is employed as an anthelmintic and cathartic, and is much used as a clyster for the relief of tympanites. In small doses it is much prescribed in chronic discharges and hemorrhages from the various mucous membranes ; in the latter stages of typhoid fever, where the abdomen is tympanitic and the tongue dry ; as a combined stimulant and blennorrhetic ; as a stimulant in typhus feverf ; as a diaphoretic in rheumatism, in infantile diabetes and nephritic disorders. As a rubefacient, it is a valuable counter-irritant in numerous diseases, as to the joints in chronic rheumatism, and should often be applied with gentle friction. Turpentine stupes are highly efficacious in bronchial catarrhal affections. Dose, gtt. v-xxx, repeated, as a blennorrhetic stimulant ; f oSS— j, as a cathartic enema or anthelmintic X in emulsion or capsule. Linimentum terebinthincs (oil of turpentine, 35 parts, melted with resin-cerate, 65 parts), is used as an application to burns and scalds. Pix LiQUiDA(7dr) is an impure turpentine, procured, by burn- ing, from the wood of Pinus palustris and other species of Pinus. It is a brownish-black, viscid, semi-liquid substance, of a peculiar empyreumatic odor and a bitterish, resinous, somewhat acid taste ; soluble in alcohol, ether and the volatile and fixed oils. It consists of resin united with acetic acid, oil of turpentine and various volatile empyreumatic products. By distillation it yields pyroligneous acid and oil of tar, the residuum being pitch. The oil of tar (oleum picis liquidce) contains, besides oil of tur- pentine, creasote (see Antiseptics) and other principles. Its effects are similar to those of tar, and it is much used in the form of * London Med. Times, 1 85 1, p. 380. f Am. fourn. Med. Sci., 1866, p. 48. DaCosta. J Journal de Therap., 1876, p. 871. 25 386 MATERIA MEDICA ECCRITICS. ointment in the treatment of squamous diseases. A case is re- ported, of non-fatal poisoning,* by oil of tar, of a man who, having swallowed about one gill, was seized after seven hours with vomiting, excessive abdominal and inguinal pain and ex- haustion, the urine being high-colored and having the odor of the drug. Effects and Uses. — Tar resembles the turpentines in its effects, and is employed in chronic catarrhal affections and other diseases of the mucous membranes. Its vapor has been employed in bronchitis ; and externally it is an excellent application in tinea capitis, psoriasis and eczema. The therapeutical application of the tarry preparations in diseases of the skin has been well described by Bulkley f as follows : they are contra-indicated in cases of decided pain, heat or swelling, and indicated where it is desirable to improve the nutrition, check the itching, secretion and cell deposit of a part. Their disadvantages are odor, color and stickiness : the former can be partly disguised by oil of lavender. Equal parts of pix liquida and unguentum sulphuris is an excel- lent application to scaly eczema and palmar psoriasis, and it should be applied with friction. In liquid form the following has been used with advantage to allay the intense itching of eczema after the exudation has ceased. Jfy Picis liquidae, f 5ij ; potassae causticae, 5 j ; aquae, 5 v. M. Solve (may require dilution); in chronic cases should be rubbed in of full strength. In para- sitic diseases the following unirritating combination is useful : 3^ Iodinii, 5ij ; olei picis liquidae, f Sj. M. Solve. Mix care- fully, and rub in freely. Dose, 5ss-j several times a day, in pill or electuary. The syrup contains six per cent, of tar, and is a good prepara- tion. The ointment {unguentum picis liquidce) is made by mixing equal parts of tar and melted suet. Resina {Resin), commonly called rosin, is the residue after the distillation of the oil from turpentine. It is a yellowish-brown^ semi-transparent, solid, brittle substance, with a slight terebin- thinate odor and taste — insoluble in water, soluble in ether, alco- hol and the essential oils, readily uniting by fusion with wax and * Lancet, 1 832-3, p. 598. f Arch, of Scientific and Practical Medicine, 1873, pp. 123, 172. BLENNORRHETICS COPAIBA. 387 the fixed oils, and forming soluble soaps with alkalies. When agitated with water, in a state of fusion it becomes opaque and white. It is not used internally, but is extensively employed in the formation of plasters and ointments, to which it communicates great adhesiveness and slightly stimulant properties. Ceratum re since (resin-cerate), formerly called basilicon ointment, is made by melting resin (35 parts), lard (50 parts) and yellow wax (15 parts) together; it is an excellent mild stimulant applica- tion to burns, blistered surfaces, etc. Compound resin-cerate may be made by melting Sxij of resin, suet and yellow wax, each, with 5yj of turpentine and fgvij of flaxseed oil — a good stimulant cerate, very popular under the name of Deshler's Salve. Emplas- trum resince (resin-plaster), made by melting 14 parts of resin with 80 parts of lead-plaster and 6 parts of yellow wax, is the well- known adhesive plaster, used to retain the edges of wounds in contact, to produce extension in the treatment of fractures, to protect excoriated surfaces, and to promote absorption. COPAIBA. Copaiba is an oleo-resin obtained from several species of Copaifera (Nat. Ord. Leguminosae), large trees peculiar to South America. C. Langsdorffii, a native of Brazil, is now recognized as the principal source of copaiba, and most of the copaiba of commerce is derived* from the ports of Para and Maranham, in Brazil ; Central America also yields copaiba. The juice is obtained from incisions in the stems of the trees ; as it at first exudes it is clear, colorless and very thin, but soon acquires a thicker consistence and a yellowish hue. As found in the shops it is a clear, transparent liquid, of the consistence of olive-oil, of a pale-yellow color, a peculiar agreeable smell and a pungent, nauseous, acrid taste. By exposure to the air it acquires a deeper color and denser consistency. It is often adulterated. Copaiba is insoluble in water, but soluble in alcohol, ether, and the volatile and fixed oils ; with alkalies and alkaline earths it forms a soap. It is chemically an oleo-resin (40 to 60 per cent, of volatile oil, but the proportion of oil to resin varies considerablyf ), with a minute portion of acetic acid. The volatile oil is offi- * " Pharmacographia," 2d ed.,p. 232. f Am. Journ. of Syphilography, III, p. 293. 388 MATERIA MEDICA ECCRITICS. cinal, as is also the resin, which possesses acid properties, and is sometimes called copaivic acid. By exposure to the air copaiba gradually becomes darker and thicker, and finally hard and brittle, owing to the volatilization and oxidation of its oil. Copaiba was formerly called a balsam, but this title is incorrect, as it contains no benzoic or cinnamic acid. Effects and Uses. — The effects of copaiba are analogous to those of the terebinthinates. In large doses it proves cathartic and occasionally emetic, and in small doses it is absorbed, communi- cating its peculiar odor to the secretions and exhalations, and stimulating the secretions from the mucous membranes and kid- neys ; it is also a gentle excitant to the circulatory system. The urine of persons who have taken copaiba for some time yields a precipitate with nitric acid, like albuminous ' urine, due to the action of the acid on the resin. The resinous precipitate, how- ever, is soluble in alcohol, which does not dissolve coagulated albumen. Elimination takes place slowly. Occasionally copaiba causes symptoms of strangury when given in large doses. It sometimes produces an eruption of the skin, and some persons are unable to take it in any dose, on account of the gastro-intes- tinal irritation which it occasions. When its administration is too long continued, or when excessive doses are given, it may un- doubtedly cause serious damage to the structure of the kidney. Copaiba is employed in diseases of the mucous membranes, par- ticularly those of a chronic character, as chronic bronchitis, chronic diarrhoea, leucorrhcea, gonorrhoea, gleet, catarrh, and irritation of the bladder, and, like turpentine, occasionally in rheu- matism and iritis. As a remedy in gonorrhoea it has long enjoyed great popu- larity, and is given with advantage even in the earliest stages. Though often of signal service in the treatment of gonorrhoea, yet it frequently fails to ameliorate the disease, for, in 15 cases in which copaiba was the basis of treatment together with injections, recorded by Milton,* the average duration of each was 88 days — not brilliant evidence of the utility of the remedy. The good results obtainable with this drug are often missed through inat- tention to concomitant matters. During the acute stage the * " Gonorrhoea," etc., 1877, p. 75. BLENNORRHETICS CUBEB. 389 inflammatory symptoms must be combated by rest, the local application of lead- or ice-water, the parts kept clean, the urine neutralized, a non-stimulant diet enforced, and above all, erections should be suppressed, as by avoiding lascivious thoughts, and chordee restrained by giving a large dose of potassium bromide (5/4— j), at 9-10 p.m., combined with a motor-depressant, as tincture of gelsemium (gtt. x), both to be repeated at 3-4 a.m., the time when chordee is most likely to begin. Chordee can also be checked by the application of a glass or rubber bottle filled with cold water to the perineum. Urethral injections of copaiba have been tried, but have not yielded good results ; it therefore appears to be necessary, in order to obtain its curative effects, that the drug should be modified in the system before its passage over the urethral tract. In gonorrhceal vulvitis and vaginitis it is com- paratively useless. Copaiba is sometimes advantageously com- bined or alternated with cubeb. When it nauseates, it should be suspended, or the dose reduced. It is best administered on an empty stomach. It is often advantageously combined with solu- tion of potassa, which diminishes the acidity of, and hence the irritation produced by, the urine. Administration. — Dose, gtt. xx to f 5j t. d., in emulsion, with some aromatic water,* or in pilular mass (massa copaiba), made by mixing copaiba 94 parts with magnesia 6 parts, or in capsules of gelatin, which is the preferable mode of administration. These can be obtained in the shops, each containing n^v or x. It is also administered as a clyster, in emulsion. Oleum Copaib^e {Oil of Copaiba) (Q5H24), obtained by distilla- tion from copaiba, is usually colorless, with the odor and taste of copaiba, and produces the same effects on the system. (U. S. Dispensatory, 15th Ed.) Dose, gtt. x-xv, in emulsion or dropped on sugar. CUBEBA CUBEB. Cubeb is the unripe fruit of Cubeba officinalis (Nat. Ord. Piperacese), a climbing perennial plant of Java and other parts of the East Indies. The berries are gathered for use when unripe, * Chapman's Copaiba Mixture is, copaiba and spirit of nitrous ether, each half a fluidounce ; powdered gum-arabic and sugar, each a drachm ; compound spirit of lav- ender, 2 fluidrachms; tincture of opium, a fiuidrachm; distilled water, 4 fluidounces; dose, a tablespoonful three times a day. 390 MATERIA MEDICA ECCRITICS. and are dried. They are about the size of a small pea, of a blackish or grayish-brown color, a reticulated surface, and fur- nished with a stalk two or three lines long. The shell is hard, and contains a blackish seed, which is white and oily within. The odor of cubeb is aromatic ; the taste warm, acrid, and camphor- aceous. The berries deteriorate by age, most rapidly in powder, owing to the escape of their volatile oil. Their most interesting constituents are a volatile oil (which is officinal) (C 30 H 48 ), a principle called cubebin, and resinous matter ; the resinous matter consists of both a hard and a soft resin, the former insoluble in ether, the latter soluble in ether, of acid reaction, and termed cubebic acid. The oil is carminative and stimulant, and the blennorrhetic and diuretic properties of cubeb reside chiefly in the resin ; cubebin is inert. Effects and Uses. — In large doses cubeb, like the other oleo- resins, excites more or less gastro-enteric disturbance. In small doses it produces a stomachic effect like that of black pepper; after its absorption it acts as a gentle excitant to the vascular system, with a very" decided stimulant action on the mucous sur- faces, particularly those of the urino-genital apparatus ; it also frequently proves diuretic. It is eliminated chiefly by the urine, increasing the excretion of uric acid, and under its use the urine yields a precipitate with nitric acid. An eruption, like urticaria, sometimes follows the administration of both copaiba and cubeb. It is used chiefly in the treatment of gonorrhoea, and should be given in the early stage of the disease, under the same conditions as copaiba (q. v.). The late Prof. Joseph Pancoast prescribed it as follows : 1^ Pulveris alumenis, 5j ; pulveris cubebae, Siv ; pul- veris cinnamomi, Sss. M. et Sig. — Tablespoon in half glass of water, three times a day. When thus given, it quickly allays the scalding pain which accompanies urination. In other mucous discharges, as chronic catarrh with profuse secretion, leucor- rhcea, gleet, and cystitis, cubeb has been also employed with advantage. Administration. — Dose of the powder, 5j-hj t. d., in gonorrhoea; in chronic mucous disorders smaller doses are given. The oil is often employed, but it does not possess the full virtues of cubeb — dose, gtt. x-xij, to be repeated and gradually increased; it may be taken in emulsion, or dropped on sugar, or made into gelatin- BLENNORRHETICS OIL OF SANTAL. 39 1 ous capsules with oil of copaiba. The oleo-resin contains both the volatile oil and resin, with a portion of cubebin, and is an excel- lent preparation — dose, ^v-xxx, suspended in water; of the tincture, the dose is f5j-ij t. d. : of the fluid extract, the dose is f5ss-j. Troches of cube b are made with the oleo-resin, oil of sas- safras, extract of glycyrrhiza, and acacia, mixed with syrup of tolu. Each troche contains gr. ^ of oleo-resin. OLEUM SANTALI OIL OF SANTAL. The oil of Santal or of Sandal Wood is a volatile oil distilled from the wood of Santal urn album [Nat. Ord. Santalaceae), a small tree found in tropical Asia. The oil is pale yellowish and thick, readily soluble in alcohol when fresh, having an aromatic odor resembling the smell of the wood, and a pungent, spicy taste. It has been highly recommended in the treatment of gonorrhoea, having been introduced by Henderson* who states that he always obtained with it marked suppression of the discharge, and by whom it is regarded as quite equal to copaiba. Beach f reports his experience in ioo cases as follows: average duration of the uncomplicated cases six weeks, shortest case six days, longest about 42 days, which is good evidence of its efficacy. He gave gtt. xx or more t. d. In this disease its effects seem to be similar to those of copaiba, but it is not so apt to disagree with the stom- ach. In a series of 12 cases of gonorrhoea in which it was admin- istered in doses of gtt. x, t. d., the results were not uniform. In a few cases it appeared to cut short the disease in about four days ; in others it disagreed with the patient and was abandoned, and in some cases no benefit was obtained (C. B.). MiltonJ records 22 cases without a single cure. It occasionally (in about four per cent, of cases) produces vertigo, when the dose should be lessened or the medicine discontinued. It is very expensive, and is often adulterated with olive-oil. It may be given in doses of ^v-xx, t. d. on a lump of sugar, in mucilage, in alcohol and cinnamon water, or it can be obtained in gelatin capsules, ^v each, in the * Glasgow Med. Journ., Vol. xm, p. 70; and Med. Times and Gaz., 1865, p. 571. f Boston Med. and Surg. Journ., 1868-9, P- 2I 3* % " Gonorrhoea etc.," 1887^.87. 392 MATERIA MEDICA ECCRITICS. shops. An objection to its use is the odor of the drug, which its ingestion soon imparts to the breath. It should be administered at the onset of the disease. MATICO. This name is given to the leaves of Artanthe elongata (A T at. Ord. Piperacese), a shrub of Peru. They are from two to six inches long by about an inch in breadth, oval-lanceolate and acuminate in shape, crenate, strongly veined or reticulated, bright-green on the upper surface, paler beneath, of a pleasant, aromatic odor and a strong, spicy, slightly astringent taste. The stalks and spikes of the plant are generally mixed with the leaves, more or less compressed into a lump of a greenish color. Matico contains resin, volatile oil, artanthic acid, tannin, etc. Effects and Uses. — Matico is a pleasant, aromatic tonic, with a special determination to the mucous membranes. It is used as an alterative stimulant in the entire circle of diseased mucous membranes, especially those of the urinary passages. It is also used internally as a hemostatic, and locally as a styptic. Dose, of the powder, 5ss-j ; of Xheflirid extract, f 5ss-j ; of the tincture, f5j-ij. PAREIRA. Pareira or Pareira Brava is the root of Chondodendron tomentosum (Nat. Ord. Menispermaceae), a native of Brazil. It comes to us in large, wrinkled, twisted or forked cylindrical pieces, of variable thickness and length, covered with a thin, grayish-brown bark. The interior is ligneous, yellowish, porous, inodorous, and of sweetish, nauseous, bitter taste. It imparts its virtues to water, and contains a bitter alkaloid, termed cissam- pcline (C 18 H 21 N0 3 ), (identical with pelosine, luxine and beberine, Fliickiger,*) resin, fecida, etc. The stem is sometimes found in the shops mixed with the root ; it is inert. Effects and Uses. — Pareira is an excellent remedy in chronic diseases of the urinary passages, particularly chronic inflamma- tion or irritation of the bladder, with morbid secretion. It is thought to be also tonic, aperient, and diuretic. Dose, in sub- stance, 3ss-j. The fluid extract is much used — dose, f5ss-j.f * " Pharmacographia," 2d edition, pp. 28 and 109. f A good prescription in irritable bladder is fluid extract pareira brava, f ^j ; com- pound spirit of juniper, f ^ ij ; benzoic acid, 3 j ; sulphate of morphine, gr. j ; dose, a teaspoonful three times a day. BLENNORRHETICS UVA URSI. 393 BUCHU. This is the name given to the leaves of Barosma betulina and' other species of Barosma {Nat. Ord. Rutacese), shrubby plants, growing "at the Cape of Good Hope. As found in the shops, buchu leaves are from three-quarters of an inch to an inch and a half long, from three to five lines broad, elliptical, lanceolate- ovate or obovate, sometimes pointed, sometimes blunt, notched, and glandular at the edges, and of a green color, paler on the under surface. Three varieties are known, viz. : short or round buchu (derived from B. betulina), medium-sized (from B. crenu- lata), and long buchu (from B. serratifolia). They have a strong, aromatic odor and a bitterish taste, like that of mint. Water and alcohol extract their virtues, which depend on a volatile oil (which yields barosma camphor *) and bitter extractive. Effects and Uses. — Buchu is a gentle stimulant to the secre- tions generally, particularly to the kidneys and urinary mucous membranes ; it may be made to act also as a diaphoretic. It is employed in chronic catarrh of the urethra and bladder, chronic nephritic complaints, retention or incontinence of urine ; as a diuretic in dropsies, and as a diaphoretic in rheumatic and cuta- neous complaints. Dose, of the powder, gr. xx-xxx ; of the fluid extract, f 5ss— j. UVA URSI. Arctostaphylos Uva ursi, or Bearberry {Nat. Ord. Ericaceae), is a small trailing evergreen shrub, with coriaceous, obovate leaves (somewhat like the box leaves and red-whortleberry leaves), about half an inch in length, pale rose-colored flowers appearing from June to September, and small red berries which ripen during the winter. It is found in the northern parts of Asia, Europe and America. The leaves are the only part used. When dried they have a faint hay-like odor and a bitterish, astringent taste. They yield their virtues to water and alcohol, and contain tannic and gallic acids, ursone, a crystallizable gluco- side termed arbutin (C^H^O^), a bitter substance termed ericolin (C 34 H 56 21 ), extractive, resin, gum, etc. Effects a?td Uses. — Uva ursi is astringent, tonic, and diuretic, * " Pharmacographia," 2d edition, pp. 28 and 109. 394 MATERIA MEDICA ECCRITICS, and exercises a beneficent control over discharges from mucous surfaces ; hence its employment in catarrh of the bladder, chronic bronchitis with profuse discharge, etc. It is applicable Fig. 38. also to the ordinary uses of the vegetable astringents. Dose, of the powder, gr. x-5j. The dose of the fluid extract is f5ss-j. CH1MAPHILA. Chimaphila umbellata, Pipsissewa, Wintergreen, or Ground- Holly (Nat. Ord. Ericaceae), is a small indigenous evergreen plant, common to the northern parts of Europe, Asia and America, and found abundantly in woody situations in all parts of the United States. It has an erect stem three to ten inches high, lanceolate, somewhat wedge-shaped, serrated, dark-green leaves arranged in irregular whorls, and beautiful five-petaled flowers, of a white color tinged with red and a very agreeable perfume, which appear in June. The leaves are the officinal portion. In the fresh state they have a fragrant smell when bruised, which they lose after drying. Their taste is bitterish and astringent, but somewhat aromatic. They contain arbutin, tannic acid, chimaphilin, etc. Chimaphila maculata, or Spotted BLENNORRHETICS CHIMAPHILA. 395 Pipsissewa, possesses properties analogous to those of C. umbel- lata, from which it differs principally in the character of its leaves. They are of a deep olive-green color, mixed with greenish-white; and the flowers are of a pure white, and appear in July. Effects and Uses. — Pipsissewa is a tonic, astringent, diuretic and Fig. 39. CHIMAPHILA UMBELLATA. blejinorrhetic ; resembling buchu and uva ursi in its effects, but being a more active diuretic, and is used in the disorders of uri- nary organs to which they are applicable, and, from its diuretic properties, in dropsy, especially when attended with debility of the digestive organs. The dose of the fluid extract is f 5ss-j. 396 MATERIA MEDICA ECCRITICS. MYRRH A MYRRH. Myrrh is a gum-resin obtained from Balsamodendron Myrrha {Nat. Ord. Burseraceae), a small shrubby tree of Arabia Felix and Africa. Most of the myrrh of commerce is derived from the eastern coast of Africa, in the Somali* district, where it is collected by the Arabs. The juice exudes spontaneously and concretes upon the bark (like cherry-tree gum). It is imported from Bombay, and occurs in small, semi-transparent, reddish- yellow fragments or tears — sometimes agglutinated together in large masses — of irregular shape and size, with an agreeable, peculiar odor and a bitter, aromatic taste. It is brittle and pulver- izable, has a resinous fracture, and makes a light-yellowish powder. Inferior kinds of myrrh are darker and less translucent and odorous. Myrrh is a gum-resin (of resin 25-40 per cent.), containing also a little volatile oil (^ per cent.) and a bitter principle (glucoside ?). It forms with water an emulsion, and is soluble in alcohol and ether. Effects and Uses. — Myrrh is a stimulant, . expectorant and emmenagogue. It is prescribed in chronic catarrhal and asth- matic affections in which a combined corroborant and expectorant effect is desirable. Chalybeates and aloes are frequently united with it in uterine affections. Locally, it is a good application to spongy gums and aphthous sore mouth. In fetid breath the fol- lowing is a good cleansing mouth-wash : ^ Tincturae myrrhae, f Sj ; acidi carbolici liquidi, ^x. M. Sig. — Teaspoonful in y 2 tumbler of water as a mouth-wash. Administration. — Dose, gr. x-xxx in powder or pill, or sus- pended in water, as in mistura ferri composita (see p. 161). The tincture is employed chiefly externally ; dose, internally, f5ss-j. Pills of aloes and myrrh, compound g alb anum pills and compound iron-pills are officinal emmenagogue preparations of myrrh. BENZOINUM BENZOIN. Benzoin is a balsamic resin obtained from Styrax Benzoin, or Benjamin tree {Nat. Ord. Styraceae), a tall tree of northern Sumatra,f and Siam. It is obtained by incisions in the bark, * Pharm. Journal, XII, p. 226. Jas. Vaugh. -j- " History of Sumatra," p. 123, 1783, Marsden. BLENNORRHETICS STORAX. 397 from which it readily exudes, afterward hardening by exposure to the sun and air, when it'is pared off with a knife. Two kind's are known, the more valuable consisting chiefly of whitish tears, united by a reddish-brown connecting medium, and called benzoe amygdaloides, the other of brown or blackish lumps, without tears, known as benzoe in sortis {benzoin in sorts). Benzoin has a fra- grant odor, a feeble, slightly aromatic taste, is soluble in alcohol and ether, and is precipitated from its alcoholic solution by water. Its chief constituents are resin and benzoic acid (C 7 H 6 2 ), which places it among the balsams ; it contains volatile oil and occasion- ally cinnamic acid (C 9 H 8 2 ). Samples containing the latter should be rejected (U. S. P.). Effects and Uses. — This drug owes its virtues chiefly to benzoic acid, which will be considered under the head of Antiseptics. Benzoin is a topical irritant, and after absorption, stimulates the broncho-pulmonary and other mucous membranes. It resembles myrrh in its effects, but is rather more acrid and stimulating. It is adapted to chronic bronchial affections, but is seldom employed alone. As a fumigation in chronic laryngitis it has been recom- mended by Trousseau and Pidoux. It is also used in chronic cystitis when the urine is alkaline and deposits phosphates, but the benzoates, especially ammonium benzoate, are more adapted to these cases. Dose, gr. x-xxx. The tincture of benzoin and the compound tincture (containing benzoin, purified aloes, storax and balsam of tolu dissolved in alcohol) are used as stimulating expecto- rants and in bowel complaints; dose, f5ss-ij. As benzoin has the property of obviating the rancidity to which lard is liable, this is a very useful vehicle for medicated ointments. Adeps benzoinatus consists of benzoin, 2 parts, and lard, ioo parts. Benzoin is much used in the form of fumigating pastiles. STYR AX STORAX . Storax is a balsam prepared from the bark of Liquidambar orientalis {Nat. Ord. Hamamelaceae), a native of Asia Minor. It is obtained by steaming the bruised bark and then expressing it, and occurs as a soft, viscid, brownish mass of the consistence of honey, yet more or less tenacious, of a fragrant odor and a warm taste. It contains storesin, an amorphous substance— the most 39$ MATERIA MEDICA ECCRITICS. abundant constituent — an oil termed styrol (C 8 H 8 ) (not always present), resin, cinnamic acid (and is therefore a balsam), and an essential oil. Alcohol and ether are its proper solvents. It is almost always more or less adulterated. Effects and Uses. — It is used as a stimulant expectorant, chiefly in the compound tincture of benzoin ; dose, gr. x-xx. BALSAMUM PERUVIANUM BALSAM OF PERU. Balsam of Peru is a balsam obtained from Myroxylon Pereirae {Nat. Ord. Leguminosae), a tree of Central America (Salvador). It is obtained from incisions in the bark, and is collected on rags inserted in the openings, which are afterward boiled in water, when the balsam settles at the bottom, and the water is poured off. A white balsam, obtained from the fruit of this tree by expression, and a tincture of the fruit in rum, are also known in Central America. Balsam of Peru has the consistence of honey, a dark, reddish-brown color, a pleasant smell, a warm, bitterish, acrid taste, and is soluble in alcohol and partially so in boiling water. It is heavier than water. Its constituents are cinnamein (benzylic cinnamate, a colorless aromatic oil), resin, benzalcohol, benzylic benzoate, stilbene, and cinnamic and benzoic acids. Effects and Uses. — It is a stimulating blennorrhetic and tonic, employed occasionally in chronic catarrh, asthma, gonorrhoea, leucorrhcea, etc., but not much used in this country. Externally it is applied to indolent ulcers. Dose, f 5ss in emulsion. BALSAMUM TOLUTANUM BALSAM OF TOLU. Balsam of Tolu is a balsam obtained from Myroxylon toluifera {Nat. Ord. Leguminosae), a tree of the neighborhood of Cartha- gena. It is procured from incisions in the trunk of the tree, and concretes in the vessels in which it is received. It has a soft, tenacious consistence, varying with the temperature, and by age becomes hard and resin-like. It is shining, translucent, of a reddish-brown color, a fragrant odor and a warm, sweetish, pun- gent taste, inflammable, entirely soluble in alcohol and essential oils, and, like the other balsams, yields its acid to boiling water. Its ingredients are resins, benzylic benzoate (a colorless aromatic oil), benzylic cinnamate, tolene, and cinnamic and benzoic acids. Effects and Uses. — It is a stimulant blennorrhetic and tonic, EMMENAGOGUES. 399 useful in chronic catarrhal affections, and, from its agreeable flavor, much employed as an ingredient of cough mixtures. The vapor of an ethereal solution of this balsam is inhaled with advantage for the relief of cough. Dose, gr. x-xxx, in emulsion, frequently repeated. The tincture (tinctura tolutanci) is added to cough mixtures; dose, f5j-ij. The syrup (syrupus tolutanus) is used as a vehicle for other medicines. Balsam of tolu is an ingredient of the compound tincture of benzoin. The following gum-resins, previously noticed among anti- spasmodics, are employed as expectorants : — Asafcetida (Asafetida). (Seep. 113.) Ammoniacum {Ammoniac). (Seep. 115.) Galbanum. (Seep. 115.) ORDER VI. EMMENAGOGUES. Emmenagogues (from ifj./j.ijvta, the catamenia, and aycayoq, excit- ing) are medicines which promote the menstrual discharge. This discharge may be suppressed from various causes, and hence very opposite classes of remedies are employed to restore it. Thus, when amenorrhcea depends on ancemia, the preparations of iron are the most effectual emmenagogues ; on the other hand, when it occurs in connection with plethora, blood-letting and evacuants are resorted to. There are probably no articles which exert any specific influence upon the catamenia, as the discharge from the uterus is not one of the excretions through which medicinal agents pass out of the system. Medicines, however, which excite the pelvic circulation and stimulate the organs in the neighborhood of the uterus have a tendency to increase or excite the menstrual discharge. They are — ,1. The mild acrid cathartics, as Aloes (p. 337), etc. 2. Many of the stimulating diuretics, particularly Cantharides (P- 377)- 3. Some of the blennorrheas, particularly Senega (p. 378). 4. Guaiacum (p. 362), usually classed with the diaphoretics. Indirectly, the menstrual discharge is frequently promoted by — I . The preparations of Iron and of Manganese (especially Potas- sium Permanganate), which are the best emmenagogues in chlo- rotic and anaemic cases. 400 MATERIA MEDICA ECCRITICS. 2. Mercurials, which prove emmenagogue from their influence in exciting the secretions generally. The following articles are employed exclusively as emmena- gogues : — SABINA — SAVINE. Savine is the tops of Juniperus Sabina (Nat. Ord. Coniferse), a small evergreen bushy shrub of the south of Europe. They resemble closely the tops of Juniperus virginiana, the indigenous Red Cedar, which are sometimes substituted for savine in the shops. The latter has a greenish color, a strong, peculiar, heavy odor and a bitter, nauseous, resinous taste. Its virtues depend on a volatile oil, which is officinal. Physiological Effects. — Savine is a local irritant. Taken inter- nally, in medicinal doses, it stimulates the circulation and secre- tions, with a very decided action on the uterus. In large doses it will cause vomiting, purging, abdominal pain, suppressed or bloody urine, with 'symptoms of nervous depression, as shown in unconsciousness, stertorous breathing, perhaps convulsions, and death, usually from collapse. Fatal* results have occurred in several cases from its use to provoke premature labor. Medicinal Uses. — Savine is employed internally almost exclu- sively as an emmenagogue, and is considered one of the best medicines that can be used to stimulate the action of the uterine vessels, and its physiological action is intensified by combination with oil of rue. Pereira f pronounces it " the most certain and powerful emmenagogue of the whole Materia Medica." It has been successfully used in menorrhagia depending on relaxation of the uterine tissues. It has been also recommended in chronic rheumatism, and as an anthelmintic. Topically, it is used to keep up the discharge from blisters, to destroy warts, etc. Dose, in powder, gr. v-x; but it loses much of its oil by drying; of the fluid extract the dose is ttjjv— x. Ceratum sabince (fluid extract, 25 parts, resin cerate, gp parts) is used to make perpetual blisters. Oleum Sabince (Oil of Savine) (C 10 H 16 ) is the preparation principally used internally. Dose, gtt. v-x — in capsules, pill or emulsion. * " A Treatise on Poisons," 4th ed., p. 605. Christison. f " Mat. Med. and Therap.," 4th ed., p. 332. EMMENAGOGUES TANSY. 401 Oleum Rutve {Oil of Rue) is a volatile oil distilled from Ruta graveolens (Nat. Ord. Rutacese), a perennial European plarrt, with tripinnate leaves, obovate leaflets and yellow flowers. The oil is a colorless or greenish-yellow liquid, of a characteristic, aromatic odor, a pungent, bitterish taste and a neutral reaction. It consists chiefly of methyl-nonyl-ketone (CH 3 .CO.C 9 H 19 ). Its action is similar to that of oil of savine, but is less powerful. Two cases of non-fatal poisoning from an unknown quantity of decoction of the root, in females, followed by miscarriage, are recorded.* Dose, gtt. ij-v every 3 or 4 hours. TANACETUM TANSY. Tansy is the leaves and tops of Tanacetum vulgare {Nat. Ord. Composite), an herbaceous, perennial plant, indigenous to Europe but cultivated in our gardens and growing wild about waste places. The leaves are bipinnatifid, the segments cut-toothed, smooth, dark green ; the heads yellow, in a dense corymb, appearing in summer; the odor is strongly aromatic and the taste pungent and bitter. It contains a volatile oil, tanacetin (a bitter principle), resin, tannin, etc. Effects and Uses. — When the oil is given to animals in large doses, it causes vomiting, dilated pupil, muscular twitchings, followed by clonic convulsions and a cataleptic state with death from paralysis of the respiratory muscles. The lungs were found engorged, the left side of the heart empty and the kidneys much congested. In man, small doses cause a sensation of heat in the epigastrium, flushing of face, giddiness and diuresis. In toxic doses it causes burning pain, vomiting and sometimes purging, loss of consciousness, violent convulsions of cerebral origin and death from respiratory paralysis. Grave symptoms were produced by gtt. xv of the oil ; but as recovery took place after 5jss had been taken, the minimum fatal dose is not known. An unknown but large quantity of tansy-infusion f taken by an adult negress to produce abortion caused her death, the symptoms being incoherence of speech, contracted pupils, * " Woodman and Tidy," 1882, p. 358. f Med. Times and Gazette, April, 1 86 1, 377. 26 402 MATERIA MEDICA ECCRITICS. hebetude, and finally paralysis of the voluntary muscles, with those of deglutition, and coma. The uterus was not affected, and stimulants failed to arouse her. It has been employed as a stimulating emmenagogue, but is an unsafe remedy. It has also been used to produce abortion, taken with criminal intent. Dose, of the powder, gr. x-xxx in infusion ; of the oil, ™KJ-ij. The following unofficinal drugs enjoy a reputation as emmena- gogues :— Apiol or Parsley-Camphor is obtained from the volatile oil of the root of Petroselinum sativum {Nat. Ord. Umbelliferae). It occurs as a colorless or yellowish oil, having a strong odor of parsley and a pungent taste, and is soluble in alcohol, ether and chloroform, but not in water. It is said to be a mixture of sev- eral constituents (Maisch). It has been used in amenorrhcea of functional origin, especially when due to anaemia, and is believed to be a stimulant to the ovaries. In neuralgic dysmenorrhea, it has also been used with success. It is given in doses of gtt. v-vj enclosed in gelatin-capsules, morning and evening for four or five days before the expected menstrual period. Polygonum Hydropiperoides (Water-Pepper or Smartweed) {Nat. Ord. Polygonacese) is an indigenous herb, growing abun- dantly in moist places, with lanceolate, minutely pellucid-punctate leaves, and slender spikes of greenish or whitish flowers. It con- tains polygonic acid, etc. Effects and Uses. — It is a cardiac stimulant, diaphoretic, diuretic and expectorant, stimulates the menstrual flow, and is aphrodisiac; in large doses it causes nausea, vomiting and purging; and when applied locally, it is an irritant, exciting inflammation and vesica- tion when rubbed on the cutaneous surface. It is strongly recommended by Dr. Eberle in functional amenor- rhcea and by others in functional impotence, and Dr. B. Wood- ward has used it with advantage in diarrhcea and dysentery. It has also been used as a diuretic to promote the expulsion of small calculi from the kidney and in gravel, and locally as a counter-irritant. A fluid extract may be used in doses of ^x-f5j. ALTERATIVES. 4O3 CLASS III.— HEMATICS. ORDER I. HEMATINICS. This order (from alfiar(va f the red coloring matter of the blood) includes only the Preparations of Iron, or Chalybeates. The chalybeates increase the number of blood-corpuscles, or the amount of hematin in the blood, and are employed therapeutically in diseases dependent on a deficiency of these elements. They belong eminently to hematics (or medicines which occasion changes in the condition of the blood) ; but as they possess also general and local tonic effects, independent of their action on the blood, they have been classed and treated of among the mineral tonics (see p. 157). ORDER II. ALTERATIVES. Alteratives may be defined' to be medicines which produce such a modification of the nutritive processes as enables the vital prin- ciple to restore healthy action in morbid conditions of the system. The modus operandi of these medicines is not understood. Per- haps their effects are owing to a correcting influence on the quality of the circulating fluid (thus, in inflammations they may act by diminishing the abnormal quantity of fibrin in the blood, rendering its red corpuscles less disposed to aggregation, and decreasing the number and adhesiveness of its white globules) ; perhaps their curative operation is of a substitutive character (by setting up an antagonistic action which takes the place of diseased action in the system) ; or perhaps they may attack diseased cells, causing their disintegration and rapid removal from the body by means of the excretions. Under the influence of alteratives the secretions and exhala- tions are increased, the textures softened, and morbid growths and deposits are absorbed. The exudation of plastic or coagu- lable lymph is checked, and, as a consequence, also the formation of false membranes, and visceral and glandular enlargements and indurations are diminished and often disappear. If pushed too far, the alteratives soften and even destroy the textures, impoverish the blood so as to interfere with the func- tions of nutrition, and produce a condition of marasmus and cachexia. 4O4 MATERIA MEDICA HEMATICS. Their principal therapeutic employment is as antipJilogistics or resolvents. The mercurials are chiefly employed in acute inflam- mations ; the preparations of iodine in chronic inflammations. Mercurials are used in acute sthenic inflammations, especially in such as have a tendency to terminate in effusions of lymph which would seriously interfere with the function of the part, by form- ing adhesions or false membranes. The iodic preparations are adapted to inflammations of a chronic character, and .are particu- larly serviceable in indurations or enlargements of glands and organs, and in affections of the bones and fibrous tissues. Owing to the injurious results which follow the prolonged exhibition of alteratives, they are to be administered with caution, and their effects closely watched. HYDRARGYRI PRiEPARATA PREPARATIONS OF MERCURY. Metallic mercury or quicksilver is obtained principally from the red sulphide {cinnabar"). The chief supply of quicksilver was long derived from Spain and Austria, but the markets of the United States are now furnished from New Almaden, in Califor- nia. Mercury is an odorless, tasteless, volatile, liquid metal, of a whitish color. Its atomic weight is 199.7 ; its symbol is Hg. While it retains the liquid metallic state, mercury is inert ; but when taken internally it sometimes combines with oxygen in the alimentary canal, and thus becomes active. A non-fatal case in which Sivss of quicksilver was taken to produce abortion is reported by Sir G. D. Gibb *; the chief symptom was trembling palsy ; there was no salivation, coloration on the gums, nor action upon the uterus. In the state of vapor it frequently proves inju- rious, in some instances exciting salivation, ulceration of the mouth, etc., in others inducing a peculiar affection of the nervous system termed shaking palsy {tremor mercurialis) y which is often attended with loss of memory, vertigo and other evidences of cere- bral disturbance, and sometimes terminates fatally. Workmen in quicksilver are liable to this affection. It is supposed by some chemists that the activity of mercurial emanations is owing to the oxidation of the metal before it is inhaled ; by others, that, in the finely-divided state in which it exists as a vapor, it is in itself poisonous. * The Lancet, 1873, p. 339. ALTERATIVES PREPARATIONS OF MERCURY. 405 All the compounds of mercury possess activity. Some of them are violent caustic poisons ; all of them are more or less irritant. When the mercurials are taken internally their effects vary with the quantity administered. In small and repeated doses, their influence is first shown in an increase of the activity of the secernents and exhalants. The cutaneous, mucous, biliary, sali- vary, urinary, and probably also the pancreatic secretions are all increased in amount, and at the same time the absorbent system becomes more active, so that accumulations of fluids, morbid enlargements, indurations, etc., will often disappear. Mercury increases the flow of bile. Most of the mercurial preparations probably accomplish this merely in a mechanical manner, i. e., by causing reflex contraction of the gall-bladder and ducts, due to the irritation of the mucous membrane of the duo- denum ; but corrosive sublimate would seem, from the experi- ments of Rutherford and Vignal, to have considerable power as a stimulant of the hepatic secretory apparatus. When mercury is given in larger doses, these effects are more intense. The proportion of red corpuscles * is diminished. The mucous membrane of the mouth and the salivary glands not only take on increased secretory action, but become irritated and inflamed. The gums first show the mercurial influence, and are tender and tumefied ; the whole mouth soon becomes sore ; the tongue is swollen ; and the saliva and buccal mucus flow abun- dantly, sometimes to the extent of several pints a day. At the same time the breath acquires a peculiar fetidity, and the patient perceives a metallic taste in the mouth. The resolvent action of mercury is now still more obvious than when its impression is milder, and considerable emaciation usually ensues from inter- ference with nutrition and the absorption of fat. Formerly these effects, which are termed sialagogue (from the excessive flow of saliva), were commonly produced for the cure of diseases, and, as a general rule, gradually subsided, leaving the health unim- paired. When, however, the use of mercury is pushed too far, or it is administered to persons peculiarly susceptible to its action, a train of very serious symptoms ensues — as excessive salivation, * " Report of Edin. Committee on the Action of Mercury on the Biliary Secre- tions," 116, 2d ed., 1874. Hughes- Bennett. 406 MATERIA MEDICA HEMATICS. ulceration of the mouth, sloughing of the gums, loosening of the teeth, and occasionally necrosis of the alveolar processes. A peculiar febrile condition called mercurial fever, diarrhoea, skin diseases, neuralgia, rheumatism, disorder of the nervous system, and marasmus, are other symptoms which are frequently noticed after the abuse of mercury. After its absorption mercury (and there is no doubt that it is absorbed,* since it has been found in the blood, saliva, liver, etc.) produces several important changes in the quality of the blood. Exceedingly minute doses given for some time, but not too fre- quently repeated, increase the proportion of red corpuscles in this fluid, and the bodily weight. This has been proven by Schlesinger f in an elaborate series of investigations upon dogs. Immediately upon the establishment of salivation, the blood exhibits an increase in the quantity of fibrin and red corpuscles ; but at a later period it loses color, consistence and coagulability, and the relative proportion of albumen, fibrin and corpuscles is diminished. This antiplastic action on the blood renders mercu- rials valuable as antiphlogistic remedies. It is in part eliminated by the urine, feces and saliva. Medicinal Uses — Liquid metallic mercury was formerly admin- istered to remove mechanical obstructions of the bowels, but its use has been abandoned. The preparations of mercury are em- ployed therapeutically with various objects: — 1. As indirect tonics and cholagogues — with a view to their action on the secretions — in dyspepsia and constipation accom- panied with torpor of the liver, in gout, rheumatism, chronic skin diseases, etc. Blue pill, mercury with chalk, and calomel, are employed with this view : the two former are preferred as least irritating. 2. As antiphlogistics. Mercury was formerly given in nearly all cases of sthenic inflammation with a tendency to plastic effusion. At present, however, its use as an antiphlogistic is principally restricted to acute inflammation of the serous mem- branes of sthenic type during the stage of exudation, and after the plastic effusion has ceased to be poured out, with a view to * " Mat. Med. and Therapeutics," Stille, n, i860, 782, quoted, -j- Arch, filr exper. Path. ti. Pharmak., XIII, 317. ALTERATIVES PREPARATIONS OF MERCURY. 407 prevent its organization and facilitate absorption. In this way- it is given in pleuritis, pericarditis and peritonitis, and with a similar view in pneumonitis and iritis. Many writers, however, relying on other remedies, deprecate the use of mercurials in the treatment of these diseases, with the exception of iritis, in which they are universally acknowledged to be of benefit. Minute doses of mercurials, frequently repeated, are highly recom- mended in acute glandular affections about the throat and neck, as tonsillitis, parotitis, etc. In acute sthenic dysentery, a mer- curial — especially calomel — may often be given with advantage. When given with a view to their antiplastic effects, it is no longer thought necessary to cause profuse salivation ; it is suffi- cient to produce constitutional effects as manifested by a metallic taste in the mouth, slight tumefaction of the gums and slight tenderness of the teeth when knocked together forcibly. During the maintenance of this condition the patient should use warm clothing, avoid exposure to cold, and take light and nourishing food. If salivation or ulceration occur, the drug must be stopped and astringent gargles, as brandy and water, solutions of chlor- inated soda or lime, alum, etc., may be employed. In cases of sloughing sores, silver nitrate, or the mineral acids should be applied. Gastro-enteric irritation is to be treated with laxatives and opiates. The mercurial cachexia requires change of air, generous diet, tonics, etc. When the system is contaminated with mercury, it may be eliminated by the use of potassium iodide, which forms soluble compounds with the mercury retained in the economy. Mercurials are contra-indicated in all asthenic inflammations, serous exudations, or where much debility exists. 3. As antisyphilitics. Mercury has long been regarded as the only reliable antisyphilitic agent. So far no satisfactory explana- tion has been made as to its mode of action. Hughes-Bennett (loc. at.) and Wilbouchewitch * have shown that the blood of syphilitics who were taking mercury underwent an increase in the number of red globules. It has no direct curative influence on the primary symptoms ; but after the system has been contaminated with the syphilitic virus, mercury is the most certain and rapid means of * Arch, de Physiol. Norm, et Pathol., 2d ser., 1, 1874, 509. 4 frequently repeated, it is one of the best means of checking obstinate vomiting ; for this purpose gr. y 1 -^ with sodium bicarbonate gr. j may be sprinkled on the tongue every half hour, which will often be of great service in the irritable stomach following the ingestion of indigestible food, after the contents of the stomach have been evacuated, and in cholera morbus. It is sometimes added to other medicines to increase their action on the secretions, as to squill or digitalis, and has recently been lauded as a diuretic in cardiac dropsy*. Cohn's f clinical investigations, however, have not led him to place much reliance on calomel as a diuretic in cardiac and other dropsies. As the diuretic action of the mercurial preparations seems to depend upon their stimulant action on the liver, leading to the increased formation of urea, as in the case of other chola- gogues, t and as Rutherford has shown that calomel is not a true hepatic stimulant, it is probable that either some of the corrosive chloride was present in the calomel, causing diuresis, or that the latter was transformed into that salt in the alimentary canal§. To children, calomel may be given in proportionally larger doses than to adults, and it rarely salivates them. In some cases of infantile diarrhoea, very minute doses of calomel, as gr. y\r, yj, ^, every hour or two, are highly efficacious. Exter- nally, calomel is applied in powder, as an errhine, in opacity of the cornea; and made into an ointment (5j to §j. lard), it is an excellent application in a variety of cutaneous affections. It is also used in the treatment of syphilis by fumigation. For this pur- pose calomel 5ss maybe volatilized in a water-bath placed beneath a cane-bottomed chair on which the patient is seated, without his clothes, but wrapped to the neck in blankets which should envelop the chair and apparatus. The patient should sleep in the blanket in which he was wrapped during the fumigation. Hydrargyri Chloridum Corrosivum {Corrosive Mercurial Chloride). This is mercuric chloride, commonly called corrosive sublimate (HgCL). It is made by subliming a mixture of sodium * Pester Med.-Chir. Presse, Nos. 51 and 52, 1885, Jendrassik. f " Ueber die diuret. Wirkung des Calomel," Inaug.- Dissert., Berlin, 1887. % Brit. Med. Journ., Feb., 1886, pp. 377 and 433. See abstract of Report by Dr. Noel Paten to Scientific Grants Committee of the British Medical Association. \ Practitioner, Sept., 1886, Spiller Locke. ALTERATIVES PREPARATIONS OF MERCURY. 417 chloride and mercuric sulphate (which is previously obtained by boiling mercury with sulphuric acid) ; double decomposition takes place, resulting in the formation of mercuric chloride ancf sodium sulphate. Corrosive sublimate occurs in the form of white, semi-transparent, crystalline masses, permanent in the air, inodorous, and of an acrid, styptic taste. It is soluble in 16 parts of cold water or 2 parts of boiling water, more soluble in alcohol, and still more so in ether. The aqueous solution, when exposed to light, is decomposed, with the precipitation of calomel and evolution of hydrochloric acid. It is incompatible with many of the metals, the alkalies and their carbonates, soap, lime-solution, tartar emetic, silver nitrate, the lead acetates, potassium and sodium iodides, the sulphides generally, syrup of sarsaparilla, and with many vegetable substances (as the bitters) and albumin- ous liquids (as milk, etc.). The tests for detecting corrosive sub- limate in solution are: I. A solution of potassa, soda or lime throws down a yellow precipitate ; 2. Potassium carbonate, a brick-red precipitate; 3. Ammonia, white ammoniated mercury; 4. Potassium iodide, a bright scarlet-red mercuric iodide, readily soluble in excess of the precipitant; 5. Stannous chloride, in small amount, a white precipitate of calomel — in excess, a dark- gray precipitate of metallic mercury ; 6. Sulphureted hydrogen, or a sulphide, in minute amount, produces a whitish or gray pre- cipitate, and in large amount a black sulphide ; 7. If the solution be acidulated with hydrochloric acid and gently heated, bright copper-ioil, when plunged into it, becomes coated with a silvery- white deposit of mercury; and the metal may be afterward obtained by sublimation in a test-tube in the form of globules. The above is the method of obtaining mercury from organic mixtures, and it will detect about x J- Q of a grain (Wormley*). The deposit on the copper must be distinguished from deposits of arsenic and antimony, which are obtained in the same way. Under the microscope the mercury sublimate appears to be globular, the antimony amorphous, and the arsenic in octahedral crystals. Physiological Effects. — In medicinal doses, as gr. yg— i» corro- sive sublimate occasions a beneficial alterative effect, without any * " Micro- Chemistry of Poisons," 1885, p. 352. 27 41 8 MATERIA MEDIC A HEMATICS. obvious activity. It is a true hepatic stimulant of considerable power, increasing also the formation of urea and uric acid, and thus acting as a diuretic,* and likewise feebly stimulating the intestinal glands. Its continued use may cause salivation, but it has less tendency to produce this result than any other prepa- ration of mercury. Medicinal doses, if too large or too long continued, frequently produce gastro-enteric symptoms and the constitutional effects of mercury. In excessive doses corrosive sublimate is a violent caustic poison, from its affinity for the albu- men, fibrin and other constituents of the tissues. It acts very rapidly, producing the most intense gastro- enteritis, with violent vomiting and purging, abdominal pain and tenderness, bloody stools, with death from collapse, or, after a time, with convulsions and coma. The urine is albuminous or bloody, diminished in amount or suppressed. The precise fatal quantity cannot be stated, for in a number of cases the toxic amount has varied widely ; for instance, Taylor f reports the death of a child from gr. iij ; Herapath % records a fatal case from gr. xx in solution, in a man ; while a girl § of eighteen recovered after swallowing about gr. xix. The best antidote is albumen (in the form of white of eggs) ; or, if this is not attainable, gluten (in wheaten flour) or casein (in milk) may be substituted. Ferrous sulpiride (if given imme- diately), and a mixture of iron filings (two parts) with gold dust (one part), also decompose corrosive sublimate. In cases of poisoning, the stomach must be evacuated as soon as possible, and the after-treatment consists in the free use of demulcents, and opiates. Medicinal Uses. — Corrosive sublimate is used chiefly as an alterative in secondary syphilis, both by the stomach and by hypodermic injection, and also in cutaneous and rheumatic affections ; it is a good remedy, too, in chronic diarrhoea and dysentery with slimy and bloody discharges. In tertiary syphilis it is combined advantageously with potassium iodide, as in the following : ty Hydrargyri chloridi corrosivi, gr. iss ; potassii iodidi, 5ij ; elixir aurantii, foij ; aquae, ad f Syj. M. Sig. — f3ij, in * Practitioner, Sept., 1886. f "Medical Jurisprudence," 1865, p. 225. % The Lancet, 1845, P- 6 5°- \ Guy's Hosp. Reports, 185 1, p. 212. ALTERATIVES PREPARATIONS OF MERCURY. 419 water, t. d., after meals. The dose, when alone, is gr. yV~i three or four times a day, after meals, in pill ; or, if in solution, disguised^ by elixir of orange. It has also been used hypodermically. For this purpose various solutions have been used. 1^ Hydrargyri chloridi corrosivi, gr. j ; aquae destillatse, f§j. M. Of this solu- tion tt^x contain gr. -£%. As the injection of corrosive sublimate is followed, in many instances, by inflammation and abscess, and as it seems to have no decided advantage over the other methods, we do not advise its adoption. When used hypodermically mercury is claimed to be more energetic, efficient, and rapid in its action than when administered either by the mouth, by inunction, or by fumigation. M. Martineau, who has employed it largely in syphilis, declares there is no pain, neither phlegmon nor abscess, no stomatitis (without there was previously an unhealthy condition of the buccal mucous membrane), and no gastro-intestinal disturbance, when the solution is neutral, the needle fine and very sharp, and the injection made in the dorsal region. Though highly recom- mended by numerous syphilographers, the hypodermic use of mercury has not gained much favor with the profession at large, and it is principally employed only when mercurials are not well borne by the mouth or by inunction. The average dose for hypodermic use is gr. xV~ tV- Externally it may be used as a caustic. It is destructive to the lower forms of life, and hence may be used as an antiseptic in weak solution (i part to 2000 parts of water, or about gr. j-f Sivss, vide Antiseptics), instead of carbolic acid ; a weak solution (gr. J^-j-ij to water f Sj) is much employed as a wash to ulcers, an injection in gleet, a colly rium, etc. An ointment (gr. J^-j-ij to lard Sj) is a good application in porrigo, tinea, eczema, pityriasis, and skin diseases generally of parasitic origin. There is danger from the external application of corrosive sublimate to a large surface. In gonorrhoea after the acute stage has passed, corrosive sub- limate, gr. Y2~i m wa ter, fSviij is an excellent injection, and according to Koch is the most active agent with which to kill the gonococci. After the first trial the strength should be regu- lated just short of irritating the urethra. As a tineacide in ringworm the strength may be gr. iij-v in an ounce of compound tincture of benzoin, the solution to be 420 MATERIA MEDICA HEMATICS. applied every few days with a brush. The parts should first be cleansed with sapo viridis, or an alkaline solution. The following is serviceable to destroy crab-lice : 3^ Hydrargyri corrosivi sub- limati, gr. vj ; acidi acetici diluti, f 5ij ; aquae, ad f §iv. M. Sig. — Apply with sponge morning and evening. The acid is added to dissolve the nidus of the lice around the base of each hair-shaft. Hydrargyri Iodidum Viride (Green Mercurial Iodide) (Mer- curous Iodide) (Hg 2 I 2 ) is made by rubbing mercury and iodine together, with the addition of a little alcohol. It is a greenish- yellow powder, insoluble in water and alcohol, but soluble in ether. By exposure to light it is partially decomposed, and becomes of a dark-olive color. Effects and Uses. — This mercurial exercises a specific influence over the lymphatic and glandular systems, and is employed in syphilis and scrofula. It is a favorite with many practitioners in the treatment of the syphilides : 3^ Hydrargyri iodidi viridis, gr. iv; morphinae sulphatis, gr. j. M. et ft. pil. xx. One of these pills may be given one-half hour after meals, and the dose gradually increased by one pill per day until tenderness of the gums or gastro-intestinal symptoms supervene, when the dose must be lessened. Dose, gr. j£- j ; it should not be given with potassium iodide, which decomposes it into the red iodide and metallic mercury. Externally, it is applied, in the form of oint- ment, to syphilitic ulcers, etc. Hydrargyri Iodidum Rubrum {Red Mercuric Iodide) (Hgl 2 ) is made by mixing solutions of potassium iodide and mercuric chloride, from which a double decomposition ensues, resulting in the formation of potassium chloride in solution, while red (mer- curic) iodide is precipitated. It is a scarlet-red powder, which becomes yellow when heated, insoluble in water, but soluble in boiling alcohol and solutions of potassium iodide and sodium chloride. It is a powerful irritant and caustic, and is employed in the same cases as the green iodide, though much more ener- getic. It is useful in rheumatism, especially when of syphilitic origin. Dose, gr. y 1 ^-, gradually increased to gr. ^, in pill or alcoholic solution ; or, still better, dissolved in a solution of potassium iodide. In late secondary or in tertiary syphilis the following prescription is often of service : 3^ Hydrargyri iodidi rubri, gr. iij ; potassii iodidi, oij J elixir aurantii, fgiij ; aquae des- ALTERATIVES PREPARATIONS OF MERCURY. 42 I tillatae, q. s. f§viij. M. et sig. Take a teaspoonful 3 times a day. Externally it may be used in the form of ointment (gr. xvj mixed with ointment Sj), and as an antiseptic agent (q. v.). Hydrargyri Cyanidum {Mercuric Cyanide). This salt is made by adding a solution of potassium ferrocyanide to sulphuric acid, by which hydrocyanic acid is produced, and this, being received in a vessel containing water and red mercuric oxide, generates water and mercuric cyanide (Hg(CN) 2 ). It is found usually in the form of permanent, prismatic, white and opaque crystals, of a disagreeable styptic taste, soluble in water, less so in alcohol. It is an active poison, two fatal cases being recorded by Christison,* one from gr. x, the other, gr. xxiijss. It is used as an antisyphilitic remedy, as a substitute for corrosive sublimate, over which it has the advantage of not pro- ducing epigastric pain, and of not being decomposed by the alkalies and organic substances. Dose, gr. -^ to y&. Hydrargyrum Ammoniatum (Atnmoniated Mercury) (NH 2 Hg CI). This preparation, commonly called white precipitate, is made by precipitating a solution of corrosive sublimate by ammonia ; ammonium chloride is formed in solution, and ammoniated mer- cury is thrown down. It is considered to be mercuric ammo- nium chloride. It is a perfectly white powder, insoluble in water and alcohol, decomposed by boiling water, inodorous, and has an earthy, afterward metallic, taste. It cannot be mixed with iodine, bromine or chlorine without decomposition. It is largely adulterated, chiefly with calcium sulphate. Its effects are poi- sonous, for Graham \ reports a case of non-fatal poisoning in a man who, having swallowed 5ij, was seized with vomiting and bloody diarrhoea, but no salivation nor sponginess of the gums occurred. It is used only as an external application, in the form of ointment {iinguentum hydrargyri ammoniati, 10 parts of ammo- niated mercury to 90 parts of benzoinated lard), to cutaneous eruptions, and to destroy pediculi and the tinea of ring-worm. Hydrargyri Subsulphas Flavus (Yellow Mercurial Subsul- phate). This salt, commonly called turpeth mineral, from its resemblance to the root of Ipomcea turpethum, is made by throw- ing mercuric sulphate (as obtained frpm the action of sulphuric * "A Treatise on Poisons," 4th ed., p. 427. f Brit. Med. Journ , 1869, -p. 329. 422 MATERIA MEDICA HEMATICS. and nitric acids on mercury) into boiling water; the mercuric sulphate is instantly decomposed into a soluble acid, salt and the insoluble yellow subsulphate — turpeth mineral — which is precipi- tated (Hg(HgO) 2 S0 4 ). It is an inodorous, lemon-yellow powder, entirely dissipated by heat, of a rather acrid taste, and sparingly soluble in water. It has been employed as an alterative, in doses of gr. %-% : as an emetic ; in croup it is highly recommended in doses of gr. ij-v in syrup or honey, repeated in fifteen minutes if there has not been decided vomiting, and given throughout the attack whenever the breathing becomes suffocative from accumulations of mucus. It produces free vomiting without effort or subsequent depression ; it has been used in chronic enlargement of the testis, in the same doses. In an overdose it is poisonous,* gr. xl having proved fatal to a man, the chief symptoms being violent vomiting and purging. Hydrargyri Sulphidum Rubrum {Red Mercurial Sulphide) {Mercuric Sulphide) (HgS), or cinnabar (which is found as a native combination), is manufactured by subliming a mixture of one part of sublimed sulphur and five parts of mercury. It occurs in the form of heavy, brilliant, deep-red crystalline masses, which are inodorous, tasteless, entirely volatilizable by heat, and insoluble in water and alcohol. It is not employed internally, but is used in the way of fumigation, in venereal ulcers of the throat and nose ; 5ss may be thrown on a red-hot iron and inhaled. It is but little used. Cinnabar is used as a paint, under the name of vermilion. * Unguentum Hydrargyri Nitratis {Ointment of Mercurial Nitrate). Mercurial Nitrate is employed chiefly in the form of ointment. This preparation, known as citrine ointment, is made by dissolving 7 parts of mercury in 10 parts of nitric acid, and adding the solution to a mixture of nitric acid 7 parts, with lard- oil 76 parts, previously melted at 15 8°, and stirring until effer- vescence ceases. The chemical changes which result here are not precisely known ; but mercuric nitrate (2(Hg2N0 3 ).H 2 0) is probably formed, with fatty acids and ela'idin. Citrine ointment has a fine yellow color and an unctuous consistence ; but if not very carefully made, it becomes greenish, hard and friable. It is * " Med. Jurisprudence," Taylor, 1865, p. 233. ALTERATIVES AURIC AND SODIUM CHLORIDE. 423 an excellent stimulant and alterative application, much employed in porrigo, psoriasis, crusta lactea, impetigo, psorophthalmia, and a wide range of ulcerated and eruptive affections. It is best to* dilute it, at first, with lard. Liquor Hydrargyri Nitratis {Solution of Mercurial Nitrate) {Mercuric Nitrate) (Hg2N0 3 ) is prepared by dissolving red mer- curic oxide (40 parts) in a mixture of nitric acid (45 parts) with distilled water (15 parts). It is a dense, transparent, nearly color- less liquid (sp. gr. 2.100), of a strongly acid taste, containing about 50 per cent, of mercuric nitrate in solution with some free nitric acid, and is employed as a caustic application in hospital gangrene, venereal and malignant ulcers, and, diluted, in cuta- neous affections. A teaspoonful of mercury * dissolved in strong nitric acid killed a lad aged sixteen, in two and a half hours, with abdominal pain, purging and vomiting. Diluted with 12 parts of water it forms a useful application to mucous patches. AURI ET SODII CHLORIDUM AURIC AND SODIUM CHLORIDE. Auric and sodium chloride is a mixture of equal parts of these salts (AuCl 3 NaC1.2H 2 0). It is an orange-colored salt, without smell but having a nauseous metallic taste. It is soluble in alcohol ; more so in water. Effects and Uses. — Locally it is a caustic. Internally it is a stimulant to the nervous system, especially to the spinal cord. It acts like the mercurials on the blood, reducing the oxidizing power of the red globules (Farquharson). It stimulates the glandular secretion and increases the secretion of urine and of perspiration. Salivation, without tendency to ulceration, some- times occurs after prolonged use, but is less apt to occur after the use of this salt than after the other salts of goldf. In large doses it causes violent gastro-enteritis. It stimulates the sexual organs and is said to increase the catamenia. Large doses cause symptoms analogous to those of poisoning by mercuric chlo- ride. The same treatment is indicated. This salt is used chiefly as an alterative in chronic cases of tertiary syphilis and in scrofula. It is also recommended in * London Med. Gazette, VII, p. 339. j- Schmidfs Jahrb., June, 1870. Martin. 424 MATERIA MEDICA HEMATICS. nervous dyspepsia, duodenal catarrh, etc. In the chronic forms of Bright' s disease, granular and fibroid kidney, improvement sometimes follows the use of small doses of this remedy, and in functional impotence it is not without value. Dose, gr. -^q - tV- It is best given in pill or wafer. iodum — IODINE. Iodine (I) is an elementary, non-metallic substance, found in the vegetable, animal and mineral kingdoms of nature, as in marine plants, oysters, sponges, mineral springs, etc. It is chiefly manufactured from the residuum of kelp (the impure soda obtained from the incineration of sea-weeds), in which it exists as a sodium iodide, by the action of sulphuric acid and manganese dioxide. It occurs in crystalline scales, of a bluish- black color and metallic lustre, of a strong, peculiar odor and a hot, acrid taste. It is very volatile, evaporating even at common temperatures ; is freely soluble in glycerin, alcohol and ether, and but very slightly soluble in water (i part in 7000 parts of water). Its solubility in water is very much increased by the addition of certain salts, as the potassium iodide, sodium chlo- ride, etc. When heated its vapor has a rich violet color, whence its name (from l 1883. f N. Y. Med. Rec, Jan. ioth, 1885. 428 MATERIA MEDICA HEMATICS. the tincture that it may be diluted with water without decom- position ; dose, gtt. xv-xxx. Iodine ointment (tingitentum iodi) (made with iodine 4 parts, potassium iodide 1 part, water 2 parts, and benzoinated lard 93 parts) is employed as a local application in goitre, scrofulous tumefactions, etc. Iodine baths have been employed, with iodine and potassium iodide dissolved in water, in a wooden bath-tub, in the proportion of iodine gr. iij and potassium iodide gr. vj to a gallon of water. POTASSII IODIDUM POTASSIUM IODIDE. This salt is prepared by treating an aqueous solution of potassa with iodine in slight excess. By this process a mixture of potas- sium iodide and potassium iodate is obtained, and the iodide is afterward deoxidized and converted into iodide by heat and mix- ture with powdered charcoal. Potassium iodide (KI) occurs in semi-opaque, white or transparent anhydrous crystals, permanent in a dry air, rather deliquescent in a moist one, of an acrid, saline taste, somewhat like that of common salt. It is wholly soluble in water and alcohol, and its aqueous solution dissolves iodine, forming io dure tied potassium iodide. It is frequently adulterated with other salts. It is incompatible with acids and acid salts, spt. nitrous ether, soluble lead salts and the mercurials generally ; with potassium chlorate, if a mineral acid be added, a poisonous potassium iodate is produced. Effects and Uses. — The effects of potassium iodide are analo- gous to those of iodine, but less energetic. Locally, it acts as an irritant. Internally in large doses it sometimes occasions nausea, vomiting, heat of stomach, and purging ; but it may be given in larger doses, and for a longer period, than iodine without causing gastro-enteric derangement. Pelikan in 1856 denied that the iodides of the alkalies irritate the gastro- intestinal mucous membrane, and this is also affirmed recently by Dr. A. Smirnoff (loc. cit). Under its prolonged use, the digestive function of the gastric juice fails, although the quantity secreted remains unal- tered (A. Smirnoff*). It stimulates the secretions, particularly those from mucous membranes, and very often produces coryza. Potassium iodide decidedly lessens the secretion of milk, and as * " Inaug. Dissertation," St. Petersburg, 1884. ALTERATIVES POTASSIUM IODIDE. 429 it disturbs the function of the glands the relative quantity of the different ingredients fluctuates. Iodine appears in the milk very soon after the first dose of the salt is taken, and disappears as soon as the drug is stopped. It is found in combination with the casein of the milk, but the amount present bears no constant relation to the amount of the salt administered (Dr. Max StumpP). It is eliminated by the mucous membranes generally, but chiefly by the kidneys acting as a diuretic and increasing the amount of water, urea, uric, phosphoric and sulphuric acids in the urine. Its constitutional effects are powerfully alterative and resolvent, as it increases the disintegration and elimination of albuminous compounds, thus causing wasting and emaciation when admin- istered in health ; but like iodine, it acts most readily on morbid products. It is employed in bronchocele and scrofula ; in tertiary .syphilis (in which it is usually combined with or followed by some mercurial preparation), and other chronic diseases, accom- panied with enlargements or indurations. It is a most valuable antisyphilitic remedy when the bones and fibrous tissues are affected. In all nervous affections of syphilitic origin, as syphilitic neuralgia or paraplegia, large doses of the salt give prompt relief, and in gummata of the brain they are of signal advantage. It has been given hypodermically when it disorders the digestion. In chronic rheumatism and gout, particularly where the fibrous tissues are attacked, it is of great efficacy. It is highly recommended in the early stages of interstitial hepatitis (cirrhosis) before contraction has taken place. As a diuretic in serous effusions it has been found useful ; and in spasmodic asthma, given between the attacks, it will often prevent their occurrence or increase the interval between them. As an elimi- native antidote in mercurial and saturine poisoning its action has been already noticed. It has been recommended in hydro- cephalus ; and has been found to exercise a beneficial operation in the treatment of aneurism. In deep-seated aneurism, large doses (gr. xx-xl) are advised by Burney Yeo,fwho thinks these exert a favorable influence by diminishing cardiac action and * Deutsche* Arch. f. klin. Med., Jan., 1882. f Lancet, Feb., 1886. 430 MATERIA MEDICA HEMATICS. lowering the general blood-pressure. Dr. H. W. Stelwagon* recommends it highly in subacute and chronic eczema, espe- cially when arsenic has failed to exert a favorable influence on the disease, combined with suitable external treatment. He gives gr. ss increased to gr. v to a child in syrup of orange-peel and water, or to an adult, gr. v-x in Huxham's tincture or com- pound tincture of gentian. Administration. — Dose, gr. v-xv to 5j or more (depending on the idiosyncrasy of the patient), three times a day, in solution, but very much larger doses may be required in tertiary syphilis. Mr. Jonathan Hutchinsonf recommends beginning with a small dose (gr. ij-iij) at first, increased by the addition of gr. ij per week, if the cure be not progressing rapidly. He finds a com- bination of ammonium, sodium and potassium iodides often answers better than the potassium salt alone, and that free am- monia or sal volatile increases the efficiency of any of the iodides. The compound syrup of sarsaparilla is one of the best vehicles to disguise its unpleasant taste. An ointment (12 parts, sodium hyposulphite 1 part, benzoinated lard 81 parts, boiling water 6 parts), is employed for the same purpose as iodine ointment, and does not discolor the skin ; it is, however, of feebler efficacy. It is said that when administered in milk, not only is the unpleas- ant taste somewhat disguised, but the salt is less apt to disagree with the stomach. Ammonii Iodidum — Ammonium Iodide (NH 4 I) — is made by the double decomposition of potassium iodide and ammonium sulphate in hot aqueo-alcoholic solution. It occurs as a white, granular, very deliquescent salt, becoming yellowish-brown by exposure, but when deeply colored, the U. S. P. directs that " it should not be dispensed." It is very soluble in water and alco- hol, of a taste like that of potassium iodide, but a little sharper. It has been similarly used as the latter salt, and recommended in catarrhal jaundice after the acute symptoms have subsided (gr. j-iij p. r. n.), and in the early stages of cirrhosis of the liver. It is also very useful in chronic bronchitis, capillary bronchitis and in pneumonia, to promote the absorption of the exudation and to prevent caseous degeneration. * Med. News, April 2d, 1885. f " On Syphilis," 1887. ALTERATIVES IODOFORM. 43 I Sodii Iodidum — Sodium Iodide (Nal) — may be made by the double decomposition of iron iodide and sodium carbonate. It is a soluble, white, crystalline salt, used to fulfill the same indi- cations as potassium iodide, than which it is said to be better borne. Iodine is employed in medicine in various chemical combina- tions. The iron, lead and mercurial iodides have been noticed. Iodized starch (amylum iodidum) has been highly recommended as a dressing for syphilitic ulcers, etc. Zinc iodide (see p. 198) is employed as a tonic and astringent. Sulphur iodide {sulphuris iodidum) is prepared by heating together iodine 4 parts, and washed sulphur 1 part ; it is a grayish-black solid substance, of a radiated crystalline appearance, having the smell and taste of iodine, decomposed upon exposure to the air and by boiling water and alcohol, insoluble in water, but soluble in 60 parts of glycerin ; it is used internally in scrofulous and cutaneous affections, in doses of gr. }4~), and externally in tinea capitis, lupus, lepra, acne, etc., in the form of ointment (gr. xxx to lard Sj). IODOFORMUM IODOFORM. Iodoform is obtained by the action of chlorinated lime upon a heated alcoholic solution of potassium iodide, which yields calcium iodate and iodoform, the latter being separated by the solvent action of boiling alcohol. It is formyl teriodide (CHI 3 ), and occurs in the form of small, scaly, yellow crystals, having a saffron-like odor and sweet taste, insoluble in water, but solu- ble in alcohol, ether, chloroform, and the fixed and volatile oils. Physiological Effects. — According to Dr. G. Rommo* Mikhail P. Pohakoff and others, the effects of iodoform internally are as follows : Nervous system ; in warm-blooded animals, iodoform at first lowers the functional activity of the nerve-centres ; voluntary motion is next affected and finally abolished (espe- cially in frogs) ; anaesthesia is present to some extent, and the reflex functions of the cord are depressed ; the excitability of the nerve-trunks to external stimulation is lessened, as is also muscular contractility. A period ensues if a sufficiently large * Arch, de Physiol., 1883. 432 MATERIA MEDIC A HEMATICS. dose has been taken during which there is excitation of the nerve-centres, with clonic and tonic contractions of the muscles. Circulation : the capillaries in the web of the frog's foot at first dilate but afterward contract. In mammals, a moderate dose primarily retards and strengthens the pulse, while slightly eleva- ting the arterial pressure from stimulation of the cardio-inhibitory centre : under full doses, the pulse becomes markedly slower and feebler, and the blood-pressure falls. Larger doses at first cause slowing of the pulse, which, however, soon becomes quick and irregular, from paralysis of the cardiac centre, but this is soon followed by secondary retardation and final arrest in diastole, from paralysis of the cardiac muscle. Respiration and tempera- ture : moderate doses cause a rise in the temperature from 1.8° to 2. 7° (in dogs); larger doses produce a marked fall of temperature (7. 2° to g° F.) and convulsive respiratory movements. Gastro-intestinal tract : full doses cause vomiting and diarrhoea (in dogs). Secretion : it increases the salivary, biliary, and intestinal secretion. Elimination : it is eliminated unchanged in small quantities by the lungs, but principally leaves the system as alkaline sodium iodate, in the urine, which may be found one hour after iodoform has been administered and may be present for three days. When an excessive dose has been taken, elimination is checked, albumen and blood appear in the urine, glomerulo-nephritis and fatty degeneration of the liver, heart and other organs occur, and an inflammation of the spinal cord, with results similar to acute polio-myelitis, is found. According to Schede and to Kuster the symptoms of poisoning may be divided into six classes: 1. In this class of cases high fever is the only symptom. 2. Fever with gastro- intestinal irritation, rapid pulse, and depressed spirits ; recovery is the rule. 3. Very rapid, compressible pulse, but no fever ; a very dangerous form. 4. Very rapid pulse and very high fever ; few recover. 5. Great depression, collapse, and death; seen espe- cially after severe operations. 6. Cerebral symptoms, resembling meningitis. The best preventive to poisoning by iodoform consists in remembering that its absorption, even when used externally, is much more rapid than its elimination. Should poisoning occur, withdraw every particle of the adherent dressing, sustain the ALTERATIVES IODOFORM. 433 system with stimulants and opium, and give large doses of potassium bicarbonate (Behring*). Topically it is a germicide, and local anaesthetic. Medicinal Uses. — Bozzolo, following Moleschott, recommends it highly in glycosuria. He finds that the elimination of sugar and the amount of urine are diminished and the blood-pressure lowered by the daily use of gr. xv-xxx (i Gm. to 2 Gm.). From its action on the circulation it is recommended by Moleschott, Testa, and others, in valvular diseases where the hypertrophy is not compensatory. In these affections, given in doses of gr. y^, five or six times a day, it lessens the dyspncea, and cedema and increases the urine, the heart beats more regularly, and the tendency to hemoptysis disappears. Numerous observers speak highly of its use in phthisis as increasing the body weight and appetite, diminishing the cough, expectoration, and night-sweats and slightly lowering the temperature. It is of more value in the early than in the later stages of this disease. As an anthel- mintic, it has been used for the destruction of taenia and of ascarides, but observers differ as to its value in these affections. It has also been used internally in syphilitic rheumatism and various neuralgic affections, and Dr. Thomann has employed it with advantage, suspended in glycerin, as a hypodermic injection in recent syphilis with skin manifestations and lymphatic involve- ment. Dose, gr. j-iij, three times a day, in pill, but much larger doses have been given without producing untoward effect. In the form of vapor it is said to possess anaesthetic properties, inferior, however, to those of chloroform. Externally it is a local anaes- thetic, and has been found a good application to chancres and irritable ulcers, as bed-sores ; it is used also to relieve the pain of cancers, and for these purposes it may be dusted over the ulcerated surface, which is then to be dressed with glycerin spread upon lint, and may be powdered over the surface of foul-smelling ulcers, to allay their odor. A saturated solution of iodoform in chloroform is serviceable in relieving the pain of neuralgia and gout ; an iodoform suppository is also useful in painful diseases of the rectum and bladder. Altschul recommends iodoform as the most efficacious application for burns of the second and third * Deutsche Med. Wochensck., Jan., 1883. 28 434 MATERIA MEDICA HEMATICS. degree ; he prefers either an iodoform-gelatin of the strength of io per cent., or better still, an iodoform paste prepared as follows : 3^ White wax, 5ss ; olei olivse, f 5j ; liquoris plumbi subacetatis, f 5iv ; iodoform, oij-iv. M. As an antiseptic, Mikulicz * found iodoform to be equal to carbolic acid, and less apt to produce constitutional disturbance from absorption. As a dressing to open wounds he found it would check profuse discharge, pre- vent decomposition, and stimulate healthy granulations. In treating deep wounds he recommends a pencil composed of iodoform, i part, with oil of theobroma, 2 parts. The smell can be overcome by adding oil of bergamot, ^j, to iodoform gr. x. In septic, gangrenous, or sloughing wounds it forms an excel- lent dressing, and is very useful in chronic or irritable leg- ulcers. Rommo [pp. cit) found it more efficacious in preventing the appearance of bacteria than in arresting their multiplication. In strumous diseases it is almost a specific. Burman speaks highly of a solution of iodoform, §j, to collodion, f§x, painted well beyond the line of redness in erysipelas ; and Dr. Tschalo- voski has seen excellent results follow the application of the powder to smallpox pustules, during the stage of suppuration, to prevent pitting. In purulent inflammation of the cornea, in the membranous forms of conjunctivitis, and as an antiseptic in ophthalmic surgery, the pure drug, finely powdered, is highly recommended. Bougies made with iodoform in glycerin and gum-acacia, have been passed into the uterine cavity (previously washed out with carbolized water) of puerperal women and allowed to dissolve, when septicaemia was feared ; and it has been used as an injection in acute gonorrhoea in the proportion of 3v to carbolic acid, gr. jss, glycerin, foiiss, and water, f§ss. Only one injection should be used per diem for three or four days, after which it may be used twice daily. The oi?ttment consists of iodoform, io parts, rubbed up with benzoinated lard, go parts. IODOL. Iodol (not officinal) obtained by the action of iodine on certain constituents of animal oilsf, is chemically tetra-iodo- pyrol (C4I4NH). It is a " light-yellowish-gray, fine and specific- * Wiener Med. Wochenschrift> 1881. f Lancet, Nov., 1885, p. 1013. ALTERATIVES — IODOFORM. 435 ally light powder," soluble in 5000 parts of water in 3 parts of alcohol, and in about its own weight of ether. The addition of water to the alcoholic solution causes a milky precipitate*. It is very rich in iodine, containing 88.9 per cent. It has very little taste, and is free from disagreeable odor. When in con- tact with the tissues and secretions of the body iodine is readily liberated, but no constitutional phenomena have attended its long-continued use as an external applicationf. It is slightly caustic, adhering readily and uniformly to the surface of a wound, and forming a gray protective film to the granulations underneath. It is said to aid the process of cicatrizationj. Its antiseptic power, which is due to the liberation of iodine, is about equal to that of iodoform, -to which it is preferable from its comparative freedom from nauseous smell and taste and the absence of toxic symptoms attending its external use. Whether used locally, or adminis- tered internally, its presence can shortly be detected in the saliva and urine. As an external application it has been extensively used in the treatment of chancres, buboes, and also in simple indolent ulcers with good results, and in no case was there any erysipelatous or diphtheritic inflammation observed. Dr. Petersen, of St. Peters- burg, however, applying it as a dusting powder to chancroids three or four times daily, observed that usually about the third day the granulations became flabby, "as if hyaline," and the granulation-process was retarded. Iodol has been much lauded as a substitute for iodoform in ophthalmic practice, % particularly in the chronic forms of conjunctivitis and in sluggish corneal ulcers, || but is contra-indicated in affections of acute irritative character. According to Katzaiiroff, iodol always caused much more irritation than iodoform, when the powder was applied to a healthy eye, and did not prove as useful in his hands, except in phlyctenular conjunctivitis, trachoma and opacities of the cornea, in which it was of great service. * Merck's Bulletin, June, 1888, p. 17. f Practitioner, May, 1887, p. 336. R. N. Wolfenden. % Bull. Gen. de Therap., Fev., 1887. Dr. Juquer. \ Centralbl. fiir Bract. Augenheilk.,]&x\., 1886. Glassner. || V Union Mid., Mars 22d, 1886; Annates d' Oculist, Mai, Juin, Juillet et Aout, :886. Dr. Trousseau. 436 MATERIA MEDICA HEMATICS. In nasal, laryngeal and pharyngeal affections it is highly recom- mended, particularly in laryngeal phthisis, in which it is often of signal value (R. N. Wolfenden). Internally, it has been used as a substitute for iodoform. Dose, gr. %-\], in capsule, pill or solution. Locally to the eye or throat, it is used in powder or in alcoholic solution diluted with glycerin (iodol I part, alcohol 16 parts, glycerin 34 parts), and to wounds in powder, solution, ointment (1 or 2 per cent), bougies, wool or gauze. OLEUM MORRHILE COD-LIVER OIL. This is a fixed oil obtained from the liver of Gadus Mor- rhua, the common cod {Class Pisces ; Ord. Teleostia, Fam. Gadida) — a well-known fish of the northern Atlantic — and also from the livers of several other species of Gadus. It is prepared by sub- jecting the livers to heat, either in boilers with water or by means of steam externally applied, and afterward draining off* the liquid portion, from which the oil separates on standing. It is said to be sometimes procured also by expression. Three varieties are known, the white or pale-yellow ', the brownish-yellow , and the dark- brown. They differ chiefly in the mode of preparation — the pale being prepared from fresh livers, the dark-brown from those which are collected at sea and have undergone putrefactive decomposition, and the brownish-yellow from those in which putrefaction has only partially commenced. The pale oil is the purest ; the dark oil is the most offensive to the taste and smell, and the least acceptable to the stomach. Cod-liver oil'is of the consistence of lamp-oil, and has a pecu- liar odor, resembling that of shoe-leather — which is usually pre- pared in the United States with this oil — and a fishy-acrid taste. These sensible properties are probably ' the best tests of the genuineness of the oil, and jt should be rejected if the smell and taste of shoe-leather are wanting, or if those of lamp-oil or fish- oil are very perceptible. The sp. gr. of the best oil is about 0.920—0.925. The oil undergoes a gradual change from exposure to the air, and should, therefore, be kept in full and well-stop- pered bottles. It is insoluble in glycerin and water, somewhat so in alcohol, readily soluble in ether and chloroform. It con- tains a great variety of chemical constitneitts, the most important of which are fatty acids, several biliary principles, a peculiar brown ALTERATIVES COD-LIVER OIL. 437 substance called gaduin (which is not, however, supposed to be the active ingredient), iodine, chlorine and traces of bromine. Dr. Joseph Lefage,* assisted by Dr. Chapoteaut, obtained a product from the oil which they named morrhuol, and which represents the active principles of cod-liver oil. It is obtained (i) by treating the oil with an aqueous solution of sodium bicarbonate, which dissolves the acid at low tempera- ture ; (2) by agitating the oil with 90 per cent, of alcohol, sepa- rating it from the oil and submitting it (alcohol) to distillation. Morrhuol is acrid, bitter, very aromatic and partly crystalline at ordinary temperatures. It contains considerable quantities of iodine, bromine and phosphorus. The oil after its removal is tasteless and odorless. Cod-liver oil may be distinguished from other oils by the agency of sulphuric acid, a drop of which, when added to fresh cod-liver oil, on a porcelain plate, causes a centrifugal movement in the oil, and gives rise to a fine violet color, soon passing into yellowish or brownish-red. This reaction is attributable, how- ever, to the bile contained in the oil. By reaction with ammonia, in distillation, the peculiar volatile principle trimethylamine (the odorous principle of pickled herring) is developed. Physiological Effects. — Cod-liver oil, like all fats, is appropriated in the small intestine, and not in the stomach. Its prolonged use, in doses which allow it to be retained by the digestive tube, produces very marked beneficial effects in a wide range of chronic diseases, dependent on a vitiated condition of the functions of digestion, assimilation and nutrition. Its modus medendi is not well understood, some therapeutists believing it to act merely as a nutritive agent, valuable from the readiness with which it is assimilated ; others attributing its curative powers to an altera- tive action from the iodine and bromine or other principles which it contains. Its effects are, however, probably due merely to its nutrient action, in supplying a sufficiency of molecular base for interstitial growth. The biliary principles which it contains pro- mote its absorption and appropriation by the system. The most striking feature of its action on the economy is increase of weight; and usually, where it fails to increase the weight, it is of little * Der Fortschritt, Feb. 20th, 1886, from Le Bull, de Therap. and Le Bull.. Com. 43 8 MATERIA MEDICA HEMATICS. service. It is believed, also, to diminish the formation of uric acid in the system, and hence may be useful in gout. In large doses, cod-liver oil produces nausea and diarrhoea, and these effects occasionally follow the use of medicinal doses. Medicinal Uses. — Cod-liver oil has long been known as a remedy in rheumatic diseases ; and within the last forty years it has come into extensive use as an alterative in tuberculous and scrofulous affections. In the treatment of phthisis pulmonalis it is now looked upon, in Great Britain and the United States, as superior to any other agent, and as possessing an undoubted power of arresting the progress of both the general and the local symptoms of the disease. Although efficacious in all the stages of phthisis, its value is most conspicuous early in the disease, especially before the formation of true tubercles. Morrhuol is strongly recommended in the first stage of tuber- culosis, in infantile scrofulosis and rachitis, and in chronic bron- chitis.* Dr. E. Chazeaud,f from the careful study of ten cases of pulmonary phthisis in which he had administered morrhuol, concludes that it increases the appetite and weight, lessens or extinguishes the cough and with it the symptoms of debility, and diminishes the excretion of urea. Over the different forms of scrofula it exercises also a very decided control — particularly glandular enlargements, ulcers, diseases of the joints and spine, ophthalmia, etc. In the various cutaneous affections, tertiary syphilis, chronic rheumatism and gout, and the entire circle of chronic disorders in which there is a tendency to marasmus, and where the nutrition is defective, cod- liver oil is employed with benefit. Its good effects are most con- spicuous in proportion to the youth of the patient. Admiiiistration. — Dose, fSss two or three times a day, one hour after each meal; though, if unacceptable to the stomach, it is best to begin with f5j doses. The addition of a little ether (gtt. xij-xx to f5j of oil) promotes its digestion. It must be persevered with for a long time before its good effects appear. It is best given in some aromatic water, or a little ardent spirit, or the froth of porter ; and it may be rendered * Dr. Joseph Lefage, op. cit. f Etudes cliniques sur le morrhuol, these, par E. Chazeaud, Paris, 1887. ALTERATIVES PREPARATIONS OF ARSENIC. 439 more agreeable to the stomach by combination with one of the mineral acids. The union of the oil with lime-water, just enough to form a soap, often renders it acceptable to delicate stomachs, and it may be flavored with oil of bitter almond. If it produce diarrhoea, astringents should be administered with it, or the dose should be decreased, or the oil stopped. It is used as a clyster in cases of ascarides and lumbricoides ; and externally, in cutaneous affections and opacity of the cornea. Phosphorated cod-liver oil is made by the direct addition of phosphorated oil (see p. 178) to the amount of cod-liver oil required to furnish the desired strength of phosphorus. Morrhuol is best given in capsules (gr. iij = gr. 80 of the oil) on account of its disagreeable taste and aromatic smell. ARSENII PR^PARATA PREPARATIONS OF ARSENIC. Metallic arsenic is inert, though when swallowed it may prove powerfully poisonous by becoming oxidized and converted into arsenious acid. It is not used in medicine. Acidum Arseniosum (Arsenious Acid)(As 2 3 ), sometimes called white arsenic, arsenic oxide or arsenic, is obtained principally as a secondary product in the roasting of cobalt ores (the cobalt arsenides) in Saxony and Bohemia. It is afterward purified by sublimation, and when recently prepared, occurs in glassy, color- less, transparent masses of a vitreous fracture, which gradually become white and opaque, progressively from the surface in- ward. It is kept sometimes in the shops in the form of a fine white powder ; but in this state it is liable to adulteration with chalk or calcium sulphate, and it should, therefore, be always purchased in masses. It is entirely volatilized by heat, at a tem- perature not exceeding 424.4 F. ; has no smell and little or no taste; is soluble in water, and also in alcohol and oils. Cold water dissolves from yoVo tn to 3-5-5-th P art of its weight of arsenious acid, or about gr. ss-j to f Sj. If boiled for a short time with water, about -^-th part will be dissolved ; if boiled for an hour, yg-th part will be dissolved, or about gr. xij to f Sj.* Tests. — Owing to the frequent use of arsenious acid as a * " Med. Jurisprudence and Toxicology," 1884, p. 239, Reese; and Taylor's " Med. Jurisprudence," 7th Am. ed., p. 140. 440 MATERIA MEDICA HEMATICS. poison, a knowledge of the means of detecting its presence is of great importance. In the solid state it may be recognized in the first place by its volatility (heated over a spirit-lamp, it passes off as a white, inodorous vapor, and is deposited on a cool sur- face as an amorphous powder or in octahedral crystals) : secondly, when thrown on burning charcoal it is deoxidized, and gives out the garlicky odor of metallic arsenic (other substances give off a similar odor) ; and thirdly, if heated in a glass tube with char- coal or black flux, it sublimes and condenses in the form of a brilliant steel-gray ring or mirror, soluble in sodium or calcium hypochlorite. In aqueous solution arsenious acid may be detected by the following reagents : sulphuretted hydrogen or ammonium sulphide produces a lemon or sulphur-yellow arsenic trisulphide, which may be distinguished from antimonial and stannic sul- phides by being soluble in a solution of ammonium carbonate and insoluble in diluted hydrochloric acid ; the addition first of ammonia and then of silver 7iitrate produces a canary-yellow silver arsenite ; and the addition of ammonia and then of cupric sul- phate produces an apple or grass-green cupric arsenite; gr. ioo boiled with diluted hydrochloric acid, and then treated with sulphuretted hydrogen, yield a deposit of arsenic trisulphide weighing gr. 124. The arsenic trisulphide may be r^^^ and made to yield metallic arsenic, if heated with soda flux or potash flux. A very delicate test of arsenious acid in solution is that of nascent hydrogen termed Marsh's test. When the acid is sub- mitted to the action of nascent hydrogen (evolved by the action of diluted sulphuric acid on pure zinc), it is deoxidized, and unites with the hydrogen to form arseniuretted hydrogen gas. This gas has a garlicky odor, and is recognized by its burning with a bluish-white flame which deposits on a plate of cold glass or porcelain, held over the jet, a lustrous steel-gray or brownish- black spot or mirror of metallic arsenic, surrounded by a faint white ring of arsenious acid ; the metallic spot deposited is dis- tinguishable from antimony, obtained by a similar process, by the addition of a drop or two of fuming nitric acid, with heat, which dissolves both metals, the solutions yielding on evaporation white residues, but the arsenical residue, touched with a drop of strong solution of silver nitrate, assumes a brick-red color, while ALTERATIVES PREPARATIONS OF ARSENIC. 44 1 the antimonial residue remains unchanged ; and also the arsenic can be dissolved by a solution of sodium or calcium hypochlo- rite, which does not affect antimony. Another test is that of Reinsch, and consists in boiling a solu- tion of the acid with hydrochloric acid and copper foil or wire, when the latter acquires a steel-gray coating of metallic arsenic, passing, as it increases, into black. Other metals, as mercury and antimony, are deposited on copper under similar treatment, so that additional tests will have to be made to prove their absence. The Berzelius- Marsh test consists in the decomposition of arseniuretted hydrogen gas in the reduction tube (of a Marsh- apparatus) by heat, with the production of a metallic deposit before the flame is reached. It is now considered to be the most delicate of all tests. When arsenious acid is dissolved with liquid organic substances, it should first be separated from insoluble matters by filtration, and the metallic arsenic may be then obtained by Reinsch 1 s pro- cess, and the liquid or subliming tests afterward applied. If the poison be mixed with solid organic substances, they should be cut up and boiled with water acidulated with hydrochloric acid, and the solution afterward filtered and again boiled, etc. Physiological Effects. — Arsenious acid acts locally as an escha- rotic by destroying the vitality of the parts to which it is applied. In medicinal doses it stimulates the digestive and nutritive func- tions, as is shown by the well-known results of arsenic-eating among the peasantry of Austria. Ringer and Murrell's* experi- ments upon frogs show that arsenic is poisonous to all nitro- genous tissues, but that it takes some time for it to destroy the conductivity of the motor nerves and the muscular irritability. Their experiments differ from those of Sklarekf in respect to sensation and reflex action, for they found that the afferent nerves retained their conducting power, while Sklarek states that sensation and reflex action are abolished in ten minutes. The paralysis finally produced by arsenic is centric, with which state- ment all observers agree. Its physiological effects are not, at * Journ. of Physiol., 1878-9, p. 213. f Arch, fur Anat. u. Physiol., 1 866, p. 481. 44 2 MATERIA MEDICA HEMATICS. first, very obvious. When continued for some time, it generally produces more or less heat and dryness of the throat and stom- ach, with nausea, increased secretion from the bowels and kid- neys, irritation of the conjunctival and nasal mucous membranes, and a peculiar swelling of the face termed oedema arsenicalis ; after the latter symptom appears, the medicine should be suspended. No matter how administered, or by what channel it enters the system, arsenic shows a marked selective affinity for the gastro- intestinal and mucous tracts. Injected into the blood in mammals it causes enormous sinking of the blood pressure with slowing of the pulse rate (Unterberger*). Small doses increases the cardiac action and the activity of the capillary circulation ; large doses cause palpitation, a small, quick and irregular pulse, with flushed face and cold extremities ; poisonous doses depress the circula- tion and (in the lower animals) paralyze the heart in diastole. Arsenic, if too long continued or given in an excessive dose, decreases the number of globules in the blood, decomposes the hemoglobin and renders it less coagulable (Brodie, quoted by Phillips). Small doses stimulate, while larger doses depress, both the respiratory centre and the pulmonary end-organs of the pneumogastric. At first the urine is increased, but if the drug be continued it is diminished, and may be bloody or albuminous (Kosself). In too long-continued or too large medicinal doses, arseni- ous acid sometimes produces a sort of chronic poisoning, char- acterized by disorders of the digestive apparatus, conjunctivitis, oedema of the face, but more especially of the eyelids, salivation, a cutaneous eruption, loss of the hair and nails, paralysis, convul- sions, and, if its use be persevered in, coma and delirium may result, terminating in death. In excessive doses arsenious acid is a violent poison, usually destroying life by gastro-enteritis, in from one to two or three days. Three fatal cases of arsenical poisoning have, however, been recently reported, in which no gastro-intestinal inflammation was found (J. Stewart J). When very large quantities are taken, it sometimes acts on the cerebro-spinal system, producing death * Arch, fur exper. Pathol, u. Pharmakol., II, p. 89. f Arch, fur exper. Pathol, u. Pharmak., 1878-9, p. 213. % Med. News, March 17th, 1888, p. 304. ALTERATIVES PREPARATIONS OF ARSENIC. 443 by narcotism in a few hours. Occasionally gastro-enteric and cerebro-spinal symptoms both occur. Pain and diarrhoea are not infrequently absent, as in the cases reported by Taylor (loc. cit!). Two grains of arsenious acid have proved fatal, though much larger amounts have been taken with impunity, as in the case of a woman * who swallowed 5ij, and who recovered after being vomited with tartarized antimomy. Very large quantities often cause emesis, which removes the poison from the stomach. M. Brouardelf records a case of death of a nursing infant, fol- lowing symptoms of arsenical poisoning in its wet nurse, who, however, recovered. He considers it dangerous to administer arsenic to wet nurses, as the lacteal secretion is active in elimi- nating it. Dissections in cases of poisoning from this agent reveal red- ness (sometimes accompanied with extravasations of blood), ulceration, softening, effusion of lymph, and even gangrene, in the alimentary canal. Congestions of the broncho-pulmonary mucous membrane and of the lungs themselves are often observed, and acute fatty degeneration of the liver, spleen, kid- neys, etc., is often seen, even when the poisoning has existed for a few hours only. The blood is often fluid and dark-colored. The absorptionj of arsenious acid into the system, after its administration, is shown by its presence in the blood, viscera, bile, urine, sweat, the buccal, bronchial and intestinal mucous membranes, and, after the ingestion of large doses, a considerable amount is found in the liver (Lolliot§). According to Rabuteau||, arsenic diminishes the excretion of urea, but other observers have not confirmed this statement. It is rapidly eliminated by the urine, and also by the bile, and even the skin, tears and saliva. The milk of nursing women to whom it has been admin- istered also contains arsenic (Brouardel ; Pouchet). After it has ceased to appear in the excretions, the administration of potas- sium iodide will cause it to reappear, showing that a part of it remains deposited in the tissues. Recently arsenic has been found to be deposited in the nervous system : thus, if in fresh * Guy's Hosp. Rep., 185 1, p. 203 ; Taylor. f'Societe de Med. Legale," 1885. %Arch. Gen. de Med.,t. iv, 6ieme Ser., p. 173; Bergeon et Lemaitre. I Bull. Gen. de Therap., LXXV, p. 358. || Gaz. Hebdom., V, p. 705. 444 MATERIA MEDICA HEMATICS. muscle I part is found, the proportion in liver is 10.8; in brain, 36.5 ; in the spinal cord, 37.3 (Scolosuboff *). Experiments have proved that arsenic in solution, injected into the mouth, rectum or vagina after death, will diffuse itself through the body and may be found in the liver, lungs, kidneys and even in the brain a point of great importance in legal medicinef . Antidotes and Treatment in Cases of Poisoning. — The evacuation of the contents of the stomach by emetics or by the stomach- pump, if seen very soon after swallowing the poison, should be the first object in these cases. Demulcent drinks are to be also freely given. The ferric hydrate (Ferri Oxidum Hydratuni) should be administered, as soon as it can be procured, in the state of pulp or magma. It is prepared by the action of an alka- line solution on a ferric salt. Ammonia water is directed by the U. S. P. to be added to the solution of ferric iron (see pp. 160, 162). The ferric hydrate is a soft, moist, reddish-brown magma, which acts as an antidote to arsenious acid by forming with it an insoluble, inert ferrous arseniate (Fe 3 2As0 4 ). The dose is about twelve times the supposed amount of poison taken, and it should be given in the fresh and pulpy state, as it gradually loses its antidotal virtues when kept. The ferric hydrate with mag- nesia {Ferri Oxidum, Hydratum cum Magnesia) is also directed to be kept in the shops as an antidote to arsenic. It should be administered in the same manner as ferric hydrate, and possesses the advantage of a tendency to act on the bowels. Dialyzed Iron is also an antidote to arsenic in the stomach. To insure its conversion into ferric hydrate, its ingestion should be followed by the administration of a tablespoonful of sodium chloride. Light magnesia (which has not been too strongly cal- cined) and freshly-precipitated gelatinous magnesia may be also used as antidotes. The after-treatment consists in the use of demulcents, opiates, and, if necessary, stimulants. Medicinal Uses. — Arsenious acid is a very valuable alterative remedy, but it must be exhibited with caution. It is employed with the greatest success in the treatment of chronic miasmatic affections, as dumb-ague, especially such as have resisted the use *"Compte Rendus des Seances," H, 6ieme Ser.,p. 304. f Journ. Amer. Med. Assoc, Aug. 4th, 1883. ALTERATIVES PREPARATIDN3 OF ARSENIC. 445 of cinchona, or have frequently re-appeared. For this purpose it should be given in the dose of gr. yV - T2 thrice daily, after meals, and the quantity gradually pushed until its effects are obtained, as upon the stomach. When the point of toleration is reached, the size of the dose can be regulated so that the medicine may be taken for a considerable period. In chronic cutaneous affections, particularly the scaly diseases (lepra, eczema squamosum, psoriasis and pityriasis), it is highly useful, but it should not be given while any acute inflammatory symptoms are present, or where there is much itching, burning, or heat of skin, as under these circumstances it is apt to increase the affection. Pemphigus is often benefited and sometimes cured by the judicious administration of arsenical preparations, as are also certain cases of acne, especially when occurring on the face and characterized by numerous, finely papular lesions. As arsenic exerts its influence on the rete mucosum particularly, it is more efficacious when the superficial layers of the skin only are involved. It is used also in certain affections of the nervous system, chorea in particular, over which it exercises a marked control ; in neu- ralgia, it is often of great value, especially when combined with iron and quinine ; in chronic rheumatism, in irritable dyspepsia, gastric ulcer, diarrhcea, bronchitis, phthisis (where there is not much hectic, nor rapid disintegration of tissue), and as a tonic generally, especially when anaemia is present, it is often com- bined with iron and quinine : 1^ Acidi arseniosi, gr. j ; quininse sulphatis, gr. xxiv ; ferri sulphatis exsiccati, gr. xij ; oleo-resinae capsici, gr. iv. M. et ft. pil. xxiv. Sig. — One pill may be taken immediately after meals three times a day. As an external application, arsenious acid has been applied to indolent sinuses, lupus, onychia maligna, etc., either pure or mixed with several parts of sulphur ; when thus used, it should be applied freely, as a large amount is more likely to render absorption impossible, by the rapid destruction of the tissues which it causes. A minute crystal of arsenic moistened with creasote on cotton will deaden the pain in the cavity of a carious tooth. It is an ingredient of various empirical compounds employed in the treatment of cancer. 446 MATERIA MEDICA HEMATICS. Administration. — Dose, gr. /g - -^ , in pills with bread-crumb, t. d., to be reduced when conjunctivitis appears, and suspended after the establishment of the oedema arsenicalis ; and after being taken a fortnight, it should always be intermitted for a day or two. It is less apt to occasion gastric irritability when given immediately after a meal. The usual and safer form of exhibiting this remedy is that of solution with potash. Liquor Potassii Arsenitis (Solution of Potassium Arsenite) (HK 2 As0 3 ), or Fowler's Solution. This is prepared by boiling 1 part of arsenious. acid and potassium bicarbonate, each, in 10 parts of distilled water, and when dissolved, adding 3 parts of compound spirit of lavender, and water enough to make the solu- tion weigh 100 parts ; allow the solution to stand for eight days and then filter. It is a transparent liquid, of an alkaline reaction, and has the color, taste and smell of spirit of lavender. It is decom- posed by the reagents which act upon arsenic, and is incompatible with infusions and decoctions of cinchona. Its effects and uses are analogous to those of arsenious acid, though some practi- tioners have denied their therapeutic identity. The treatment in acute poisoning is the same as that for arsenious acid. Fowler's solution is administered internally in the same dis- eases in which arsenious acid is given. When arsenic is to be prescribed for a long time, the acid itself should be selected, but when used for a short period, or to produce a constitutional impression rapidly, the more soluble arsenical preparations are preferred (Fowler's solution, sodium arseniate, or its solution, etc.). The solution of potassium arsenite is the most available form of arsenic for administration in the various forms of chronic skin diseases which have already been alluded to {vide p. 445), and may be advantageously combined with the bitter wine of iron, which will often prevent the gastro-intestinal derange- ment which is otherwise likely to ensue. The average dose in these cases is ^ij-iv, t. d., prescribed with food or directly after- ward, always carefully watching and guarding against the super- vention of toxic symptoms. It is a good tonic, also, in anaemia, and in chlorosis especially, when the subject is a young girl just arriving at the age of puberty, where iron disorders the digestion, or where the early ALTERATIVES PREPARATIONS OF ARSENIC. 447 stage of tuberculosis is suspected. It is well to administer it for a week or more continuously, and to alternate with a less soluble form of arsenic. In irritative dyspepsia, flgj-ij well diluted, before meals, is of great value. In gastric ulcer * the same treatment is recom- mended, combined with a milk diet and regulation of the bowels. It appears to lessen the amount of sugar in the urine in diabetes mellitus, and has been used internally and hypoder- mically with varying results in the treatment of relapsing fever. As a tonic it is well combined with syrup of calcium lacto- phosphate. Dose, *KJ-x, t. d. Each fluidrachm contains of arseni- ous acid, gr. -^. Sodii Arsenias {Sodium Arseniate) (Na 2 HAs0 4 .7H 2 0), is made by melting together arsenious acid, sodium nitrate and sodium carbonate, then dissolving the fused salt in boiling water, and afterward crystallizing. In this process the arsenious acid is oxidized into arsenic acid by the nitric acid of the sodium nitrate, and then combines with the soda of both salts to form colorless, transparent, prismatic crystals, slightly efflorescent, very soluble in water, of a somewhat saline, slightly acrimonious taste. This salt is employed to fulfill the therapeutic indications of the other arsenical preparations, and has the advantage of a somewhat milder local action. Dose, gr. y^— i- ^ ^ s prescribed sometimes externally in the form of baths, in chronic nodose rheumatism and gout, 5ss-iij in each bath. It is generally used internally in the form of — Liquor Sodii Arseniatis [Solution of Soditim Arseniate), made by dissolving I part of sodium arseniate (rendered anhydrous at a heat not exceeding 300 ) in 99 parts of distilled water ; dose, gtt. x-xx. Cigarettes made of paper saturated with a solution, two or three times the officinal strength, are smoked in asthma. • Liquor Acidi Arseniosi {Solution of Arsenious Acid) (for- merly called solution of arsenic chloride) is made by boiling 1 part of arsenious acid with 2 parts of hydrochloric acid and 25 parts of distilled water, until the acid is dissolved, and adding to the solution, when cold, water enough to make it weigh 100 parts. * Brit. Med. Jour., 1884, p. 1203, Strahan. 448 MATERIA MEDICA — HEMATICS. Dose, the same as that of Fowler's Solution, than which it is thought to be less apt to disturb the stomach. Arsenii Iodidum {Arsenic Iodide) (Asl 3 ), made by rubbing 5 parts of iodine and I part of arsenic together, is an orange-red crystalline, volatilizable solid, wholly soluble in water, and has been used both internally and externally in skin diseases. Dose, gr. \, t. d. ; for external use, gr. iij to lard oj. Liquor Arsenii et Hydrargyri Iodidi (Solution of Arsenic and Mercuric Iodide). This solution, known as Donovan's Solu- tion, is prepared by dissolving 1 part of arsenic iodide and mer- curic iodide, each, in enough distilled water to make the solution weigh 100 parts. It is merely an aqueous solution of the two iodides (Asl 3 and Hgl 2 ). It has a pale-yellow color, a slightly styptic taste, and is incompatible with the salts of the alkaloids and the alkalies. Effects and Uses. — This is a highly valuable alterative prepara- tion in the various forms of papular and scaly cutaneous affec- tions, and in obstinate syphilis. It was introduced by Mr. Donovan, of Dublin, in 1839, an d has been a good deal em- ployed in the United States. Dose, gtt. v to xx or more, t. d. CALCII PHOSPHAS PR^CIPITATUS PRECIPITATED CALCIUM PHOSPHATE. This salt is made by reacting upon bone-ash with hydro- chloric acid, which dissolves the calcium phosphate in the bones, and gives it up again on the addition of water of ammonia. It is a white, inodorous, tasteless, insoluble powder, sometimes called the bone phosphate of calcium (Ca 3 2P0 4 ). It is an import- ant and valuable medicine, not only in diseases of deficient ossification, as ununited fractures, caries of the bones, rickets, etc., but in all conditions of defective cell-growth and mal-nutri- tion, from its undoubted influence in promoting natural cell- growth and nutrition. Thus it is employed (often in connection with other phosphates, as those of iron, sodium and potassium) in scrofula, phthisis, anaemia, diarrhoea, chronic bronchitis, abscesses, prolonged suppurations, and wasting diseases of every kind. On account of its insolubility it is apt to form intestinal concretions. Dose, gr. v-x, given dusted into a little milk. A better (because more soluble) preparation is the syricp of calcium ALTERATIVES — CALCIUM HYPOPHOSPHITE. 449 lacto-phosphate (syrupus calcii lacto-phospliatis), containing lactic acid, calcium phosphate, orange-flower water, sugar, hydro- chloric acid, ammonia water and water. An emulsion containing 50 per cent, of cod-liver oil with syrup of the lacto-phosphate is an excellent preparation. Dose, f5j-iv. CALCII HYPOPHOSPHIS CALCIUM HYPOPHOSPHITE. This salt is prepared by boiling phosphorus in a mixture of calcium hydrate in boiling water; phosphoretted hydrogen escapes, and calcium phosphate and hypophosphite are formed in the liquid, from which the insoluble phosphate and residuary lime are separated by filtration, and the hypophosphite (CaH 4 2P0 2 ) is afterward crystallized out in the form of white, pearly crystals, of a nauseous, bitter taste, soluble in six parts of water, and insoluble in strong alcohol. All the soluble sulphates and carbonates produce precipitates with this salt. Potassii Hypophosphis — Potassium Hypophosphite (KH 2 - P0 2 ) — is prepared by mixing solutions of calcium hypophosphite and potassium carbonate. It occurs in white, opaque, confused crystalline masses, having a disagreeable, bitter taste, very deli- quescent and very soluble in water and alcohol, but insoluble in ether. Sodii Hypophosphis — Sodium Hypophosphite (NaH 2 P0 2 .- H 2 0) — is prepared by mixing solutions of calcium hypophosphite and crystallized sodium carbonate, and crystallizes in white tables of a pearly lustre, very deliquescent (but less so than potassium hypophosphite), very soluble in water and alcohol, and insoluble in ether. The hypo phosphites have been introduced in the treatment of phthisis under an impression that they prove useful by furnishing phosphorus to the tissues. They more probably act by stimula- ting cell-growth and nutrition, and may be given to fulfill the same indications as the precipitated calcium phosphate. They are incompatible with the soluble salts of mercury and silver. Dose, gr. x-xxx t. d. The calcium hypophosphite is the most eligible salt, but they are often given together in the form of — Syrupus Hypophosphitum — Syrup of Hypophosphites — consisting of calcium hypophosphite 35 parts, sodium and potas- sium hypophosphites each 12 parts, dissolved in water by the aid 29 450 MATERIA MEDICA HEMATICS. of citric acid I part, and flavored with spirit of lemon, 2 parts, of sugar 500 parts ; the whole to weigh 1000 parts. It is a good preparation to fulfill the indications of the hypophosphites. Dose, f5j-ij. Syrupus Hypophosphitum cum Ferro — Syrup of Hypophos- phites with Iron — contains ferrous lactate 1 part, dissolved in syrup of hypophosphites, 99 parts. It is used for the same pur- poses and in the same doses as the last preparation. Ferric hypo- phosphite has been noticed with chalybeates (see p. 165). CALCII CHLORIDUM CALCIUM CHLORIDE. This salt (CaCl 2 ) is prepared by neutralizing hydrochloric acid with chalk or white marble, and adding a little chlorinated lime and slacked lime. It is a colorless, translucent salt, very deli- quescent, readily soluble in both water and alcohol. It should not be confounded with chlorinated lime, which is also sometimes called " chloride of calcium." It resembles the calcium preparations generally in its effects, and is a very efficient remedy in all strumous affections of children, as glandular enlargements, accompanied by colliquative diarrhoea, a coated tongue and fetid breath (Coghill*). Milk is a good vehicle in which to give it. It is also given with benefit in wasting diseases generally and in consumption. Dose, gr. v-xx. AMMONII CHLORIDUM AMMONIUM CHLORIDE. This salt, formerly termed ammonia muriate, and often known as sal ammoniac, is obtained from the gas-liquor of coal-gas works (usually by neutralizing the ammonia with hydrochloric acid), and also in the preparation of animal charcoal from bones. It is brought in the crude state from Calcutta, for use in the arts, and in the refined state, for medicinal employment, from England. It occurs in white, translucent, tough, fibrous, hemispherical, convex-concave cakes (NH 4 C1), about two inches thick, difficult to powder, inodorous, of a pungent, saline taste, slightly deliques- cent, very soluble in water, and less so in alcohol. For medicinal use it is purified by the addition of water of ammonia to a solution of chloride, and occurs as a snow-white * The Practitioner, XIX, p. 247. ALTERATIVES AMMONIUM CHLORIDE. 45 I crystalline powder, soluble in 2^ parts of cold and in its own weight of boiling water, and soluble also in alcohol. Effects and Uses. — The physiological effects of the ammonium salts have been considered under the head of Ammonia Prepara- tions (vide p. 212). The local action of ammonium chloride is that of an irritant. In large doses it purges. In small doses, after absorption, it proves a powerful resolvent-alterative, dimin- ishing the solid constituents of the blood, with an increased flow of the secretions generally ; it has an especial action upon the mucous membranes, promoting nutritive changes and epithelial exfoliation. Under its use the solids of the urine are increased, except uric acid, which is slightly diminished. Even in very large amounts it is not considered poisonous. It is not much employed either in Great Britain or the United States, but is extensively used in Germany as a refrigerant in mild fevers attended with stoppage of the secretions ; as a resolvent in organic enlargements ; in amenorrhcea, and in catarrhs, urethritis, etc. It is also used in bronchitis and pneumonia as an expecto- rant, combined with fluid extract of glycyrrhiza (which somewhat disguises its unpleasant taste) and with other expectorants : 1^ Ammonii chloridi, 5ij ; extracti glycyrrhizae jluidi, f 5j ; syrupus ipecacuanhae, f 3iv ; syrupus pruni virginianae, f§iij ; syrupus tolutani, q. s. foyj. M. et Sig. — A dessertspoonful every three or four hours in acute bronchitis when expectoration is begin- ning to be established. Of late this salt has been used with advantage in muscular rheumatism and in neuralgia; and its resolvent powers are highly spoken of in fibroid tumors of the uterus. Dr. Peters* advocates its use in large doses combined with Huxham's tincture in rheumatic affections of the joints. In albuminoid or waxy infiltration of the liver, it is of undoubted avail in doses of gr. x-xx t. d. In the early stages of cirrhosis of the liver it is of value, and it has been highly recommended in torpidity of the liver, chronic hepatitis, etc., but according to the experiments of Rutherford and Vignal, it does not increase the secretion of bile, although they found it stimulated the intestinal glands. Dose, gr. v-xxx every two or three hours, in powder or mucilaginous solution. Exter- * N. Y. Med. Rec, Jan. 23d, 1886. 452 MATERIA MEDICA HEMATICS. nally it is used in solution (immediately upon being dissolved) as a refrigerant lotion (Sj to water Oss), in cutaneous affections and indolent ulcers (5j to water Oss). Troches of ammonium chloride each contain ammonium chloride gr. ij with sugar, tragacanth, and syrup of tolu. AMMONII PHOSPHAS AMMONIUM PHOSPHATE. This salt enjoys considerable reputation as an alterative. It is made by adding stronger water of ammonia to diluted phos- phoric acid, evaporating and crystallizing ([NH 4 ] 2 HP0 4 ). It occurs in transparent, colorless crystals, having the form of six- sided tables, of an alkaline, somewhat saline taste, soluble in water, and insoluble in alcohol. As usually found in the shops, it is a mixture of the neutral and of the acid ammonium phos- phate. Effects and Uses. — It has been used in this country as a remedy in gout and rheumatism. In combination with ammo- nium carbonate and aromatic spirit of ammonia, it has been also used with advantage in diabetes. Dose, gr. x-xl three or four times a day, dissolved in an aromatic water. POTASSII CHLORAS POTASSIUM CHLORATE. This salt is prepared by various processes : a good one is by reaction upon solution of caustic potassa, mixed with lime, with a stream of chlorine ; the chlorine is converted into chloric acid by oxygen from the lime, and the acid combines with the po- tassium to form potassium chlorate (KC10 3 ). It is a white, an- hydrous salt, crystallizing in rhomboidal plates of a pearly lustre, and is inodorous, and of a cool, saline taste. It is but little changed by exposure to the air; it is soluble in 16 parts of cold water or 2 parts of boiling water. It is said to be soluble in all the animal fluids without decomposing them or undergoing change itself. Effects and Uses. — In its effects potassium chlorate resembles the other potassium salts (see p. 244), especially the nitrate. Introduced by the stomach, it is rapidly absorbed unaltered (Isambert * ). When taken internally for some time, it gives a * " £tudes clin., physiol., et chim. sur l'emp. therap. du chlorate de potassse," 1856, Paris. ALTERATIVES — POTASSIUM CHLORATE. 453 bright, arterial tinge to the venous blood, and reduces the volume and frequency of the pulse. It does not diminish the excretion of urea, but largely increases the secretion of urine, by which it rapidly passes out of the system unchanged, as well as by the saliva (Rabuteau *). It has been pointed out by Dr. Jacobi that when given for some time this salt produces irritation of the kidneys and finally chronic tubal nephritis. The appetite is improved under its use, and salivation is an occasional effect. Large doses may be taken with impunity, but excessive quantities have produced fatal gastro-enteric inflammation. In the case of Dr. Fountain,! who died from swallowing 5j, taken to prove its inertness, violent gastro-enteritis set in, and at the end suppression of urine, with death in seven days. Fatal cases of poisoning from this salt have been reported, apparently from blood poisoning, the heart and large vessels having been found filled with coagula. As it contains a large supply of oxygen, it was at first em- ployed with a view to its oxidizing influence in contaminated conditions of the blood, as in malignant fevers, etc., but as it does not part with oxygen except when exposed to a very high temperature (67 1° F.), this view of its action is scarcely tenable. It is still considered a valuable alterative in typhus, scarlatina, etc., by many practitioners. Probably its most positive remedial effects are seen in various forms of stomatitis, follicular, mercu- rial and gangrenous. It is used also in diphtheria, croup, cyanosis, asthma, and even neuralgia. Externally, in solution, it is an admirable wash or gargle in stomatitis, ozaena, the sore throat of scarlatina, subacute and chronic pharyngitis, diphtheria, and fetid, ulcerated surfaces generally ; mixed with sugar, the powder is an excellent application in the aphthous sore mouth of children. Dose, internally, gr. v-xxx three or four times a day, in some pleasant vehicle. It should not be prescribed in powder with the metallic sulphides, glycerin, vegetable powders, as tannin, catechu, etc., as when triturated with these substances it parts with some of its oxygen and forms explosive compounds. Tro- ches of potassium chlorate [trochisci potassii chloratis) are made by * Gaz. Hebdom., v, 1868, p. 705. f Am. Med. Times, 1861, p. 245. 454 MATERIA MEDICA HEMATICS. rubbing together potassium chlorate, sugar, tragacanth, spirit of lemon, and with water forming a mass ; each troche contains 5 grains of potassium chlorate. For external use, 5ij-iv may be dissolved in water, Oss. Sodii Chloras {Sodium Chlorate) (NaC10 8 ). This salt may be made in the same way as potassium chlorate, substituting a solu- tion of soda for that of potassa. It occurs as colorless, transpa- rent tetrahedrons, permanent in dry air, odorless, with a cooling saline taste, readily soluble in water, soluble also in alcohol. In effects and uses it is similar to potassium chlorate, but milder in its action. It is not much used internally. Dose, gr. v-xx. POTASSII BICHROMAS POTASSIUM BICHROMATE. The chief ore from which salts containing chromium are obtained is chrome ironstone, found in Sweden and in south- eastern Pennsylvania. By roasting the powdered ore with potas- sium carbonate and nitre, the (yellow) potassium chromate is obtained, and by acidulating a solution of this with sulphuric acid, the (red) bichromate is formed (K 2 Cr 2 7 ) ; it separates in orange-red, anhydrous, tabular crystals, soluble in water, insoluble in alcohol, and of a cooling, bitter taste. Effects and Uses. — It is an irritant caustic, acting in overdoses as a corrosive poison, for which the proper antidotes are mag- nesia, soap and the alkaline carbonates. In small doses it is alterative, and has been used in syphilis. In large doses it is emetic. Two drachms have caused death,* while a youth f recovered after taking §ij, though it produced severe gastro- enteric inflammation. Externally it is a good application, in powder or in saturated solution, to syphilitic warts, excrescences, etc. Dose, as an alterative, gr. \ daily, in pill, with some bitter extract ; as an emetic, gr. \. ORDER III. ANTACIDS. Antacids are rhedicinal agents employed to neutralize acids in the blood, primae viae and secretions. The alkalies and alkaline earths and their carbonates are the substances included in this * Woodman and Tidy, 1882, p. 169. f Guy's Hosp. Reports, 185 1, p. 214. ANTACIDS. 455 division. The alkalies, in the concentrated state, destroy organi- zation and act as corrosive poisons; they are administered internally only in a state of extreme dilution. The alkaline car- bonates produce a less intense chemical action on the tissues than the alkalies ; and the bicarbonates are less active than the mono- carbonates. The alkaline earths, particularly magnesia, ate less energetic in their local action than the alkalies proper ; and their carbonates manifest little or no chemical influence upon the tissues. When swallowed in a state of dilution, the alkaline prepara- tions combine with the free acids which they encounter in the stomach. The salts which are thus formed, unless carried off by the bowels, are absorbed into the blood, and are thrown out by the secretions, especially by the kidneys. It must be remem- bered that, as already stated (see p. 245), alkalies increase acid and diminish alkaline secretions, when in contact with the orifices of the glands which secrete them. In like manner, acids increase alkaline and diminish acid secretions (Ringer) (see pp. 169, 249). While in the intestines, besides neutralizing acids, the alkalies also promote the digestion and absorption of fatty sub- stances, by forming with them an emulsion. After absorption they exert a liquefacient action on the blood, and render the urine alkaline. Their long-continued use disorders the functions of digestion and nutrition, produces a chronic deterioration of the blood, and sets up a cachectic condition somewhat analogous to scurvy. In the concentrated form the alkalies are employed as escha- rotics. The various alkaline preparations are administered, internally, in the diluted form — 1. As antacids, in dyspepsia accompanied with excess of acid in the primae vise, and they are probably also of advantage in dyspeptic cases, by promoting the digestion of fatty matters. As dyspepsia with acidity probably depends frequently on fermentation of the ingesta, due to deficient secretion of acid gastric juice, the administration of alkalies would prove of advantage, not by neutralizing the acid in the stomach, but by correcting the deficiency of .the secretion on which the dyspepsia depends. If the condition, on the other hand, depend on a profuse secretion of acid, then the administration of alkalies can do nothing more than palliate, by neutralizing, the excessive 456 MATERIA MEDICA HEMATICS. acidity. When alkalies are exhibited before meals, they increase the acid secretion of the gastric mucous membrane ; given after meals they neutralize the excess of acid. Acids taken before meals decrease the amount of acid secreted by the stomach ; while, if given after meals, they will supply the place of the acid of the gastric juice, should there be a deficiency in that secretion. The vegetable tonics and aromatics are frequently combined with antacids, very advantageously, in the treatment of dyspepsia. 2. To relieve irritability of the stomach and check vomiting. 3. As antidotes in cases of poisoning from acids. 4. As antilithics, to neutralize lithic acid when it is separated in undue quantity by the urine ; and also as lithontriptics, or solvents of calculi, especially lithates. They are improper when there is a tendency to the deposition of phosphates ; and in treating cases of uric acid .deposit it is unnecessary to render the urine more than neutral, as, if it be made alkaline, the phosphates formed may be deposited round the uric acid calculi. 5. In the treatment of acute rheumatism and gout, where they act by neutralizing the excess of acid with which the blood is charged in these diseases. 6. To relieve irritability of the urinary organs — ardor urinae in gonorrhoea — cutaneous irritation— uterine irritation — pruritus ani, etc. — especially when these conditions of irritability are dependent, as is often the case, on excess of acid in the system. 7. As diu- retics (see p. 366). 8. As antiplastics and resolvents, in inflamma- tion. And, 9. By many therapeutists, in diabetes mellitus. The antacid preparations should be administered in a state of large dilution, with a view to facilitate their absorption, and to prevent an irritant and purgative action on the bowels. POTASSII PRiEPARATA POTASSIUM PREPARATIONS. The preparations of potassium employed as antacids are the So- lution of Potassa, Potassium Carbonate and Potassium Bicarbonate. The general effects of the potassium preparations are those previously described (see p. 244). They increase both the solid and watery portions of the urine, and in large doses render it alkaline. Under their use, however, the uric acid, either free or combined, is greatly diminished, and, it is asserted, is converted into oxaluric acid, which is metamorphosed into oxalic acid and urea. ANTACIDS — POTASSIUM PREPARATIONS. 457 Liquor Potassa {Solution of Potassa) is prepared by the action of lime on a solution of potassium bicarbonate ; the lime abstracts carbonic acid from the bicarbonate, and precipitates as calciurh carbonate, leaving the potassium hydrate in solution ; or it may be made, more directly, by dissolving potassa, 56 parts, in dis- tilled water, 944 parts. Solution of potassa is a limpid, colorless liquid, without smell, of a very acrid, caustic taste, an alkaline reaction, and imparts a soapy feeling to the fingers when rubbed with it; sp. gr. 1.036; it contains 5 per cent, of potassium hydrate (KHO). Effects and Uses. — The antacid, diuretic, antilithic and resolvent properties and indications of this preparation have been described above. It is more irritant to the stomach than the potassium carbonates, and is therefore less eligible for protracted use. To render the urine alkaline in cystitis, Sir H. Thompson prefers it to the carbonates and citrates, as it is less diuretic. For the same reason it is useful in gonorrhoea. In excessive quantity it may act as an irritant and corrosive poison ; vegetable acids should be administered as a chemical antidote, and oils as a protective. Dose, gtt. x-xx, largely diluted with sweetened water or muci- lage. Externally it is used in a diluted state as a stimulant lotion. Potassii Carbonas {Potassium Carbonate, commonly called Salt of Tartar). This salt is prepared by calcining potassium bicarbonate, which is thus deprived of a molecule of carbonic acid and reduced to the state of carbonate (2KHC0 3 = H 2 C0 3 + K 2 C0 3 ). Potassium carbonate occurs in the form of a white, coarse, granular powder, of a nauseous, alkaline taste and an alkaline reaction, very soluble in water, but insoluble in alcohol. It is very deliquescent, forming, if long exposed to the air, an oily liquid with the water which it attracts. Acids, acidulous salts and many other substances are incompatible with it. It is employed as an antacid, anaplastic, diuretic, antilithic, etc., in the dose of gr. x-xx, in some sweetened aromatic water. It has been found specially useful in torpor of the liver and in whooping-cough. In large quantities it acts as a corrosive poison, for which vegetable acids are the chemical antidotes. Potassii Bicarbonas {Potassium Bicarbonate) is made by pass- ing carbonic acid through an aqueous solution of purified pearl- 45^ MATERIA MEDICA HEMATICS. ash (a more or less impure potassium carbonate), obtained from wood-ashes by lixiviation, and somewhat purified by solution in water, filtration and evaporation, till it is fully saturated. It occurs in transparent, colorless crystals, having the shape of irregular eight-sided prisms with two-sided summits (KHC0 3 ). They are inodorous, of a slightly alkaline taste, permanent in the air, soluble in water and insoluble in alcohol. The effects and uses of this salt are the same as those of the carbonate, but it is pleasanter in taste and less irritant to the stomach. It is much used in gout and uric acid lithiasis. Dose, gr. xx-5j. It is a good remedy in acute rheumatism, in which as much as Sjss may be given during the day, with opium to relieve pain. Fuller's alkaline* treatment of acute rheumatism consists in giving large doses so as to thorougly alkalinize the system, together with the strictest attention to the diet and the adminis- tration of tonics, as quinine, as soon as the system will tolerate them. He gives of potassium bicarbonate not less than Sjss in the first twenty-four hours, either alone or in combination with a vegetable acid largely diluted with water. When the urine becomes neutral the bicarbonate is reduced to a quantity just sufficient to keep it so (from 5/^— J^ thrice daily). Of 439 cases treated by this plan, in only 2 per cent, were cardiac complica- tions discovered. Fuller's treatment is best adapted to the obese and plethoric. SODII PR^PARATA SODIUM PREPARATIONS. The sodium preparations are analogous in effects to those of potassium. Ringer and Sainsburyf have shown that they stop the extirpated frog's heart in diastole. Schoenlein J, too, found that sodium carbonate acted directly on the heart and not through the nerves. In regard to their relative poisonous activity, the former ascertained that potassium stood first, then ammonium, while sodium possessed only slight toxic power. Being less irritant and less depressing, they are better as anti- dyspeptics, and for the relief of acidity of the primae viae. They are inferior in gout and uric acid lithiasis, as they are less power- * The Practitioner, Vol. II, p. 129. f Lancet, 1882, p. 736. \Arch.f. d. Ges. Physiol., XVIII, p. 26. ANTACIDS SODIUM PREPARATIONS. 459 ful solvents of this acid. Their eliminative action as diuretics is also more feeble. Liquor Sod,e {Solution of Soda) is prepared by the action of lime on a solution of sodium carbonate, or by dissolving soda 56 parts in distilled water 944 parts. It is a colorless liquid, having an extremely acrid taste and a strong alkaline reaction. It has sp. gr. 1.059, and contains 5 percent, of sodium hydrate (NaHO). The dose and administration are the same as those of liquor potassae. The preparations of sodium generally employed as antacids are the carbonates. There are several sources of carbonated sodium. The native carbonate (called natron) is found in Egypt, Hungary and other countries. Impure soda, obtained from the ashes of marine plants, is termed barilla or kelp — barilla when it is derived from phenogamous plants growing near the sea, and kelp when procured from cryptogamic plants growing in the sea. Sodium carbonate is now, however, chiefly made by artifi- cial means from sodium sulphate, which is obtained in part from the manufacturers of chlorinated lime, but principally by the action of sulphuric acid on sodium chloride. The sodium sul- phate is fused with ground limestone and coal, and forms a black mass called British barilla, which contains a mixture of sodium carbonate and calcium sulphide — Na 2 S0 4 + C 4 -f- CaC0 3 = CaS -f- Na 2 C0 3 + 4CO. It is afterward purified by lixiviation, calcination and other processes. Within a few years past, caustic soda and the carbonates and other sodium salts have been manu- factured near Pittsburgh, in Pennsylvania, from cryolite (a sodium and aluminium fluoride)' (3NaF,AlF 3 ), which is found in an immense deposit in Greenland, and largely imported into Phila- delphia. Recently, too, sodium carbonate has been found in large amount in a lake in Nevada. Sodii Carbonas (Sodium carbonate) (Na 2 C0 3 .ioH 2 0) crystal- lizes in large, oblique, rhombic prisms, which are transparent, very efflorescent, of an alkaline, disagreeable taste, soluble in water, but insoluble in alcohol. When heated they undergo the watery fusion and part with their water of crystallization, which is entirely expelled at a red heat. It is apt to contain sodium sulphate and chlorides as impurities. Acids, acidulous salts, lime- 460 MATERIA MEDICA HEMATICS. solution, earthy and metallic salts, etc., are incompatible with sodium carbonate. Effects and Uses. — Sodium carbonate is less irritant and has a milder and more agreeable taste than potassium carbonate. Its effects are otherwise similar, and it is administered in the same cases. In overdoses it is a corrosive poison, for which acids and oils are the antidotes. Dose, gr. x-xxx in powder, or dissolved in some bitter infusion. Owing to the variable quantity of water of crystallization which it contains, as kept in the shops, it is best given in the dried state. Sodii Carbonas Exsiccatus {Dried Sodium Carbonate). — This salt is deprived of its water of crystallization by heat, and occurs in the form of a white powder. Dose, gr. v-xv in pill, made with soap and aromatics. Sodii Bicarbonas {Sodium Bicarbonate) (NaHC0 3 )is prepared by saturating the carbonate with carbonic acid. In the process followed in this country the water contained in the carbonate, which is liberated during the process of its saturation, is drained off. Thus obtained, the crystals have the form of the carbonate, retaining pnly one equivalent of water, but are opaque and porous. They occur usually in granular masses, or in the form of a white, opaque powder, which contains variable amounts of soda not fully saturated with carbonic acid, and is known as sodii bicar- bonas venalis {commercial sodium bicarbonate). This is purified for medicinal use by percolation with distilled water, and the purified salt occurs as a snow-white powder, soluble in 13 parts of water, of a mild, slightly alkaline taste. It is a permanent salt. By exposure to heat L gradually parts with its carbonic acid, and at a red heat is converted into the anhydrous carbonate. The effects and uses of this salt are the same as those of the carbonate, but it is less irritant and of more agreeable taste. Dose, for an adult, gr. x-xxx, which may be pleasantly taken in carbonic acid water. It is often combined with aromatics in acid dyspepsia or flatulence : ly Sodii bicarbonatis, 5ij ; tincturae nucis vomicae, f 5ij ; tincturae zingiberis, f 5iv ; tincturae capsici, f 5j ; sacchari albi, §ss ; aquae menthae piperitae, q. s. fSyj. M. S. Of this, a dessertspoonful may be taken three or four times a day. Sodium bicarbonate is an ingredient of Seidlitz powders (see p. ANTACIDS — LITHIUM PREPARATIONS. 46 1 335). Troches of sodium bicarbonate contain sodium bicarbonate, sugar, nutmeg, and mucilage of tragacanth, each troche con- taining gr. iij of the bicarbonate. Sodium bicarbonate may be sprinkled with advantage over burns and scalds ; or a solution of 5/4 to water Oij may be applied to the parts, on lint, to alle- viate the pain (McClellan* and Spring f). Equal parts of it and common salt make a good application to the bites of bees, hornets, and spiders. LITHII PR^EPARATA — LITHIUM PREPARATIONS. Lithium is found in several minerals, as lepidolite, etc., but in minute amount. It is extracted chiefly by the agency of sul- phuric acid ; the sulphate is converted into a chloride by a solu- tion of barium chloride, and from the chloride, the carbonate (Lithii Carbonas) (Li 2 C0 3 ) is prepared by the addition of ammo- nium carbonate. It is a white powder, of a mild alkaline taste, soluble in 130 parts of water, more soluble in carbonic acid water, and insoluble in alcohol. The lithium salts act on the system in a similar manner to the other alkalies. They are said to render the urine more alkaline than do the other members of this group. Lithium carbonate is a very valuable antacid in gout and rheumatism, from the fact of its low combining number and the great solubility of the lithium urate, thus enabling the carbonate to act powerfully in eliminat- ing uric acid from the system. Garrod J, who first called atten- tion to lithium in the treatment of gout, experimentally proved its efficiency as a solvent of uric acid deposits by placing a meta- carpal bone and bit of cartilage, both of which were infiltrated with gouty nodules, in a solution of lithium carbonate, which, in a few days, dissolved away the deposit. It probably also dimin- ishes the formation of uric acid, and the author has found it highly efficacious in the cure of gout. It is, too, a good diuretic. Dose, gr. v-x two or three times daily, largely diluted, and best given in carbonic acid water. Lithii Citras [Lithium Citrate) (Li 3 C 6 H 5 7 ), a deliquescent * Louisville Med. News, 1878, p. 108. f Phila. Med. Times, March, 1878, p. 273. % " Gout and Rheumatic Gout," 1859, p. 435, 462 MATERIA MEDICA HEMATICS. white powder, soluble in 5.5 parts of water, is made by adding a solution of citric acid to the lithium carbonate. It is converted into a carbonate in the system, and is, therefore, possessed of the same properties, but is more refrigerant. Strong solutions of lithium salts have been found useful externally in removing gouty enlargements. Lithii Benzoas {Lithium Benzoate) (LiC 7 H 5 2 ) is prepared by the gradual addition of benzoic acid to a heated watery solution of the carbonate, and evaporating. It may be obtained in the form of glistening pearly scales, of a soapy feel and a cool, sweetish taste, soluble in three and a half parts of water at 6o°. The ready solubility of this salt and its freedom from deliques- cence, and the benzoic acid which it contains in combination, give it especial value in the treatment of the various forms of disease dependent upon uric acid deposits. Dose, gr. iij-v repeated. AMMONII PR^PARATA AMMONIUM PREPARATIONS. The preparations of ammonium (previously noticed under the head of Stimulants, p. 211) are administered as antacids, in cases in which a stimulant action is not objectionable. Spiritus ammo- nice aromaticus [aromatic spirit of ammonia) is the preparation usually employed, and is an excellent antacid carminative in heartburn attended with flatulence, nausea with syncope, etc. Dose, gtt. xxx-f3j. MAGNESII PR^EPARATA — MAGNESIUM PREPARATIONS. Magnesia (p. 329) and its Carbonate (p. 330) are employed as antacids in dyspepsia, sick-headache, gravel, etc., particularly where a laxative effect is also desirable. Dose, gr. x-xxx. Troches of magnesia are made by mixing magnesia, nutmeg, sugar, and forming with mucilage of tragacanth a mass, each troche containing gr. iij of magnesia. CALCII PR.EPARATA — CALCIUM PREPARATIONS. The preparations of calcium employed as antacids are Lime- solution, Precipitated Calcium Carbonate, and Prepared Chalk. They are very useful in cases of acidity or irritability of the stomach, but their action on the bowels is the reverse of that of magnesia, ANTACIDS CALCIUM/ PREPARATIONS. 463 and hence they can hardly be administered where there is a tendency to constipation. They are also much employed in diarrhoea, and occasionally as alterative resolvents in glandular enlargements, and to relieve irritability of the bladder from calculus. Liquor Calcis (Lime- Solution, Lime-water) is a saturated solu- tion of lime in distilled water. It is a colorless, inodorous liquid, of a disagreeable alkaline taste, containing about 0.15 per cent, of calcium hydrate (Ca2HO). By exposure to the air it gradually absorbs carbonic acid, with the formation of insoluble calcium carbonate. It should, therefore, be kept in full, well- stoppered bottles, or they should contain some undissolved lime. Effects and Uses. — Lime-solution combines antacid and astrin- gent properties, and is applicable to all the cases in which antacids are proper, where an astringent effect on the bowels is not objectionable. It is an excellent remedy in gastric irritability, attended with nausea and vomiting, and may be given mixed with an equal part of milk, which disguises its unpleasant taste. A diet of milk and lime-solution is very useful in dyspepsia accompanied with vomiting of food. Lime-solution is employed also in diarrhoea after inflammation has been subdued, in diabetes, and as an alterative-resolvent in glandular affections. Externally it is used as a wash in tinea capitis, prurigo, scabies, etc., as an application to foul ulcers, and as an injection in leucorrhcea and gleet. Atomized inhalations of lime-solution have been found useful in diphtheria and membranous croup. Dose, internally, fSss-iij-iv several times a day; for children, f5j. Linimentum calcis (lime -liniment) (equal parts of lime-solution with cotton -seed oil, sometimes called carron oil) is an invaluable liniment in burns and scalds, and in smallpox. Syrupus Calcis (Syrup of Lime) contains 5 per cent, of lime and 30 per cent, of sugar. It has been used as an astringent in diarrhoeas, and as an antidote to poisoning by carbolic acid. It is much stronger than lime-water — ^ X x of the syrup being equal to f§j of the latter. Dose, f oss— ij, well diluted. Calcii Carbonas Pr^ecipitatus (Precipitated Calcium Carbon- ate) (CaC0 3 ) is made by mixing boiling solutions of calcium chlo- ride and sodium carbonate. It is a fine white powder, insoluble 464 MATERIA MEDICA TOPICAL MEDICINES. in water, and free from grittiness, but possessing no superiority over prepared chalk. Creta Pr^eparata (Prepared Chalk) (CaC0 3 ) is made from chalk or whiting by levigation and elutriation. It occurs in little white conical loaves, which are tasteless, odorless, insoluble in water, but more soluble in carbonic acid water. Its effects are those of an antacid and de sice ant-astringent. It is used in dyspepsia and gout attended with an excess of acid in the system ; also in diarrhoea ; and as it forms soluble calcium salts with the acids of the stomach, its employment has been suggested in rachitis. Dose, gr. x-xxx, in powder or sus- pended in water with gum and sugar. Pulvis cretce compositus (compound chalk-powder) is made by mixing prepared chalk (30 parts) with powdered acacia (20 parts), and sugar (50 parts). Mistura cretce (chalk-mixture) consists of compound chalk-powder (20 parts) mixed with water and cinnamon water (40 parts of each) ; dose, foss, repeated. Laudanum and tincture of kino or of catechu, and aromatics, are often added to this mixture in the treatment of diarrhoea. Troches of chalk are made by mixing prepared chalk, acacia, nutmeg and sugar, and forming a mass with water ; each troche containing gr. iv of prepared chalk. CLASS IV, -TOPICAL MEDICINES. ORDER I.— ANTISEPTICS AND ANTIPYRETICS. Antiseptics (r{, against, and 7tdper6s, fever) are those which reduce the temperature of the body, such action being particu- larly conspicuous when the body-heat is elevated by a febrile process, and almost nil in the normal state. The antiseptic and the antipyretic properties of many sub- stances of this group bear a definite relation to each other, so that they are powerful in lowering febrile temperature in the same ratio as they are destructive to lower forms of life and especially ANTISEPTICS AND ANTIPYRETICS. 465 is this the case with the lower members of the aromatic series of carbon compounds. The theory of putrefaction which, based upon the researches of Pasteur, has been steadily gaining ground and is now almost universally adopted, refers the changes which take place in decom- posing matter to the agency of organized germs ever present in the atmosphere, which, finding a suitable nidus in putrescible material, grow and multiply, producing chemical decomposition as a result of their presence. As in many diseases (e. g., relaps- ing fever, diphtheria, etc.) certain organized germs have been found to take an essential part in the diseased process, if not to produce it, and as their presence is suspected in many diseases in which as yet they have not been demonstrated to exist, the importance of a group of agents which are destructive to these low forms of life can hardly be exaggerated. The extent to which this group of remedies will destroy disease germs in the body without injuring the vitality of the human being, cannot be definitely laid down. Certain it is that as yet we possess very few specifics in medicine, especially against the zymotic diseases, which would appear a priori to be especially the class to which antiseptics would apply. Yet as many antiseptics are also anti- pyretics, they are not without use in the diseased economy, even if they do not cut short the morbid process. When applied topically antiseptics are of great value, not only as deodorants and disinfectants, but also as germicides in dress- ing wounds, ulcers, etc., as in Sir Joseph Lister's antiseptic method or its various modifications. They are also useful to prevent the spread of disease when added to the excreta of patients suffering from contagious affections. Antipyretics act * chiefly either to lessen the production of heat by retarding oxidation, and consequently cell-proliferation and chemical and molecular changes in the tissues, or by depressing the circulation either of the part (local abstraction of blood, blisters, etc.), or of the system at large (sedatives) ; or increase the loss of heat by increasing the evaporation of perspiration from the surface (diaphoretics) ; by dilating the cutaneous ves- * "A Text-book on Pharmacol., Mat. Med. and Therapeut." London, 1885, pp. 53 and 366. By T. Lauder Brunton. 466 MATERIA MEDICA TOPICAL MEDICINES. sels and thus promoting heat-radiation (alcohol, amyl nitrite, spirit of nitrous ether), or by abstracting heat directly from the surface (cold applications or drinks). Many of the antipyretics (e. g., sedatives, sudorifics, quinine, etc.), as well as of the anti- septics (alcohol, iodine, quinine and solutions of various metallic salts), have already been discussed, and it now remains to study those articles of the former group which are used to lessen heat production chiefly by retarding oxidation, as well as those reme- dies particularly employed as topical antiseptic agents. POTASSII PERMANGANAS POTASSIUM PERMANGANATE. This salt is made by mixing together equal parts of mangan- ese dioxide and potassium chlorate, dissolving in a little water, evaporating to dryness, and exposing to a nearly red heat. Potassium permanganate (K 2 Mn 2 8 ) occurs in the form of slender prismatic crystals of a deep purple color, inodorous and of a sweetish, astringent taste. It dissolves readily in water, making a beautiful lilac-solution, which is readily decolorized by Fowl- er's arsenical solution and organic matters. Effects and Uses. — There is little experience as regards the action of this salt when administered internally, although altera- tive effects are attributed to it (and probably with reason) in poisoned conditions of the blood, as in malignant fevers, diph- theria, pyaemia, erysipelas, puerperal fever, etc. It is also used with success in amenorrhcea ''Ringer), especially when of a purely functional character. It may be administered in gelatin- capsules ; dose, gr. j-ij t. d., taken for five days or a week before the expected period (H. M.). It is, however, as a powerful dis- infectant that it now claims chief attention, and it now ranks at the head of this class of agents in destroying fetid odors and poisonous organic emanations. Its power in this respect is due to the evolution of oxygen in its more active form, ozone. It is used externally in dressing foul and fetid or gangrenous ulcers, particularly in hospital gangrene, as an application to car- buncles, as a gargle in diphtheria, etc. It may be sprinkled in powder on gangrenous surfaces or applied in solution of the strength of half an ounce, an ounce, or two ounces, to a pint of water. As a disinfectant and deodorizer, a solution of from one to ten grains to an ounce of water may be exposed in saucers or ANTISEPTICS AND ANTIPYRETICS CHLORINATED LIME. 467 sprinkled on the floor, or thrown into the air in spray by the atomizer. One to three grains may be given internally in solution through the day. Condy's Fluid contains gr. ij to the f§j. As an injection in go?wrrhce 'a potassium permanganate (gr. ij to water f 5j) is highly efficacious, especially where a profuse yellowish discharge exists. In using this remedy, care must be taken to avoid the introduction of organic matter into the solution, which, by reducing the salt to an oxide, will impair its efficiency. A good plan is to make the solution as required (C. B.). Milton * states that nothing approaches it in point of efficiency as an injection in gonorrhoea. AQUA CHLORI CHLORINE-WATER. This is an aqueous solution of chlorine, and should be kept in a cool place, protected from the light, but it is soon decomposed. It contains at least 0.4 per cent, of the gas. It occurs as a green- ish-yellow liquid, having an astringent taste and the suffocating odor of the gas. It is seldom used internally, but has been employed in essential malignant fevers, as scarlatina and typhus, and as an antidote for hydrocyanic acid. Dose, f oj-iv, diluted. Externally it is used, diluted, as a wash in skin-diseases, as an antiseptic, and by inhalation in bronchial affections. Chlorine acts as a disinfectant and deodorizer, chiefly by its affinity for the hydrogen of moisture and the liberation of oxygen ; its gaseous form gives it advantages in this respect. Solutions containing chlorine and other antiseptics are useful applications to suppu- rating surfaces, by preventing the decomposition of pus, and thereby pyaemia. In case of poisoning by chlorine-water, albu- men is the best antidote. CALX CHLORATA CHLORINATED LIME. This preparation, often called chloride of lime, is prepared by passing chlorine over calcium hydrate till saturation is effected, and is said to be principally a mixture of calcium hypochlorite and chloride (CaCl 2 2 and CaCl 2 ). It occurs as a loose, grayish- white powder, or friable lumps, dry or but slightly moist, readily soluble in water, of a bitter, caustic taste and a faint odor of * " On Gonorrhoea," etc., 1887, p. 201. 468 MATERIA MEDICA TOPICAL MEDICINES. chlorine. Exposed to air and moisture, it slowly yields hypo- chlorous acid (HCIO), and this soon breaks up into water, chloric acid (HCIO3), and free chlorine, and the chloric acid again yields chlorine; 25 per cent, of chlorine should be furnished by good chlorinated lime. It has been used as an alterative in typhus, malignant scarlatina, etc., in doses of gr. j-v, in solution, several times a day; and as, a wash, externally, one part dissolved in a hundred parts of water ; or as a paste. It is chiefly, however, as a disinfectant that it is employed. Its effects are essentially those of chlorine, like which it decomposes hydrosulphuric and hydrocyanic acids, and should not be given with mercurials. Liquor Sod.e Chlorat.e (Solution of Oilorinated Soda) (NaCl,NaC10), sometimes termed Labarraque y s Disinfecting Liquid, is made by decomposing a solution of sodium carbonate by one of chlorinated lime. It is a transparent, greenish-yellow liquid, with a faint smell of chlorine, a sharp saline taste and an alkaline reaction. It has been used internally, to fulfill the same indications as chlorinated lime, in dose of ^x-f<5j, diluted, several times a day. It is useful, also, in dilution of various strengths, as an external application to every form of fetid ulcer, and is a most valuable and powerful disinfectant. Hydrargyri Chloridum Corrosivum — Mercuric Chloride. — Corrosive sublimate {vide p. 416) is very destructive to the lower forms of life, and is largely used for this purpose in the treatment of various surgical affections. It is employed in solutions (1 to 1000,- 1 to 8000) as a prophylactic to cleanse the surface of the patient, and the hands, instruments, and sponges of tie sur- geon, previous to an operation, and in the form of corrosive sub- limated gauze, or cotton, as a dressing after the operation is finished, and thus prevent the entrance of the germs on which depend suppuration, erysipelatous or diphtheritic inflammation, and other complications of wounds. To destroy germs when already present, it is also useful. Thus, in the treatment of abscesses, either acute or chronic, after evacuating the contents through a small incision, the cavity should be super-distended with the corrosive sublimate solution ANTISEPTICS AND ANTIPYRETICS CHLORINATED LIME. 469 (1-1000 or 1-2000) and the fluid retained from two to five min- utes, when it should be allowed to drain off, after which the injection is to be repeated until the fluid flows away as clear as when introduced. In this way we destroy the protophytes on which these forms of suppuration depend, and thus hasten the growth of granulations. In psoas, iliac or lumbar abscess this method of treatment probably gives the best results, and deep- seated mammary abscesses may be rapidly healed by its employ- ment. As numerous cases of poisoning are recorded, it is better to decrease the strength of the solution or to discontinue its use, and employ pressure to bring the walls of the abscess together, after a few days, when healthy granulations are springing up. As an injection in gonorrhoea, a weak solution (1-8000, or better, 1-12,000) may be used to destroy the gonococci, but even then severe pain and violent inflammation may be excited in the male urethra by such an injection. In gonorrhoea of the female, a corrosive chloride solution (1-8000) thrown into the vagina when the patient is in the recumbent position with the hips slightly elevated by a pillow is very efficacious. In the treatment of puerperal septicaemia, vaginal and even uterine injections are employed, care being taken in the latter case to throw the solution very slowly into the uterus, to be sure that it returns freely through the os uteri, to avoid the introduc- tion of air into the uterus and to discontinue the injection should much pain be complained of or symptoms of syncope or collapse supervene. It may be used not only as a dressing but also as a wash for all wounds and ulcers whatever. A solution of the required strength may be made as follows : 1^ Hydrargyri chloridi corrosivi, 5j ; divide in chart vin. Sig. — One powder dissolved in a pint of hotwdXev forms a solution of 1 to 1000; or, as the powders are somewhat difficult of solution, 1^ Hydrargyri chloridi corrosivi, 5j ; alcohol, f^ij. M. Sig. — f5ij, in a pint of water = 1 in 1000 parts. If the latter solution is to be kept for some time, it is well to add an equal weight of ammonium chloride to the corrosive sublimate to prevent decomposition of the latter salt. Compressed tablets are also kept in the shops, which are very 470 MATERIA MEDICA TOPICAL MEDICINES. convenient for making solutions. If mercuric chloride be used to disinfect instruments, they should not be allowed to remain in the solution, as otherwise mercury will be deposited on the surface of the metal, and the instrument tarnished. Gauze, lint, cotton, wool, jute, saw-dust, etc., are impregnated with solutions of the corrosive chloride and used as surgical dressings. Bromine (see Escharotics) and iodine are antiseptics, acting in a manner similar to chlorine. They are seldom used for this purpose. Hydrargyri Iodidum Rubrum {Mercuric Iodide, vide p. 420) is also used in aqueous solution as an antiseptic (1 to 2000). It has not, however, replaced the mercuric chloride as a germicide. Acidum Sulphurosum {Sulphurous Acid) contains about 3.5 per cent, of sulphurous acid gas in distilled water, and is made by heating sulphuric acid with charcoal and distilled water. The sulphuric acid is deprived of an equivalent of oxygen by the charcoal, and becomes sulphurous acid (H 2 S0 3 ). It is a colorless liquid, having the smell of burning sulphur and a sulphurous, sour, and somewhat astringent taste. It is a powerful deoxidizing agent, very destructive to vegetable life, and is believed to exert a similar influence on disease germs. It is readily absorbed by the stomach, and is eliminated by the urine and feces as a sulphate. Internally, it is very efficacious in sarcina ventriculi, or yeast vomiting; dose, f5j, largely diluted with water. Exter- nally, it is used in skin diseases (particularly those of a parasitic nature, either animalcular or cryptogamous), diluted with two or three measures of water or glycerin. Sodii Sulphis {Sodium Sulphite) (Na 2 S0 3 .7H 2 0) is used as a substitute for sulphurous acid, which is developed from the salt by any of the organic acids. It occurs in white, efflorescent, prismatic crystals, of a' sulphurous taste, soluble in four parts of cold and one part of boiling water. Dose, 5j, three times a day; a solution (5j-f5J of water) is a good /^^/application in erysipelas. Sodii Bisulphis {Sodium Bisulphite) (NaHS0 3 ) occurs in opaque, prismatic crystals or a crystalline or granular powder, ANTISEPTICS AND ANTIPYRETICS BORIC ACID. 47 1 slowly oxidizing and losing sulphurous acid on exposure to air, having a faint sulphurous odor and taste, soluble in 4 parts of cold and 2 parts of boiling water. It is used as a substitute for sodium sulphite, to which it is preferred because of the greater proportion of sulphurous acid which it contains. Dose, gr. v-xx. Sodii Hyposulphis {Sodium Hyposulphite) (Na 2 S 2 03.5H 2 0) is used for the same purposes. It occurs in white, tabular crystals, of a pearly lustre and sulphurous taste, which are efflorescent, and very soluble in water and alcohol and insoluble in ether. Dose, gr. x-xx three times a day, and for external use, 5j dis- solved in water fSj. Potassii Sulphis {Potassium Sidphite) (K 2 S0 3 .2H 2 0) occurs in white, opaque fragments or powder, of a saline and sulphurous taste, very soluble in water ; its uses and doses are the same as those of sodium sulphite. Magnesii Sulphis {Magnesium Sidphite) (MgS0 3 .6H 2 0) is also employed in zymotic diseases and in flatulent dyspepsia, to prevent the formation of gases in the alimentary canal. It is less unpalatable than the sodium salt, and besides contains a larger proportional quantity of acid. The sodium, potassium, and magnesium sulphites are employed in the treatment of puru- lent infection. Calcium and ammonium sulphites have been also recommended, but are not officinal. The Sulphides appear to possess the power of checking the formation of pus. On this ground they are highly lauded in boils, carbuncles, etc., by Dr. Ringer. Calx Sulphurata {Sulphurated Lime), often misnamed Cal- cium sulphide, consists chiefly of a mixture of "calcium sulphide and calcium sulphate in varying proportions, but containing not less than 36 per cent, of absolute calcium sulphide." It is recommended to check the formation of pus, in doses of gr. I 1 c - every hour. In eight cases of chancroidal bubo I found the use of calcium sulphide of doubtful service in promoting their reso- lution. The dose employed was gr. \— \ t. d. (C. B.). ACIDUM BORICUM BORIC ACID. Boric or Boracic Acid (H 3 B0 3 ) exists in nature in volcanic regions, notably in Tuscany. In this region, which was formerly 472 MATERIA MEDICA TOPICAL MEDICINES. the main source of supply of this acid, jets of steam, called siiffioni, escape through fissures in the hillsides, and are made to pass through a series of shallow basins along which water is slowly flowing. The water becomes charged with boric acid, which is converted into borax. A boiling concentrated solution of borax is slowly decomposed with an excess of sulphuric acid, and on cooling, boric acid is obtained in transparent six-sided crystalline plates, unctuous to the touch, odorless, slightly bitter, soluble in cold water, more so in alcohol and very soluble in boiling water. The supply to the United States is now derived almost exclusively from Borax Lake in California, about one hundred miles north of San Francisco. Effects and Uses. — Boric acid is antiseptic and deodorant, "arrest- ing fermentation and proving very poisonous to the lower forms of life. Neumann found by experiments on dogs, verified on rabbits and young pigs, that boric acid caused a decided fall in the temperature of the body, while large doses produced diarrhoea and vomiting. Three per cent, solutions injected into the serous cavities caused no inflammation, but when large amounts were injected the animal died from paralysis of the motor nerves and muscles.* According to J. Forster,f boric acid augments'the amount of nitrogen and of solid matter excreted by the feces, the increase being in direct proportion to the amount of the drug ingested. As small a dose as gr. vij daily will produce these effects. Mr. Perez % recommends the internal use of boracic acid (gr. x, omn. trihor.) to prevent the formation of ammoniacal urine in the bladder in cases of chronic cystitis. Mododewkow reports two fatal cases of poisoning with boracic acid. In one case a pleuritic cavity and in the other a lumbar abscess were washed out with a five per cent, solution of the acid, some of which remained in both cases. The symptoms were, persistent vomiting, hiccough, erythema beginning on the face, slight temporary rise of temperature, diminished cardiac power ending in paralysis. He suggests morphine and stimulants in like cases§. * N. Y. Me 'd. Jour., Jan. 27th, 1863, quoted from Lancet. f Dingl's Polytechnik Journ., No. CCLI, p. 170. % Lancet, July, 1884, p. 133. \ Wratch, No. 31, 1881. DERIVATIVES OF THE ORGANIC RADICAL PHENYL. 473 Boric acid is used externally as an antiseptic in the treatment of wounds, burns, ulcers, abscesses, phlegmonous erysipelas, eczema, etc. It has also been used with advantage in inflamma- tion of the mucous membranes, as aphthae, diphtheritic inflam- mations of the mouth, etc. It may be dusted into the external auditory meatus in inflammation of that canal attended with suppuration, and has been used with advantage in inflamma- tion of the conjunctiva (gr. v-x to aq. f S j ) - Used as an injec- tion, it appears to shorten the duration of gonorrhoea (H. M.). Made into an ointment with vaseline or cerate (gr. x-xx to 5J) it is an excellent antiseptic dressing for wounds. SODII BORAS SODIUM BORATE. Sodium Borate or Borax occurs as a native product in several localities, the most important of which for a long time was Thibet, in Asia ; it is also made artificially by the direct combi- nation of native boric acid with soda. Borax (Na 2 B 4 7 .ioH 2 0) occurs in the form of hexahedral prismatic crystals, terminated by triangular pyramids, of a sweetish alkaline taste and an alkaline reaction. It is wholly soluble in water, slowly efflo- resces, and possesses the property of rendering cream of tartar very soluble in water. Effects and Uses. — Borax is a mild refrigerant and diuretic, and locally an antiseptic, and has emmenagogue virtues attributed to it. Dose, gr. xxx. It has been given in infantile diarrhoea as an enema, and is used externally in cutaneous affections (5j to water Oj as a wash in pruritus and in acne punctata), but especially as a detergent in aphthous affections of the mouth in children, mixed with an equal quantity of sugar. A piece of borax slowly dissolved in the mouth will often cure acute hoarseness. Glycerite of sodium borate may be made by rubbing up sodium borate §ij in glycerin Oss ; honey of sodium borate may be made by mixing 5j with clarified honey, f5j. These preparations are used chiefly as applications to the mouth and throat. DERIVATIVES OF THE ORGANIC RADICAL PHENYL. The eager search after a remedy which will replace quinine, has, within the last few years led to the discovery of medicinal 474 MATERIA MEDICA TOPICAL MEDICINES. qualities, hitherto undreamed of, in various chemical substances, and this is particularly the case with regard to certain members of the aromatic series of the carbon compounds. While the reme- dies heretofore discussed under the head of antiseptics are chiefly used externally for their action as protoplasmic poisons, the group about to be studied are used internally for their antipyretic prop- erties, and though most of them are also antiseptic, yet the latter action appears to be readily modified by slight changes in certain members of the group. Thus, while salicylic acid is antiseptic, its salts do not possess this property, and its isomers — meta- and para-oxybenzoic acids — have no such power. As some knowledge of their chemical constitution is essential to the proper understanding of the relations existing between members of this group, a few remarks bearing on this subject will not be out of place here. Phenyl, the organic radical of this group, consists of carbon, 6 atoms united with hydrogen, 5 atoms, the elements being arranged, according to the theory of Kekule, on which alone is it possible to explain the formation of its derivatives, in such a manner that the C. elements are united in a closed chain, exchang- ing with each other alternately one and two valences, and as C. is a tetrad, each with one exception, which is unsatisfied, is like- wise joined to the corresponding element H., thus — ■ H C H \ //*\ / C6 2C I II C5 3C / \A/ \ H C H I H (PhenyL) Should the unsatisfied atom of C. become saturated with H., phenyl hydride, benzine or benzol (C 6 H 6 ) is formed. The atoms of H. in phenyl hydride may be displaced by other univalent elements or radicals and substitution compounds constructed : thus should one atom of H. be displaced by hydroxyl (HO), phenol or carbolic acid (C 6 H 5 HO) is produced ; should nitroxyl (N0 2 ) displace an H. atom of phenyl hydride, nitro-benzine (C 6 H 5 N0 2 ) results ; if amidogen (NH 2 ) replace an H. atom, aniline DERIVATIVES OF THE ORGANIC RADICAL PHENYL. 475 (C 6 H 5 NH 2 ) is formed, and if carboxyl (CO HO) take the place of H., the product is benzoic acid (C 6 H 5 CO.OH). Di-derivatives containing two atoms of the same element or radical, are capable of three isomeric modifications, according as the replaced H. atoms are those numbered 1.2. or 1.3. or 1.4. in the above graphic formula, which isomers take the prefix ortho- ox meta- or para- to distinguish them ; thus, should hydroxyl displace 2H. atoms in phenyl hydride, one of 3 compounds may result — ortho-oxyphenol (/_yr^uj, I save). Effects and Uses. — Creasote possesses many properties in com- mon with carbolic acid. It is eliminated by the bronchial mucous membrane (which it stimulates as it passes out, and hence is a good expectorant), by the kidneys, etc. It is not much used, because of the difficulty of procuring the pure drug. In large doses it is an acro-narcotic poison, resembling carbolic acid, but with more marked nervous symptoms. In cases of poisoning from creasote the same treatment is to be resorted to as in poisoning by carbolic acid. In small doses it is styptic and astringent, and, though not very nearly allied to the vegetable astringent articles which con- tain tannic acid, it is, perhaps, more generally administered for its astringent than for any other properties. It is an excellent remedy in hematemesis, and is also employed in hemoptysis and other hemorrhages. It is very efficacious in allaying vomiting and gastric irritability, and has been exhibited for its astringent virtues with good effect in diarrhoea, diabetes and chronic bron- chitis, and as a nervine in epilepsy, hysteria, neuralgia, etc. Externally it is applied in various degrees of dilution, to indo- lent, sloughing and foul ulcers, and as a gargle in putrid sore throat. In the concentrated form it is a good styptic in capillary hemorrhages, and is applied with effect to the hollows of carious teeth, for the removal of the pain of toothache. 31 482 MATERIA MEDICA TOPICAL MEDICINES. Dose, internally, ^j-iij, frequently repeated, in pill or diluted with mucilage. For external use, from gtt. ij-vj, or more, may be added to fSj of distilled water. Aqua Creasoti {Creasote- Water) (1 part to distilled water 99 parts). It may be used locally as a slightly stimulating lotion, or mixed with poultices to correct fetor. Internally it is a con- venient form of administration. Dose, f5i-iv. Nitro-benzine is an important agent in aniline industries, being used in the manufacture of the latter for commercial purposes. It is not used in medicine, but is interesting on account of the numerous cases of poisoning which have occurred from its use in perfumery (in which it is known as the " Essence of Mirbane ") and to impart the flavor and smell of bitter almonds to articles of food or beverages. It has also been taken by mistake for a liqueur* The proper treatment of poisoning by this substance is prompt evacuation of the contents of the stomach if it has been swallowed, artificial respiration, and blood-letting followed by transfusion. Aniline is used especially in the manufacture of brilliant dyes. Numerous cases of poisoning are on record from the ingestion of confectionery, etc., colored by this means. Prof. Kremianski recommended it highly in the treatment of phthisis, but the committee appointed to investigate the subjectf and other experimenters^ have not obtained like results. The various aniline-colors are used in medicine as reagents in stain- ing bacilli for microscopic examination. It is also interesting as being the base of aniline acetate, from which antifebrin, one of the latest and most powerful antipyretics, is obtained. ACETANILIDE. Acetanilide or Antifebrin (C 6 H 5 NH.COCH 3 , — not officinalis a neutral chemical product, prepared by heating aniline with crys- * Deutsche milit.-arztl. Zeitung, II, 1873. f Vratch, No. 10, 1887, p. 241. \ Vratch, No. 4, p. 91 and 13, p. 288, 1887. ANTISEPTICS AND ANTIPYRETICS ACETANILIDE. 483 tallizable acetic acid in a special receptacle, distilling the product and purifying by successive crystallizations, and consists of aniline acetate from which the elements of water (H 2 0) have been separated by a dialytic action at an elevated temperature (Merck). It is a very stable compound, resisting the action of acids and alkalies at ordinary temperatures, and occurs in the form of a white crystalline powder, odorless, having a slightly sharp, but not disagreeable taste, almost insoluble in cold water (i to 160 parts), but easily soluble in boiling water (i to 25 parts), alcohol ($y 2 ) and ether (6). Effects and Uses. — The most important effects of this drug are the rapid lowering of febrile temperature and the power which it possesses of moderating the activity of the nerve-centres. As an antipyretic it is four times more powerful than antipyrine, causing a reduction of temperature within an hour after its administration, the minimum being attained in from three to five hours, followed at first by a slow and then a more rapid rise until the temperature reaches its original height, or even a little beyond it, in from three to twelve hours.* This action is more marked when the temperature is very high,f and when the medi- cine is so administered that the artificial reduction will take place coincidently with the natural subsidence: thus its effects are greater when given in the morning. More or less profuse per- spiration occurs during the reduction of the body-heat, and the succeeding rise is sometimes preceded by a rigor. From extensive and careful experiments with acetanilide, thallin or antipyrine, Pasternatzky J concludes that from five to ten minutes after taking either of these substances, the internal temperature diminishes while the cutaneous temperature rises, and the heat given off by radiation is increased in direct propor- tion to the elevation of the cutaneous temperature, although the maximum elevation is attained earlier than the maximum loss of heat, and that the sweating coincides with the latter. During the second hour the internal temperature continues to fall, but with more intensity ; the cutaneous temperature gradually subsides, * Centralbl. f. Klin. Med., No. 33, p. 1561. Cahn und Hepp. f Deutsche Med. Wochensch., No. 16, 1887. % Vratek, No. 2, p. 21 ; No. 4, p. 70, 1887. 484 MATERIA MEDICA TOPICAL MEDICINES. and the loss of heat by radiation and the sweating diminish in direct proportion to the decline of the latter. Therefore, not only do they lower temperature, but they also balance the distribution of caloric in the system. They are antipyretic, by restraining nitrogenous metamorphosis, by limiting heat-production, and also by regulating the heat-distribution of the economy. These effects are only seen in a condition of pyrexia. As the tem- perature falls the pulse becomes slower and stronger and the arterial tension is heightened. Acetanilide impairs temporarily the oxygen-carrying function of the red corpuscles, by lessening the oxy-hemoglobin and forming with it methy-hemoglobin, as is shown by the cyanosis which is sometimes observed, but this condition quickly passes away as the normal condition of the blood is restored. Gastric or intestinal disturbance is of rare occurrence, while renal irritation never results, although the amount of urine is sometimes considerably augmented ; and lastly, the elimination of urea is diminished*. In decided doses, acetanilide lowers the activity of the reflex centres, and reduces the conductivity of the motor and sensory nerves, probably to a great extent through its influence on the bloodf. An inclination to sleep accompanies this anodyne action. If given in lethal doses J (gr. v-x per kilo, of weight of animal), the effects are manifested primarily upon the constituents of the blood and then on the nervous system ; afterward general pros- tration with stupor ensues and the temperature is rapidly and progressively lowered. Sensation is first diminished and then lost ; the animal sinks into a comatose condition, followed by spasmodic convulsions, and dies in from 24 to 36 hours. The heart is at first accelerated then slowed, and the respiratory func- tions are markedly and progressively depressed. Acetanilide is chiefly used as an antipyretic and as an anodyne ; For the former purpose it is probably more generally employed at the present time than any other agent of this group, although * Russ. Meditz., No. 43, 1886, p. 728. A. Berezovski. f Comptes Rendus de la Soc.de Biol., Juillet iieme, 1887. M. Lepine. Rev. Med. de la Suisse Romande, Juin, 1887. M. Demieville. \Bull. Gen. de Therap., Fev. 28iem e> 1887. Dr. Weill. ANTISEPTICS AND ANTIPYRETICS BENZOIC ACID. 485 some observers * regard antipyrine as safer, fearing the cyanosis, tendency to collapse, and severe rigors which occasionally attend its action. In all cases of high temperature, notably in typhoid fever, phthisis, scarlatina and rheumatism, it may be given in small doses, repeated as required, with excellent effect. In acute rheumatism it not only reduces the temperature, but also is said to act on the joints in as favorable a manner as do the salicylates. In croupous pneumonia and in chronic catarrhal pneumonia, it has been used with advantage. It is used as an anodyne in the pains of various nervous dis- eases, especially those of locomotor ataxia; also in neuralgia, particularly of the fifth pair of cranial nerves ; in headaches of various kinds not depending on indigestion, and in dysmenor- rhea. In epilepsy it diminishes the violence and frequency of petit mal, but does not seem to influence grand mal. Administration. — -The dose of acetanilide ranges from gr. iv- viij, though much larger quantities have been taken with safety. It is best administered in capsules or in powder, as it diffuses readily into the blood in spite of its insolubility. ACIDUM BENZOICUM BENZOIC ACID. Benzoic Acid (HC 7 H 5 2 ) is obtained from benzoin by subli- mation, or by the action of alkalies ; it is also made in Germany from hippuric acid. As obtained by sublimation, it occurs in white, soft, feathery hexagonal crystals, of a silky lustre, and not pulverulent. It has more or less of the agreeable odor of the balsam, a warm, acrid and acidulous taste, is inflammable, sparingly soluble in cold water, .rather soluble in boiling water, but perfectly soluble in alcohol, alkaline solutions and fixed oils. It is a constituent of the balsams. Effects and Uses. — Benzoic acid is a local irritant, destroying minute organisms, possessing decided antiseptic properties, and acting on the general system as a stimulant, with a particular direction to the mucous surfaces. In large doses it increases the circulation and respiration, and is said to be a more powerful * Comptes Rendus de V Acad, des Sciences, Avril i8ieme ? 1887. GermainSee. 486 MATERIA MEDICA TOPICAL MEDICINES. antipyretic than salicylic acid. It stimulates the cutaneous and bronchial secretions, and increases the acidity of the urine. In its passage through the system it abstracts nitrogen from the elements of urea, and passes out with the urine in the form of hippuric acid ; hence its value in uraemic poisoning, and in the treatment of ammoniacal urine. It has been used in diphtheria, erysipelas, etc., with a view to its antiseptic effects, and as an expectorant in chronic bronchial affections. Locally, it is employed as a dressing for wounds, ulcers, etc., and to prevent animal fats from becoming rancid. Dose, gr. v-xx. Sodii Benzoas (Sodium Benzoate) (NaC 7 H 5 02.H 2 0) is a white amorphous powder, which effloresces on exposure to the air, and has a faint odor of benzoin and a sweetish, astringent taste. It has been prescribed as a substitute for salicylic acid, being less pow- erful as an antipyretic, but is a safer remedy. It has been used extensively in phthisis, with a view to its antiseptic qualities ; also in diphtheria, scarlet fever and the eruptive fevers generally, whooping-cough, etc. ; and in acute rheumatism as an antipyretic. From 5j-iij may be given in twenty-four hours. Ammonii Benzoas (Ammonium Benzoate) (NH 4 C 7 H 5 2 ) is made by adding water of ammonia to an aqueous solution of benzoic acid, and occurs in the form of minute white, shining, thin, four-sided laminar crystals, with a slight odor of benzoic acid and a bitterish, saline, somewhat balsamic taste and slightly acrid but persistent after-taste. It is soluble in water and alcohol, and, when heated, sublimes without residue. It is incompatible with the ferric salts. This salt, when taken internally, is probably decomposed by the gastric acids, and produces the constitutional effects of benzoic acid, for which it may be substituted ; the ammonia renders it stimulant and antacid, and acceptable to irritable stomachs. It is an excellent remedy for incontinence of urine due to the irri- tation produced by an alkaline condition of that fluid, and is used with advantage whenever the urine is ammoniacal and loaded with phosphates. Dose, gr. v-xx. ANTISEPTICS AND ANTIPYRETICS RESORCIN. 487 RESORCIN. Resorcin (not officinal), chemically meta-oxyphenol, derives its name from having been first obtained from certain resins by the action of alkalies, and from bearing some resemblance to orcin. It occurs as shining tabular crystals, having a slightly phenol- like odor and a sharp-sweetish taste, soluble in most liquids, especially in water. Effects and Uses. — Locally it is an antifermentative and anti- putrefactive agent, destroying the organisms on which these processes depend. Internally, like other agents of this group, resorcin promptly reduces febrile temperature when administered in medicinal doses, but it does not seem to affect the temperature in healthy individuals, as Dr. Justus Andeer, experimenting upon himself, took as much as 10 grammes without observing a reduction of body-heat. The antipyretic action is more marked in typhoid fever, pneumonia and erysipelas than in other febrile states, although it is present to some extent in malaria, and indeed it appears to possess some antiperiodic -power, as might be inferred a priori from the close chemical relationship which it bears to quinine, to which, however, it is very far inferior in this respect. It is well borne by the stomach. The decrease in the temperature of fever is usually preceded by transient vertigo, tinnitus aurium, flushing of the face, headache, and oppression in the chest. As the temperature declines there is nearly always a profuse per- spiration, and the pulse and respiration, which were at first accelerated, are markedly slowed. This occurs in about one hour after the ingestion of the drug and continues for from two to four hours, and is then followed by a more or less well-marked chill and a gradual rise in temperature. When a large dose is given to an animal, trembling supervenes, soon followed by general epileptiform convulsions, each occupy- ing a few minutes only, which regularly increase in severity, reach their maximum and as regularly decline. The general sensibility is not affected. The convulsions appear to be of spinal origin. The pulse is weak, rapid, and irregular, the breathing accelerated, convulsive, then shallow and weak, and finally death takes place from failure of respiration, preceded by 488 MATERIA MEDICA TOPICAL MEDICINES. a rise in temperature from excessive muscular action. Elimina- tion takes place rapidly, chiefly through the urine. Internally. — As an antipyretic, resorcin has been used in typhoid fever, pneumonia, erysipelas, rheumatism, and septicaemia. It has also been used in malaria, especially in the intermittent form, and is said to diminish recent splenic tumefaction, and to antago- nize malarial infection (Righi*). As a sedative and antifermentative it is used in acute gastro- intestinal catarrh, gastralgia and dyspepsia due to fermentation of the ingesta, for which purpose it may be advantageously com- bined with sodium bicarbonate. Locally it has been applied as an antiseptic to unhealthy ulcers and wounds, to destroy fetor and promote healthy granulations. Unna recommends a 5 or 10 per cent, ointment in pityriasis capitis, squamous eczema of the head and in seborrhceal eczema. In psoriasis an ointment of the strength of 10 to 20 per cent, may be used with advantage.- The powder or a strong ointment may be applied in parasitic sycosis with marked benefitf. According to Dr. Jackson^, it is very useful in epitheliomatous lesions where surgical interference is contra-indicated, as it exerts a powerful absorptive effect on new cell-infiltrations. Pure resorcin has also been powdered on condylomata of the penis, vulva or anus with brilliant results§. It is also used in solution of various strengths in various diseases of the mucous membranes, as in acute or chronic conjunctivitis; as a disinfectant, antiseptic, and in strong solutions, as a caustic in laryngeal diseases. In tuber- cular ulceration of the larynx, the pain soon subsides, and the cough diminishes after these applications. In gleet a 2 per cent, solution may be injected into the urethra with excellent effect (Dr. Justus Andeer||, Righi, op. cit.). Administration. — The ordinary dose is gr. v-xv, either in cap- sules or in solution in alcohol, glycerin or water, disguised with syrup of orange-peel. These doses may be repeated every four * El Siglo Medico, Mar. 9, 1884. f Centralbl.f. die ges. Therap., Mar. 1886, Ihle. % Journ. Cutan. and Genit.- Urin. Diseases, Vol. V, Nos. 6 and 7. \ Russ. Meditz., No. 38, 1886, p. 639, Gatchovsky. || Centralbl. f. die gesammte Therap., Apr. 1 884. ANTISEPTICS AND ANTIPYRETICS RESORCIN. 489 hours. Much larger amounts have been taken without producing injurious or alarming symptoms. Hydroquinone or Hydrochinone (para-oxyphenol) and Pyro- catechin (ortho-oxyphenol), neither of which are officinal, are isomers of resorcin, as has already been pointed out. Their effects are identical with those of the latter, than which they are about four times as powerful. They are little used, being super- seded by acetanilide and other antipyretics of more recent date, although, by some*, hydroquinone is thought to be among the most powerful and least harmful remedies of this group. ACIDUM SALICYLICUM SALICYLIC ACID. This acid, although known for nearly half a century as a derivative of salicin (see p. 154), has been employed only recently as an article of the Materia Medica. It has been prepared from the flowers of Spircea ulmaria or Meadozv- Sweet, and from the oil of gaultheria (where it exists as methyl salicylate), and by the oxidation of salicin. It is now made by combining pure carbolic acid with caustic soda, and treating this compound with dry car- bonic acid under the influence of a gradually-increasing heat, when one-half of the carbolic acid distils over, while the other half, into the molecule of which carbonic acid enters, remains behind as sodium salicylate ; from a hot aqueous solution of this, saturated with hydrochloric acid, salicylic acid (C 6 H 4 {3ooh}) is obtained in the form of minute, broken, acicular crystals (having usually the appearance of a pale-pinkish granular powder), which are bleached with great difficulty. It is odorless and nearly tasteless, having, however, a sweet and astringent after-taste, with slight acridity in the fauces. It is practically insoluble in cold water, but quite soluble in boiling water, a hot aqueous solution retaining when cold, in proportion to its coldness, 1 part in from 250 to 500 parts of the solution. The addition of 2 parts of sodium sulphite, or 1 part of ammo- nium phosphate, or 3 parts of sodium phosphate, renders it much more soluble in water. It is freely soluble in alcohol, ether and ( . , * Berliner Klin. Woc/iensck., No. 29, 1884, Dr. P. Seifert. 490 MATERIA MEDICA TOPICAL MEDICINES. glycerin. Dissolved in water, a fine violet color is produced on the addition of ferric chloride. Physiological Effects. — In its effects salicylic acid is allied to carbolic acid, possessing probably greater powers as an antiseptic in arresting the putrefactive and fermentative processes, while it is devoid of smell or notable taste, is not volatile, and is also, in quantities necessary for effective action, free from irritant or poisonous influence. When given internally in full medicinal doses buzzing and roaring in the ears, with fulness in the head, are experienced, which are much increased after the administra- tion of larger doses, amounting even to deafness and accompanied by headache and partial blindness. If an excessive dose be taken all the symptoms are intensified, and great restlessness, followed by delirium, involuntary evacuations, stupor, and in the lower animals convulsions, are observed. The action of salicylic acid upon the ear (as well as the similar action of quinine) has been investigated with varying results. Kirchner concludes that these remedies produce intense congestion of the tympanum and laby- rinth (due to vaso-motor disturbance), which may lead to changes in the nerve-filaments ; while Weber-Liel and Guder * found anaemia of these parts as the result of the ingestion of the drug. The heart-beat is at first increased in frequency, but afterward slowed ; excessive doses cause the pulse to become slow and labored. The blood-pressure is at first elevated (from the action of the acid on the heart and on the vaso-motor centres), then lowered. Blood : Prudden,f from experiments upon frogs, veri- fied on rabbits and on the human blood, concludes that salicylic acid restrains the migration, and in strong solutions is inimical to the life, in weak solutions to the activity, of the white blood- corpuscles. Respiration is at first quicker and deeper than nor- mal from the action of the drug on the vagi and to some extent on the respiratory centre ; later it becomes slow and labored, and death results from asphyxia. Temperature : non-toxic doses have little or no effect upon the normal temperature ; in fever, however, salicylic acid causes a marked reduction in the body- heat which lasts for several hours. Secretion : full doses cause free diaphoresis which is sometimes exhausting. The urine is * Med. Rec, Oct. 28th, 1882. f Am. Jour. Med. Sc, lxxxii, 1882. ANTISEPTICS AND ANTIPYRETICS RESORCIN. 49 1 sometimes increased, sometimes diminished, and often contains albumen. It somewhat increases the secretion of milk, and the amount of sugar in that secretion seems to be augmented*. Gastro-intestinal tract : large amounts cause nausea and often vomiting. Absorption and elimination: it is probably absorbed as a sodium salicylate, and is eliminated principally by the urine partly unchanged, and partly as salicyluric and (possibly) oxalic acids. Elimination takes place slowly. After the ingestion of large quantities the urine will be colored green from an increase of the indican. Medicinal Uses. — For its antipyretic effect salicylic acid has been used in fevers with varying success. In acute rheumatism, especially in robust patients, it is preeminently of value, reducing the temperature, relieving the joint affection and ameliorating the pain; but whether it shortens the duration and decreases the frequency of cardiac complications and relapses is still disputed. In rheumatic hyperpyrexia it is of value, but should not be relied on to the exclusion of other means of reducing tempera- ture. In gonorrhceal rheumatism and gout, where no kidney complication exists, it is also of service, and has been recom- mended in typhoid and eruptive fevers, pyaemia, puerperal fever, diphtheria, etc.; although not as effective in these diseases as in rheumatism, and, indeed, it has been condemned by some as being of no avail. It is strongly recommended in acute tonsillitis in doses of gr. x every two to four hoursf. As an antizymotic to prevent fermentation of the ingesta its use is advised in gastric catarrh, gastric dilatation, sarcina and allied complaints. As an anthelmintic salicylic acid has been used with success against tape-worm, and also internally and locally against ascarides. Externally it has been used in the moist stages of eczema and eczema rubrum with good results. As a detergent and desiccant it may be sprinkled dry on wounds or ulcers in the form of powder, or mixed in various proportions with some inert powder, as starch ; or a solution, I part to 300 parts of water, may be used as a substitute for the antiseptic carbolic dressing ; the stronger solution with sodium * Deutsches Arch. f. Klin. Med., Jan., 1882, Dr. Max Stumpf. f Brit. Med. Jour., Oct. 14th, 1882, Dr. Edward Mackey. 492 MATERIA MEDICA TOPICAL MEDICINES. phosphate, I part to 50 parts of water, is used to wash or spray foul surfaces, or as an application in diphtheria; a solution of gr. j to f oj of water is a good injection in gonorrhoea and col- lyrium in conjunctivitis. Dose, gr. x-5j. The following solu- tion makes an excellent application to inflamed or painful corns : Tfy Acidi salicylici, gr. x ; collodii flexilis, fSj. M. Whether employed internally or externally it passes rapidly into the urine, and gives with ferric chloride a blue or violet reaction. The acid retains its antiseptic properties only so long as it remains in a free state. Sodii Salicylas {Sodium Salicylate) (2NaC 7 H 5 3 ,H 2 0) is a white crystalline powder, without smell, having a sweetish alka- line taste. Internally its effects and uses are identical with those of sali- cylic acid, to which it is preferred, because it is more soluble in water and causes less gastric irritation. Dr. Gasparini * employs it in pleurisy when diaphoretic treat- ment is indicated. Locally it is recommended in solution (sodium salicylate, 5ij ; laudanum, f5ij ; water, fSviij) to relieve the suffering caused by gouty hands and feet, and rheumatic jointsf . Dr. Baudon anoints the surface three times a day, in variola, with sodium salicylate, 5j ; in cold cream, oj ; and claims that it lessens the suppuration and removes the odor. Lithii Salicylas {Lithium Salicylate} is also officinal, and is used internally to fulfill the indications of salicylic acid. The salts are given in doses corresponding to those of the acid. SALOL. Salol (not officinal) is an ether-combination of salicylic acid, 60 per cent., and carbolic acid, 40 per cent. It is not a salicylate of phenol, as has been erroneously stated in some quarters, but a salicylic-phenol-ether, and occurs as a white powder, tasteless, having a faint odor resembling carbolic acid, slightly unctuous to * Gaz. Med. ItaL, Lombard, March, 1885. f Brit. Med. Jour., Oct. 14th, 1882, Dr. E. Mackey. ANTISEPTICS AND ANTIPYRETICS SALOL. 493 the touch, insoluble in water, but easily soluble in alcohol, in ether and in the fixed and volatile oils. Effects and Uses. — It is an antiseptic, not a germicide, for, like iodoform, it will prevent the formation of bacteria, but will not destroy them when actually present (Nencki). Locally, as it is insoluble, it does not irritate the skin nor the surface of wounds when applied to them, and hence may well replace iodoform in local antisepsis. When administered internally , it reduces febrile temperature, but has no influence over that of health. This anti- pyretic action is very marked, occurs suddenly about fifteen minutes after salol has been taken, and is to a certain extent independent of the amount administered ; * that is to say, repeated doses will not lower a temperature already reduced by a single dose, although they will maintain the reduction. Simultaneously with the decline of the fever, sweating occurs, as in the case of the other agents of this group, but it is not marked, nor do the chilly sensations which sometimes precede the rise of tempera- ture ever amount to a distinct chillf. The circulation is but little influenced, even by large doses of salol (Lombard, loc. cit), but the respirations increase rapidly, so much so, that at the expiration of ten minutes after taking the medicine they have doubled in frequency, at the same time becoming very shallow, and although they are soon slowed, yet some time elapses before they return to their normal depth. Salol also possesses analgesic properties in common with other antipyretics of the aromatic series of carbon compounds, but this subject has as yet not been sufficiently investigated, to warrant a positive statement regarding its cause. When salol is taken with food, it is said to pass unchanged and undissolved through the stomach into the duodenum, where, under the action of the pancreatic juice, it is converted into car- bolic and salicylic acids ; hence it will act as an intestinal anti- septic without affecting the stomach. It is said, too, to render the bile more fluid. No toxic symptoms have been observed, and it is believed to be innocuous. It is eliminated principally by the kidneys, under * Bull. Get^. de Therap., Sept. i^ieme, iSSj, Dr. Lombard, f Deutsch. Med. Wochenschr., No. 19, 1887, Dr. Herrlich. 494 MATERIA MEDICA TOPICAL MEDICINES. the form of salicyluric acid and phenol-ether-sulphuric acid, the latter imparting the dark color to the urine, although, during a course of salol, the urine assumes a dark hue similar to that seen when large amounts of carbolic acid are taken. Salol has been much used in acute rheumatism to lower the temperature and relieve pain, and although it does this most promptly, yet its effects are much more evanescent than are those of sodium salicylate. It neither prevents relapses nor lessens the tendency to cardiac complications. It has also been used in small doses to lower the temperature in phthisis (gr. j-iij every few hours), and is recommended in typhoid fever and in pneu- monia for a similar purpose. It has been found very serviceable in intestinal catarrh, especially when the upper part of the tube is affected ; thus in catarrh of the duodenum it is of special value, as it is there that it is re-converted into its constituent parts. As it tends to liquefy the bile, it is also recommended in catarrhal jaundice, in cases of occlusion of the bile-ducts from inspissated bile, and it has been found useful in diabetes. Prof, von Nencki and others recommend it in the treatment of vesical catarrh, since it has been found to entirely prevent the decomposition of urine when mixed with it ; and, since its com- ponent parts are eliminated unchanged by the kidneys, a similar effect probably follows its internal administration. Like many of the antipyretics, it possesses the property, when administered internally (gr. iij-x t. d.), of relieving the pains of locomotor ataxia, neuritis, nervous headache and neuralgia to a remarkable degree, and also exerts a similar, though less marked, influence over lumbago, myalgia and other muscular pains. Locally it has been used as an antiseptic in dressing wounds, ulcers and other surgical affections ; and, as it does not appear to be toxic, and is to a great extent free from disagreeable odor, it would seem to be an excellent substitute for iodoform. Administration. — It may be given in capsules, pills, powder or in solution in alcohol or in oil. The dose ranges from gr. v-3j. As an antipyretic the average dose is gr. xv-xxx, and as much as 5ij-hj have been administered in twenty-four hours without deleterious effects. ANTISEPTICS AND ANTIPYRETICS NAPHTHALINE. 495 NAPHTHALINE. Naphthaline (not officinal), when pure, occurs as thin, white, shining, rhombic crystals, having a strong, pungent odor and a burning taste, insoluble in water, diluted acids or alkalies, but dissolving in alcohol, ether and oils*. It was introduced into medicine as an expectorant internally, and locally as a stimulating applicationf, but was first used as an antiseptic by Dr. E. Fischer J, in 1881, who recommended it as cheap, innocuous, and as efficacious as carbolic acid. Effects and Uses. — Naphthaline is a disinfectant, deodorant, anti- fermentative and antiseptic agent, whether applied locally or admin- istered internally. It has no antipyretic action. It does not irritate the stomach — in fact, it is believed to pass unchanged through that organ into the intestine, and there to act as an anti- septic, rendering the stools inodorous, or imparting to them its own odor to a slight degree. Although very insoluble, it is to some extent absorbed, and eliminated by the lungs and kidneys, imparting a dark color to the urine (Binz), and in large doses irritating the kidneys, and even in some cases causing violent cystitis, with strangury§. In medicinal doses, it retards or pre- vents decomposition of the urine, and hence is of value in cys- titis. It is not toxic, probably because of its insolubility. It is chiefly used internally || as an antiseptic in the treatment of gastro-intestinal and renal and cystic disorders. In indigestion due to fermentation of food ; in acute gastro- intestinal catarrh (combined with opium) ; in chronic gastro- intestinal catarrh, to prevent fermentation and the consequent nausea, heartburn and eructations, it is highly recommended. In diarrhoea and in dysentery it has also proved of use, but * Wienner Med. Blatter, No. 28, 1885, Binz. f Journ. de Pkarm. et de Chim., 1842, Dupasquier. % Berlin, klin. Wochensch., XIX, 1882, p. 1 1 3-1 1 6. \ Ibid., No. 42, 1884, Rossbach. || Cf. Binz, op. cit.; Voenno-Sanilarnoe Delo, No. 46, 1885, p. 514, Novikoff; Rossbach, op. cit.- Vratch, No. 26, 1886, p. 482, Koriander; Ibid., No. 36, 1887, p. 685, Lunin; El Genio Med.-Quirurg, Oct. 7, 1886, Dr. R. Serret ; Meditz- Obozr., Fa.sc. xix, 1885, p. 630, Dr. A. Sn'iatkoff; Jahrbuch f. Kinderheilkunde, Vol. xxvi, Nos. 3 and 4, 1887, and Centralbl. f. die gesam. Therap., Oct., 1887, Widowitz : el al. 496 MATERIA MEDICA TOPICAL MEDICINES. would appear to act more beneficially when combined with an evacuant plan of treatment than when given alone. It is also recommended in typhoid fever. In pyelo-nephritis, cystitis acute or chronic, chronic prostatitis with retention and decomposition of urine, and in cases of old strictures with multiple fistulae and ammoniacal urine, in doses of gr. xx, it is said rapidly to render the urine sweet, either limpid, neutral or acid in reaction, while it causes the pus to diminish or disappear altogether from that fluid. It has also been successfully used to cause the expulsion of parasites from the alimentary canal, and may be administered for this purpose to children in cases of lumbrici or ascarides in doses of gr. j-iij t. d., or to adults with taenia, in gr. xx-lxxx daily in divided doses (Koriander). It is also recommended as an expectorant.* Locally, \ it has been much lauded as a substitute for iodoform in the antiseptic treatment of wounds, abscesses and ulcers, either venereal or common ; and has been used as a surgical dressing after surgical operations, and even after amputations, but does not appear to possess any special advantage over the stronger anti- septics (as corrosive sublimate) when carefully used (H. M.). Administration. — Dose, gr. ss-viij to an adult. As much as gr. Ixxx have been given without unpleasant results in twenty-four hours, but as cases of cystitis and strangury are sometimes pro- duced, it is best to be cautious in administering naphthaline to a person unaccustomed to the drug. It is better administered in compressed pills or in capsules. Locally, it may be used either in the form of powder, ethereal solution (5ss-j in ether f §ss) or ointment with vaseline. The peculiar and disagreeable odor of naphthaline may be * Dupasquier, op. cit. ; Meditz. Pribav. k'Morsk, Shorn., Mar., l885,p. 218, Dr. S. M. Karst. f Cf. Dr. E. Fischer, op. cit. ; A monograph, " Ueber die Wundbehandlung mit Naphtalin" Strassburg, 1882, by Dr. Carl Bonning ; Vratch, No. 39, 1882, and No. 2, 1883, Dr. P. T. Diakonoff; Ibid. No. 25, 1885, p. 406, Dovodtchikoff ; Ibid. No. 28, 1884, p. 464, Dr. Jutzuta; Annals Anat. and Surg., May, 1883, Dr. George R. Fowler; Cenlralbl.f. Chir., No. 72, 1882, Dr. Ploftmann; Ibid. No. 50, Dr. Hager, Gaz lekarska, Nos. 7 and 8, 1883, Dr. Klink ; Rivista di Chim.-Med. e Farm., 1883, Dr. C. Raimondi; et al. ANTISEPTICS AND ANTIPYRETICS PYRIDINE. 497 altered and even rendered pleasant by trituration with a small quantity of the oil of bergamot *. Naphthol (C 10 H 7 OH, — not officinal) is beta- or wa, an eschar), called also Cauterants, are medicines which destroy the structure and vitality of the parts to which they are applied. The eschar which their appli- cation produces is followed by inflammation and suppuration of the surrounding tissues, by which the slough is separated from the living parts. They are employed — 1. To effect the destruction of morbid growths, warts, condylomata, polypi, fungous granulations, etc. 2. To destroy the virus of rabid and venomous animals, and of chancres and malignant pustules, and to prevent their absorp- tion. 3. For the cure of violent inflammation, by their substi- IRRITANTS POTASSA. 5 19 tutive action, as when they are applied to the mucous or cutaneous surfaces, in gonorrhceal ophthalmia, erysipelas, poi- soned parts, carbuncles, etc. 4. To stimulate indolent sinuses, ulcers, etc., where their influence is also of a substitutive char- acter. 5. To form issues. 6. To remove morbid heterologous growths, as lupus, cancer, warts, etc. ARGENTI NITRAS FUSUS FUSED SILVER NITRATE. Lunar Caustic (described at length p. 201) is the most commonly employed of the caustics. It has the advantage of not liquefying when applied, and its action is therefore con- fined to the parts with which it is brought in contact, and is superficial. It is used to remove fungous granulations in wounds and ulcers, to destroy warts, to alter the action of indolent ulcers, sinuses, and fistulae, to subdue the inflamma- tory action of paronychia, erythema, etc., to arrest the pro- gress of erysipelas and cancrum oris, to cut short variolous pustules, to cure skin diseases by a substitutive action, and in inflammations of mucous membranes. In dilutions of vari- ous strengths it is resorted to in every variety of inflamma- tion of the mucous membranes ; when a full impression is desired, a solution of gr. xx-xxx in distilled water fSj may may be employed; for ordinary purposes, gr. ij to water fSj. The diluted silver nitrate (vide p. 201) is also used externally. POTASSA. Caustic Potassa is prepared by the rapid evaporation of Solution of potassa (vide p. 457) with heat. While in the state of fusion, it is received into cylindrical iron moulds, and it occurs in the form of sticks, of a brownish, grayish or bluish color, a fibrous fracture, the odor of slacking lime, and a caustic, urinous taste. It dissolves in alcohol and in less than its weight of water, and attracts both moisture and carbonic acid rapidly from the air. It is more or less impure as found in the shops. By digestion in alcohol it is freed from impurities insoluble in this menstruum (as the potassium carbonates), and it may be afterwards obtained quite white and pure by evapo- ration; it is then termed alcoholic potassa. The potassa of the shops is a hydrate, consisting of the elements of water and potassa. 520 MATERIA MEDICA TOPICAL MEDICINES. Effects and Uses. — It is the most powerful known escharotic, and differs from lunar caustic in extending its action to a con- siderable depth beneath the surface to which it is applied. It is used chiefly to form issues, to destroy the virus of chancres and of malignant pustules and that from the bites of venomous reptiles and rabid animals, and sometimes also to arrest the sloughing of carbuncles, and, from its deep-reaching action, it is preferred to lunar caustic in these cases; applied to the cutaneous surface, in cases of phlegmon, threatened carbuncle, etc., it will sometimes avert the progress of inflammation. It is a good application in cases of rodent ulcer, the superficial forms of epithelioma generally, and in lupus, the diseased tissue having been removed with the knife as thoroughly as possible previous to the application of the caustic. When it is applied to the skin, this should be covered with linen spread with adhesive plaster, having a hole the size of the spot to be cauterized. A solution (5iss to fSij of water) is used as a rubefacient. Potassa cum Calce {Potassa with Lime) is prepared by rubbing up equal parts of potassa and lime. It is a grayish-white pow- der, which is sometimes made into a paste with a little alcohol, and is termed Vienna Paste ; it has been also formed into sticks. The presence of lime renders this a milder, less deliquescent and more manageable caustic than potassa ; it is a favorite application to chancres. SODA. Caustic Soda is prepared by the rapid evaporation of Solution of soda (vide p. 459) until ebullition ceases and the soda melts ; when it has congealed, it is broken into grayish-white, opaque, brittle fragments, which are very corrosive, very soluble in water, soluble in alcohol, and deliquescent, though, unlike potassa, it does not become permanently liquid, but after a time effloresces. It is employed for the same cauterant purposes as potassa, than which it is somewhat milder in action. London Paste is made by rubbing up equal parts of soda and lime. ACIDUM CHROMICUM CHROMIC ACID. Chromic Acid (Cr0 3 ) is obtained by the reaction of sulphuric acid upon a solution of potassium bichromate. It is properly IRRITANTS BROMINE. 521 chromic anhydride, and occurs in the form of anhydrous, deep- red, needleform crystals, of an acid, metallic taste ; they are deliquescent, and very soluble in water, with which they form an orange-yellow solution. Effects and Uses. — This is an eschar otic of great power, decom- posing the tissues by its rapid oxidizing action. Used in the form of paste, or solution more or less diluted, it is a most effi- cacious application to lupus, morbid growths and excrescences, as syphilitic condylomata, etc., and is unequalled as an agent for removing warts from the hands. It gives less pain than other caustics ; but it is to be used with caution, especially near deli- cate parts like the eye, as its action is deeply penetrating. The solution may be made of the strength of from gr. ioo-Sj to foj of water ; and is to be applied by means of a pencil or glass rod. Solutions of chromic acid in glycerin, which have been used, are liable to explode if the reagents are mixed too quickly ; the gly- cerin should be added drop by drop. ACIDUM ARSENIOSUM ARSENIOUS ACID. This is a powerful escharotic (vide p. 439), and is occasionally applied in lupus, onychia maligna, cancerous ulcers, and to change the action of indolent sinuses; but its use is attended with danger. When used, it should be applied freely, as a large amount causes such rapid death of the tissues that absorp- tion is rendered impossible. It may be diluted with one or more parts of sulphur. BROMUM BROMINE. Bromine (Br) is an elementary body, bearing close chemical affinities to iodine. It is a constituent of sea-water and of many mineral springs. In Europe it is obtained principally from the mother liquors of the salt mines of Stassfurt, in Germany ; in this country, from saline springs in western Pennsylvania, Ohio, and West Virginia, in which it exists as magnesian bromide. It is a volatile, dark-red liquid (sp. gr. 3), of a caustic taste and a strong, disagreeable smell, sparingly soluble in water, more solu- ble in alcohol, and still more so in ether. Its effects on the system, considered chemically, are similar to those of chlorine. It de- composes hydrogen compounds, forming hydrobromic acid, and separating the elements combined with the hydrogen ; hence it 522 MATERIA MEDICA TOPICAL MEDICINES. is a deodorant and disinfectant. On account of these properties, and because it is a liquid, it is a severe, rapid and thorough caustic. The vapor is intensely irritant to the mucous mem- brane, causing, when inhaled in sufficient quantity, laryngitis, bronchitis, and pneumonia. In the stomach it is a corrosive poison. Snell* reports a case in which §j killed an adult in seven hours. The symptoms were immediate dyspnoea, epigas- tric pain, trembling of the hands and great anxiety. In acute coryza, chronic nasal catarrh, ozaena, and hay asthma, a small quantity of a solution (5ss) in alcohol (f§iv) may be inhaled from a wide-mouthed vial with good result. Locally, in hospital gangrene, after removing the slough, it is the best escharotic. It is also used as a caustic in chancre and various forms of cancer, especially carcinoma uteri. ZINCI CHLORIDUM ZINC CHLORIDE. This is also a powerful escharotic (vide p. 198); and, in addi- tion to its corrosive properties, it appears to exercise a greater influence over the vital action of neighboring parts than some of the other caustics. The separation of its eschar leaves very healthy and vigorous granulations, and it is one of the best appli- cations that can be made to intractable, indolent ulcers and sinuses. It will sometimes cure lupus. LIQUOR HYDRARGYRI NITRATIS SOLUTION OF MERCURIC NITRATE. This preparation {vide p. 423), termed also the acid nitrate of mercury, is a valuable caustic application to malignant ulcers, hospital gangrene, chancre, etc. HYDRARGYRI CHLORIDUM CORROSIVUM CORROSIVE CHLORIDE OF MERCURY. Corrosive Sublimate is more frequently used as a stimulant or antiseptic wash than as a caustic (see p. 416). POTASSII BICHROMAS POTASSIUM BICHROMATE. This salt, already noticed under the head of Alteratives (vide p. 454), is a good caustic application, in saturated solution or in powder, to syphilitic and other vegetations. * N. Y.Journ. of Med., Nov., 1850, p. 179. IRRITANTS GREEN SOAP. 523 ACIDA MINERALIA MINERAL ACIDS. The mineral acids {vide p. 169) are powerful escharotics, but are inconvenient for many uses, on account of the extension of their action beyond the point of application. On the other hand they can be made to reach the bottoms of sinuses and fistulae, which are inaccessible to the solid caustics. Nitric acid, for such purposes, has no equal in the list of escharotics ; it is used also to destroy warts. Properly diluted, the mineral acids are em- ployed in injections, gargles, etc. ; and in the form of ointment, in skin diseases. . Copper Sulphate {vide p. 196) and Alum (vide p. 203) are mild escharotics, but are used chiefly to remove fungous granu- lations in ulcers. The actual cautery and moxa have been alluded to under the head of Heat (vide p. 39). Under " Irritants " may be considered sapo viridis and chrysa- robin, two remedies which, although not used as escharotics, are applied to the skin in certain of its diseases for their local irritant effect. The former has decided caustic properties, due to the potassa which it contains. Sapo Viridis — Green Soap — is a soft, greenish, jelly-like soap, prepared from potassa and the fixed oils, very soluble in water and alcohol. Like all soaps, especially soft soaps, it is a mild caustic, and was introduced into medical practice by Pro- fessor von Hebra, in the treatment of various cutaneous affections, especially of the scaly variety. It is useful to remove the infil- trated patches of eczema rubrum, and for this purpose should be well rubbed in with a piece of flannel until all traces of the soap have disappeared, when the flannel is wet with water and the rubbing again performed ; the surface should be then washed with clean water and carefully dried, when it will be found red and angry-looking, with here and there a minute point from which serum is oozing. Between the applications ointments are to be applied. Sapo viridis is also much used to remove scales and crusts, as in psoriasis, seborrhoea, and in various other skin affections. In tinea versicolor it will often effect a prompt cure, 524 MATERIA MEDICA TOPICAL MEDICINES. and is highly useful to cleanse the skin in parasitic affections before the application of a germicide. Tinctura saponis viridis (tincture of green soap) consists of 65 per cent, of green soap and 2 per cent of oil of lavender dissolved in alcohol. It is milder in its action than green soap, and is used to fulfil the same indications. Chrysarobinum — Chrysarobin, often improperly called Chrysophanic Acid — consists of a mixture of principles ex- tracted from araroba or goa-powder, a substance found in the clefts of Andira araroba {Nat. Ord. Leguminosae). It has also been obtained from different species of rhubarb. It is an orange- yellow powder, crystallizing in needles, insoluble in water, only slightly soluble in alcohol and chloroform, readily so in ether, and possesses neither taste nor smell. Effects and Uses. — When applied locally \ it is an irritant to the skin, causing irritation and inflammation accompanied with swelling, itching, pain, heat, and sometimes a papular eruption, especially when applied about the head and face. The action is not always limited to the part to which it is applied, but ex- tends to the healthy skin in the vicinity. Observers do not agree respecting the internal effects of this drug. It is princi- pally used as an external application in cases of skin disease due to vegetable parasites, for which it is an excellent remedy, and in psoriasis, in which disease the scabs soon disappear and the patches become white under its use. In the treatment of ringworm the parts should first be cleansed with sapo viridis in order to facilitate contact of the remedy with the parasite, and then the following solution should be applied : 1^ Chrysarobini, gr. v-x; chloroformi, fSj. M. S. — Shake before using. After this is dry, paint on, as a protective, liquor gutta-perchae. This solution of chrysarobin should be applied every few days until the parasite is effectually destroyed. Alexander * reports excel- lent results in sixty cases of ringworm of the scalp from the use of a 10 per cent, solution of chrysarobin in gutta-percha solution. It must not be forgotten that chrysarobin produces a permanent * Journ. of Cutaneous and Venereal Diseases, 1885, p. 2sZ- DEMULCENTS. 525 stain upon clothing. It stains the skin yellow, and should never be applied to the head or face on account of the liability to swelling and oedema of the eyelids. It has also been used inter- nally. The ointment (made by rubbing 10 parts of chrysarobin with 90 parts of benzoinated lard) may be used. ORDER III. DEMULCENTS. Demulcents, or Lenitives, are medicines' which soften and relax the tissues, and, when applied to irritated or inflamed surfaces, diminish heat, tension, and pain. They consist chiefly of gum or mucilage, or of a mixture of these with saccharine and farinaceous substances, and form with water viscid solu- tions. Their constitutional effects are principally nutritive, though perhaps, to some extent, they relieve irritation in distant organs by modifying the acridity of the secretions. Demulcent solutions are administered internally — I. To sheathe and pro- tect the gastro-enteric surface from the injurious effects of irri- tating substances, particularly acrid poisons. 2. To relieve irri- tation and inflammation of the alimentary canal, as in gas- tritis, enteritis, diarrhoea, and dysentery ; and for this purpose they may be administered by either the mouth or rectum. 3. In catarrhal affections, in which they are probably useful in part by the transmission of their lubricating and soothing effects on the fauces and oesophagus by reflex action to the laryngeal and bronchial membranes, and in part by modifying the acridity of expectorated matters. 4. In affections of the urinary passages, as ardor urinae, cystitis, etc., and in these cases they act chiefly by diminishing the acridity of the secretions. 5. As agreeable drinks, to quench thirst and promote the action of the secreting and exhaling organs in febrile affections. Their effects in these cases are owing partly to the water which they contain, to which they are added merely for the sake of flavor, and partly also to the nutriment which they furnish. When administered with the object of increasing the proportion of the fluid parts of the blood, demulcents are termed Diluents. 6. As light diet for the sick. 7. For pharmaceutical purposes, to suspend sub- stances insoluble in water, etc. Externally, mucilaginous solutions are employed extensively 5 2D MATERIA MEDICA TOPICAL MEDICINES. to relieve the heat, swelling and pain of inflammation, wounds, burns, etc. ; to hasten suppuration where inflammation is too far advanced for resolution ; to cleanse foul and scabby ulcers ; to promote suppuration from granulating surfaces, etc., etc. When applied externally, this class of medicines is termed emollients. Mucilaginous and amylaceous substances are applied to inflamed and ulcerated parts, mixed with water so as to form soft masses, termed — Cataplasms or Poultices, which are useful vehicles for the application of heat and moisture. When applied to a healthy part, a poultice acts as a sedative and relaxant. In the early stages of inflammation it lessens the amount of blood at the seat of morbid action, by dilating the cutaneous vessels, and prevents stasis and the migration of the white corpuscles : after stasis has taken place and migration has commenced, it favors the formation of pus, probably by aiding migration through the relaxing effect it exerts on the vessels, and also by promoting cell-proliferation : applied to a wound, it stimulates the forma- tion of embryonic and granulation tissue, from its influence over cell-proliferation (H. M). If the use of poultices be too long persisted in, the part becomes pale, sodden, relaxed and shrivelled, and even devitalized, in extreme cases. Poultices are used in the early stages of acute inflammation of internal viscera for their antiphlogistic effects : thus, the abdo- men may be covered with a large poultice in the early stages of peritonitis, if not objectionable on account of its weight, and a jacket- poultice may be used with excellent effect in the early stages of bronchitis, pneumonitis or pleuritis, the chest being completely surrounded by the poultice. They are sometimes used for the same purposes in external inflammations. For their effects on pus-formation and cell-proliferation, they are useful in external inflammation when suppuration can no longer be pre- vented, as in furuncles, carbuncles, etc., and are also applied to granulating surfaces, as in wounds or ulcers. As they stimulate the granulation-process, their application should be discontinued as soon as the granulations reach the level of the surrounding skin. When applied to a granulating surface, or, indeed, to an open wound of any kind, the poultice should be thoroughly antisepti- DEMULCENTS WATER. 527 cised, as by admixture with a solution of corrosive sublimate, else it forms an excellent nidus for the development of various forms of protophytes, the multiplication of which will be accel- erated by the heat and moisture. In the treatment of gangrenous, sloughing or foul-smelling ulcers or wounds, yeast or charcoal is often added to the poultice, to aid in the separation of the slough or to correct the fcetor. Poultices may be medicated with lead-water and laudanum, or other substances, if it be desired to abate the inflammatory pro- cess. AQUA WATER. Water has important medicinal as well as pharmaceutical uses. The Pharmacopoeia directs it to be employed in the purest attainable state, which is rain or snow water ; for pharma- ceutical purposes, distilled water (aqua destillata) should be used. Pure water is a transparent liquid, without color, taste or smell ; but owing to its extensive solvent powers, in the natural state it is more or less contaminated with foreign matters. It is a com- pound by volume of 2 atoms of hydrogen and I of oxygen (H 2 0). Effects and Uses. — Water is necessary for the solution and digestion of our food; in either insufficient or excessive amount it may prove injurious. Thus, without a proper supply of water, not only the absorption of soluble matters in the stomach is interfered with, but also the passage of undigested substances into the intestines ; and besides, some articles, as sugar, do not undergo the fermentation necessary for digestion. On the other hand, an excess of water taken into the stomach impairs diges- tion by over-dilution of the gastric juice, and will occasion the acetous fermentation of saccharine articles. Water is eliminated from the system by the intestines, skin and lungs, but chiefly by the kidneys ; and it is believed, in large amounts, to increase not only the water, but the solid constituents, of the urine ; hence its use as a diuretic. As it promotes both the metamorphosis and construction of tissue, it may produce a valuable alterative effect in morbid taints of the system, and prove a useful adjunct to more active eliminative agents. Water is the basis of all drinks administered to relieve the thirst of fever and moderate the undue viscidity .of the blood which is present in inflamma- 528 MATERIA MEDICA TOPICAL MEDICINES. tion ; it must not be permitted in excess, however, as undue amounts may produce nausea, flatulence and even vomiting and diarrhcea. The uses of water, as an external agent, have been noticed under the head of heat and cold. Carbonic Acid Water (H 2 C0 3 ) (unofficinal). Water impregnated with a quantity of carbonic acid equal to five times the bulk of the water (which may be obtained from sodium bicarbonate or from marble, by means of diluted sulphuric acid) often proves useful in allaying nausea and vomiting, and is also a good vehicle for some of the neutral purgative salts which are of unpleasant taste. M. Jacquemaire * has recently called attention to the value of carbonic acid water, under a pressure of four or five atmospheres, to sterilize aqueous solutions of the salines, the pyrophosphate of iron and pepsin. ACACIA. Acacia, or Gum arabic, is a gummy exudation from Acacia Verek and other species of Acacia {Nat. Ord. Leguminosse), thorny or prickly trees or shrubs of Africa and Arabia. Con- siderable gumf is collected by the Somali tribe on the N. E. coast of Africa, who obtain it by incision. The gum exudes either through natural cracks in the bark or through incisions made to facilitate its exudation, and hardens on exposure. Several com- mercial varieties are known, as Turkey, Barbary, Senegal, India, etc, of which the most important are Turkey gum and Senegal gum. 1. Turkey gum (Kordofan gum) is the kind usually found in the shops. It consists chiefly of small, irregular fragments, inter- spersed with larger pieces of a whitish color, which is sometimes slightly tinged with yellow or reddish-yellow. It is purer than other varieties, and is generally characterized by innumerable minute fissures pervading its substance. 2. Senegal gum occurs in roundish or oval unbroken pieces, sometimes whitish, but gen- erally yellowish, reddish or brownish-red. 3. Barbary gum comes from Morocco, and consists of two kinds, one resembling the Turkey, the other the Senegal gum. 4. India gum, though brought from India, is collected on the northeastern coast of * Bull. Gen. de Therap., Aout isieme, tf&% % f Journ. of Pharmacy, xii, 226. J. Vaughan. DEMULCENTS ACACIA. 5 20, Africa, the Somali district, and in the ports of the Red Sea. It is in pieces of varying size, color and quality, and is often con- taminated with Bassora gum, which is insoluble in water. All the varieties are more or less transparent, hard, brittle and pul- verizable, and form a white powder. They are inodorous, with a feeble, slightly sweetish taste, and when pure dissolve wholly in the mouth. When kept in a dry place they undergo no change by time. Chemical Constituents. — Acacia consists almost wholly of a pe- culiar proximate principle, usually termed Gum, but latterly des- ignated by chemists as Arabin. It is soluble in hot or cold water, forming a viscid solution called mucilage, and is insoluble in alcohol, ether and the oils. Alcohol precipitates gum from its aqueous solution ; lead subacetate (which is a delicate test), lead nitrate and solution of iron chloride also precipitate it from so- lution. Arabin {gummic or arabic acid) (C^H^On) is combined with about 3 per cent, of lime, forming a soluble salt, calcium gummate. Gums of inferior transparency and solubility contain bassorin, an inert principle, insoluble in water and alcohol. Effects and Uses. — Acacia is extensively employed, internally, as a demulcent in gastro-enteric inflammation, diarrhoea, dysen- tery, cases of acrid poison, etc. ; as a lubricant to the fauces in catarrhal affections, and also as a vehicle for anodynes and ex- pectorants in cough mixtures; and as a diluent in fevers and in- flammatory cases. It is not now considered to be digestible, and can scarcely rank (as formerly supposed) with nutrients. It is usually administered in solution (§j to boiling water Oj, to be given when cool) ; in cases of irritation of the fauces it may be taken into the mouth and allowed slowly to dissolve. For phar- maceutical purposes acacia is much used to suspend insoluble substances in water, and in making pills and lozenges. Mucilago acacice {mucilage of acacia) is used in making pills, emulsions, etc. ; it becomes sour by keeping. Syrupus acacice {syrup of acacia) (25 per cent, of mucilage of acacia mixed with 75 per cent, of syrup) is used for the same purpose. Mistura amygdalce {almond mixture) is made by dissolving a mixture of 6 parts of blanched sweet almonds, 1 part of acacia, and 3 parts of sugar, in 100 parts of distilled water ; it is a pleasant demulcent and vehicle for other medicines. By dissolving equal parts of sugar and acacia in 34 530 MATERIA MEDICA TOPICAL MEDICINES. water and evaporating, an agreeable demulcent is obtained, known as gum pectoral, which is sold as an imitation of jujube paste. TRAGACANTHA TRAGACANTH. This is a gummy exudation from Astragalus gummifer and other species of astragalus {Nat. Ord. Leguminosae), small shrubs found in Persia, Asia Minor and countries bordering on the Levant, with numerous branches covered with imbricated scales and beset with spines. Tragacanth exudes spontaneously in the hot weather, and hardens, as it exudes, in forms of various shapes. It occurs in irregular tortuous flakes or filaments, of a whitish or yellowish-white, or occasionally a slightly reddish color, some- what translucent, resembling horn in appearance. It is hard and fragile, but very difficult of pulverization, and has no smell and very little taste. When heated with water it swells and forms a paste, and if agitated with an additional quantity it forms a uni- form mixture, from which it is, however, almost entirely depos- ited upon standing a day or two. It contains two constituents, one soluble in water, resembling arabin, but not identical with it, combined with calcium, the other termed tragacanthinifZ^^iA^Oi^). Effects and Uses. — Tragacanth is seldom given internally, on account of its difficult solubility. It is useful in suspending heavy insoluble powders, and answers better than gum arabic to impart consistence to lozenges. Mucilago tragacanthce {inucilage of tragacantfi) — tragacanth 6 parts, with glycerin 18 parts, in water enough to make the whole weight 100 parts — is used in making pills and troches, and for the suspension of heavy insol- uble metallic substances. LINUM FLAXSEED. This is the seed of Linum usitatissimum, or Common Flax (Nat. Ord. Linacese), an annual plant, of the height of two feet, originally a native of eastern countries, but naturalized in Europe, and cultivated in all parts of the world. The seed and oil are both officinal. The seeds are about a line in length, oval, smooth and glossy, of a brown color externally and yellowish-white within ; a variety of flax is cultivated in Ohio, the seeds of which are greenish-yellow. Flaxseeds are inodorous, and have an oily, mucilaginous taste. They contain 30 or 35 per cent, of fixed oil, DEMULCENTS FLAXSEED. 53 I a large proportion of mucilaginous matter, vegetable albumen, etc. ; the mucilaginous matter, which is found chiefly in the husks ol the seeds, consists, about one-half, of a principle soluble in cold water, resembling arabin, and about one-third, of a principle in- soluble in water. The oil {oleum lini or linseed-oil} is obtained by expression from the interior part of the seeds ; it is laxative in the dose of f5j-ij, but it is chiefly used externally, mixed with an equal amount of lime-water, as in the old " carron oil." Effects and Uses. — Decoction is an improper mode of prepar- ing a demulcent solution of flaxseed, as boiling extracts part of the oil ; but it answers very well when it is used as a laxative Fig. 43- LINUM USITATISSIMUM. enema. Ground flaxseed forms a much-used emollient poultice (vide p. 526), which is prepared by gradually adding boiling water to flaxseed meal in a vessel previously heated, and constantly stirring until it makes a smooth dough of proper consistence, which is then spread on muslin and a piece of gauze or mosquito- netting placed upon it, to prevent it from adhering to the skin. After the poultice is applied, it should be covered with oiled silk or waxed paper, to Tetain the heat and prevent evaporation. The cake remaining after the expression of the oil, retains the mucil- aginous and albuminous constituents of the seed, and forms a 532 MATERIA MEDICA TOPICAL MEDICINES. food for cattle, under the name of oil-cake. This is used for making poultices, but it is inferior to the meal made from the seeds which have not been deprived of their oil. OLEUM GOSSYPII SEMINIS — COTTON-SEED OIL. This is a fixed oil expressed from the seed of Gossypium herbaceum (vide p. 267) and other species of Gossypium. It is subsequently purified by being bleached with alkalies and with sulphuric acid, and is finally obtained as a clear, pale-yellow oily liquid, without odor and having a bland, nut-like taste. It con- tains olein and palmitin. It is very bland, and may be used as a substitute for almond or olive-oil. It is used externally as an ingredient of linimentum ammonia (vide p. 510), linimentum cal- cis (p. 463), linimentum camphorce (vide p. 1 1 8), and linimentum plumbi subacctatis (vide p. 193). ULMUS SLIPPERY-ELM BARK. This is the inner bark of Ulmus fulva, or Slippery-Elm (Nat. Ord. Urticaceae), a lofty indigenous tree which is found through- out the United States north of Carolina, and grows most abun- dantly west of the Allegheny Mountains. The inner bark is prepared for use by the removal of the epidermis ; it is found in the shops in long flat pieces, of a fibrous texture, tawny on the outer surface and reddish on the inner, of a peculiar but not un- pleasant smell and a very mucilaginous taste. It affords a light grayish, fawn-colored powder. A large quantity of mucilagin- ous matter 'is contained in it, which is yielded readily to water, also some tannic acid. Much of the bark lately brought into the market is inferior, containing but little mucilage ; it is less fibrous and more brittle than the genuine bark. Effects and Uses. — Slippery-elm bark is a valuable demulcent, extensively and advantageously employed in dysentery, diarrhoea, genito-urinary diseases, catarrhs, etc. It is also highly nutritious. Externally it is an excellent emollient application, in the form either of infusion or of poultice made with the powder. It has been also recommended for the dilatation of strictures and fistu- lae, and, made into a spongy mass, as a tent to dilate the os uteri. The infusion — mucilago ulmi (mucilage of slippery-elm bark) (2 parts to water 100 parts) — may be used ad libitum. DEMULCENTS OIL OF BENNE. 533 SASSAFRAS MEDULLA SASSAFRAS PITH. Sassafras pith is the pith of the stems of Sassafras officinale (vide p. 364). It occurs in light, spongy, whitish, slender, cylin- drical pieces, of a mucilaginous taste. It abounds in a gummy matter, which it yields readily to water, forming a limpid, viscid mucilage. This mucilage (2 parts to water 100 parts) — is a plea- sant demulcent drink in dyspeptic, nephritic and catarrhal affec- tions, and is much used as a soothing application in ophthalmia. ALTH.EA. The root of Althaea officinalis (Nat. Ord. Malvaceae), com- monly known as Marshmalloiv, an herbaceous European plant, occasionally found, too, on the borders of salt marshes in our own country, with ovate, soft, velvety, crenate leaves and pretty flesh-colored flowers, is much used in Europe as a demulcent. The roots of other Malvaceae are often substituted for those ol the officinal roots. These are imported in pieces, three or four inches in length, of nearly the thickness of the finger, light, easily broken, white externally, of a peculiar faint smell and a mild, mucilaginous, sweetish taste. The chief constituents of marshmallow are mucilage and starch, the former soluble in cold water, the latter requiring boiling water. It contains also aspar- agin (C4H 8 N 2 03,H 2 0), a crystalline principle found in asparagus shoots and other plants. Uses. — Marshmallow decoction is employed as a demulcent in inflammatory and irritated conditions of the mucous membranes of the respiratory, digestive and urinary organs, and poultices made of the bruised or powdered root are used externally. The syrup is officinal. OLEUM SESAMI OIL OF BENNE. This is a fixed oil expressed from the seed of Sesamum indicum (Nat. Ord. Pedaliaceae), an annual plant, growing to the height of four or five feet, with ovate-lanceolate, lobed leaves, reddish-white axillary flowers, and an oblong capsule containing small oval yellowish seeds. It is a native of India, but is now raised throughout Asia and in Egypt and Italy, also in South Carolina and in the neighborhood of Philadelphia. The seed contains a fixed oil, and the leaves yield to cold water a large 534 MATERIA MEDICA TOPICAL MEDICINES. quantity of mucilage resembling that of sassafras pith. This is a highly-esteemed demulcent drink, used in cholera infantum and infantile bowel complaints. The seeds are eaten as food by the negroes in Carolina, in broths, puddings, etc. The oil, which is inodorous, of a bland, sweetish taste, and keeps well, may be used internally or externally as a substitute for olive-oil. CYDONIUM. This is the seed of Cydonia vulgaris or Quince tree {Nat. Ord. Rosaceae), a native of Europe, but cultivated in the United States for the fruit. The seed are ovate, angular, reddish-brown exter- nally, white within, inodorous, insipid, and abound in mucilage. They are used, principally, externally, in solution (inucilago cy- donii), two parts to water ioo parts; but may be given internally as a demulcent, in gastro-intestinal or bronchial inflammations. GLYCYRRHIZA. Glycyrrhiza or Liquorice Root is the root of Glycyrrhiza glabra {Nat. Ord. Leguminosae), a small herbaceous perennial plant, of the countries around the Mediterranean. It is imported from Sicily and Spain; and a portion of the Sicilian root is said to be Fig. 44. GLYCYRRHIZA GLABRA. the product of G. echinata. As found in the shops glycyrrhiza is in long wrinkled pieces, often worm-eaten, varying from a few lines to more than an inch in thickness, externally grayish-brown, internally yellowish, without smell, and of a sweet, mucilaginous* DEMULCENTS GLYCYRRHIZINUM. 535 sometimes slightly acrid taste. The best pieces are of the bright- est yellow internally. The powder is grayish-yellow, or, if it be powdered with the epidermis removed, pale sulphur-yellow. The Russian glycyrrhiza of commerce is said to be derived chiefly from G. glandulifera ; the root has a reddish tint and a scurfy surface, which distinguish it from the smoother one G. glabra. The constituents of glycyrrhiza are a peculiar transparent yellow, uncrystallizable sugar, termed glycyrrhizin (C 16 H 24 6 ) (which is scarcely soluble in cold water, but soluble in boiling water and alcohol, and is a glucoside, splitting up, when warmed with a dilute acid or upon being boiled, into glycyrretin and sugar), starch, asparagin, an acrid resin, etc. Effects and Uses. — A decoction of glycyrrhiza is a useful demulcent in dysenteric, catarrhal, and nephritic affections ; it is also added to decoctions of acrid substances, to cover their taste and acridity. It should be made of the root deprived of its corti- cal part, which is acrid and without demulcent virtues ; by long boiling the acrid resin is extracted. The powder is used in mak- ing pills (see p. 51). A fluid extract \s officinal, and is a useful addendum to cough mixtures and to disguise the taste of ammo- nium carbonate or chloride. Glycyrrhizinum Ammoniatum (Ammoniated Glycyrrhizin) is prepared by macerating and then percolating glycyrrhiza with water of ammonia, precipitating with sulphuric acid, washing the precipitate and dissolving in water of ammonia and spreading on glass plates to dry. It may be used for the same purposes as the other preparations. Extractum Glycyrrhiza {Extract of Glycyrrhiza — Extract of Liquorice) is made by the evaporation of a decoction of the half- dried root. It comes to this country chiefly from Leghorn and Messina, and in part, also, from Spain; a good extract is pre- pared, too, in New York and England. The crude extract, when good, occurs in black, flattened, cylindrical rolls, about an inch in diameter, which are dry, brittle, with a shining fracture, of a very sweet, peculiar, slightly acrid taste, and are quite soluble in water. It is, however, much sophisticated, and for internal use is generally refined by dissolving the impure extract in water and water of ammonia, without ebullition, straining the solution and evaporating; sugar is often mixed with it, and sometimes muci- 536 MATERIA MEDICA — TOPICAL MEDICINES. lage or glue. Refined liquorice {extractum glycyrrhizce punini) is in small cylindrical pieces, not thicker than a pipe-stem. Liquor- ice is a pleasant demulcent, much used as an addition to cough mixtures and lozenges and to acrid infusions and decoctions. Mistier a glycyrrhizce composite/, [compound mixture of liquorice), commonly called brown mixture, consists of the pure extract, acacia, sugar, each 3 parts; paregoric, 12 parts ; antimonial wine, 6 parts ; sweet spirit of nitre, 3 parts ; water, 70 parts ; dose, foss. Liquorice enters into the composition of several troclies already noticed. LYCOPODIUM. This is the sporules of Lycopodium clavatum or Club-moss,, and other species of Lycopodium {Nat. Ord. Lycopodiacese), low, creeping perennials, found in dry woods of Europe and America. The stem is from 2 to 4 feet long, with numerous short ascending branches, having linear awl-shaped leaves ; the sporules are found in reniform sporangia of the long peduncle which terminates the fertile branches. It consists of a fine, yellow, inflammable powder ; odorless, tasteless, and not wetted by water, and contains fixed oil and volatile bases. It is used as a dusting powder, and, as it is not wetted by water, makes an excellent application for excoriated surfaces, intertrigo, etc. It is particularly useful to prevent the irritation caused by the urine or alvine dejections coming in contact with the tender or inflamed perinaeum and nates, in infantile cases. It is also used in pharmacy to prevent the adhesion of pills. CETRARIA. Cetraria islandica, or Iceland Moss {Nat. Ord. Lichenes), is a foliaceous, erect lichen, from two to four inches high, found in the northern latitudes and mountainous districts of the new and old continents. It is obtained principally from Norway and Iceland, but is said to be abundant also in New England. As found in the shops it consists of irregularly-lobed and chan- nelled coriaceous leaves, fringed at their edges with rigid hairs, of a brownish or grayish-white color, darker on the upper sur- face, and sometimes marked with blood-red spots. It is almost odorless, and has a bitter, mucilaginous taste; its powder is DEMULCENTS CETRARIA. 537 whitish-gray. It gives up its virtues to boiling water, and con- sists chiefly of a kind of amylaceous matter (which is colored blue by iodine, and is termed lichenin — C 12 H2o0 10 ), and a bitter principle termed cetrarin or cetraric acid (C 18 H 16 8 ); it contains, besides, other principles. Effects and Uses. — Iceland moss is a demulcent tonic, and is also highly nutritious. It is adapted to cases requiring a light Fig. 45. CETRARIA ISLANDICA. aliment combined with a mild and acceptable tonic; and from its demulcent properties has a soothing influence in inflamma- tions of the various mucous membranes. It is chiefly used in chronic affections of the pulmonary and digestive organs, in the form of decoction {decoctum cetrarice), which may be taken ad libitum. By maceration in water or a weak alkaline solution, Iceland moss may be deprived of its bitter principle; and it is then used as a mild nutritive demulcent. CHONDRUS. Chondrus crispus, Carrageen or Irish Moss {Nat. Ord. Algae), is a marine alga found chiefly on the west coast of Ireland, and also on the coast of New England ; it is prepared for use by washing, bleaching, and drying. It is also prepared from 533 MATERIA MEDICA TOPICAL MEDICINES. Chondrus mammilosus. As found in the shops it consists of fronds from two to three or four inches long, mostly yellowish or dirty-white but intermixed with purplish-red portions, nearly inodorous, and of a mucilaginous taste. It swells up in warm water, and is almost entirely dissolved when boiled. Its chief constituent is a peculiar mucilaginous principle, for which the term Carrageenin has been proposed ; and it contains also some mucus, resins, etc. Effects and Uses. — It is a very agreeable nutritive demulcent, Fig. 46. CHONDRUS CRISPUS. useful in bowel complaints and pectoral affections. It may be given in the form of decoction (Sss to water Oiss boiled to Oj) flavored with lemon-juice and sugar; or it may be made with milk or cream into blanc-mange, which forms an excellent light diet for the sick. By saturating two superimposed layers ol wadding with a solution of chondrus, and drying them in a stove after they have been submitted to strong pressure, a sheet of the consistence of cardboard is produced, which, when soaked in hot water, makes an excellent poultice. AMYLUM STARCH. This term is applied by the Pharmacopoeia to the fecula ot the seed of Triticum vulgare, the well-known wheat {Nat. Ord. DEMULCENTS STARCH. 539 Graminaceae). It is a proximate principle, however, which per- vades the vegetable kingdom, being found in various parts of plants, especially in seeds, tubers, and bulbous roots It, is obtained by bringing the substances in which it exists to a state of minute division, agitating or washing them with cold water, straining or pouring off the liquid, and allowing it to stand until the fecula which it holds in suspension has subsided. It occurs as a white, opaque, odorless, tasteless, powder, or in columnar masses of a crystalline aspect, and produces a peculiar sound when compressed between the fingers. It is insoluble in alcohol, ether, and cold water. Examined under the microscope, starch is seen to consist of minute circular or lenticular granules, the laminae of which are arranged around a central point or hilum, varying in size and shape in the different varieties of amylaceous substances. The diameter of the wheat granule is about 10 1 00 of an inch. The potato starch granule is the largest, that of barley the smallest. The envelope of these granules is insoluble in cold water, but is ruptured by heat, so that the interior portion is exposed and becomes dissolved; hence starch is said to be insoluble in cold, but soluble in boil- ing water. Starch is C 6 H 10 (\ and is classed with the carbohy- drates. By the action of heat, or by long boiling with diluted sulphuric or hydrochloric acid, it is converted into dextrin, an isomeric soluble principle, and by the same process this may be converted into grape sugar. The same change takes place in grains, after germination, through the agency of a nitrogenous principle termed diastase. The test for starch is iodine, which forms with starch-solution a rich blue iodide; with bromine starch strikes an orange precipitate ; nitric acid converts it into oxalic acid. Effects and Uses. — The starchy or farinaceous articles form an important group of nutrients. Their assimilation is effected by the albuminous principles of the digestive tube (salivin, pan- creatin, etc.), which change starch into grape sugar. This is converted in part into fatty tissue, and is partly fermented into lactic acid, which acts as a calefacient. Starch is used externally as a dusting powder to excoriated surfaces, as an emollient poul- tice, and in solution as a vehicle for laudanum as an enema. It is the antidote for iodine. 540 MATERIA MEDICA TOPICAL MEDICINES. Glyceritum Amyli (Glycerite of Starch) {Plasma) contains 10 per cent, of starch thoroughly mixed with glycerin and dissolved by the aid of heat. It is excellent as a vehicle for astringent applications in ophthalmic surgery, and as an application to allay heat, burning and itching of the skin in scarlatina and smallpox ; in the latter it is particularly pleasant to the patient, and has as much effect in preventing pitting as any other application (H. M.). It is used as a substitute for ointments, and is a good excipient for pills. Amylum iodatum (iodized starch) has been already spoken of (vide p. 431). Ichthyocolla (Lsinglass), prepared from the swimming bladder of Acipenser Huso (the sturgeon) and of other species " of Acipenser (Class, Pisces; Ord. Sturiones) is the purest form of gelatin. Court plaster (Emplastrum ichthyocollce) is made by coat- ing oiled silk with a solution of isinglass. Gelatin is also used as an article of diet, and is employed in pharmacy to make capsules for the administration of disagreeable liquid medicines, and as a coating for pills. For external use, the animal fats are employed as emollients. When applied externally, they are absorbed and assimilated, and increase the body weight ; hence inunctions have been practiced in wasting diseases, as phthisis, etc. They also reduce the tem- perature of the body in febrile conditions, and allay itching and irritation of the surface, and for this purpose they are employed in the exanthemata. They are also used as excipients for other medicines, in making ointments, etc. Adeps (Lard) is the prepared fat of Sus Scrofa (the hog) ; the internal fat of the abdomen is preferred, which is washed, melted and strained. Below the temperature of 90 it occurs as a soft, white solid, which for medicinal use should be free from saline matter. It consists of olein and stearin. It is used in pharmacy as an addition to poultices, and as an inunction in the exanthemata, particularly scarlatina. Cerate (ceratuni) is made by melting together 70 parts of lard and 30 parts of white wax. Unguentum (ointment) is made by melting together 80 parts of lard and 20 parts of yellow wax. Lard-oil (the olein of lard) is a good vehicle for anodyne enemata. DEMULCENTS CETACEUM. 54 1 Adeps benzoinatus (benzoinated lard), formerly termed ben- zoinated ointment, consists of benzoin 2 parts in ioo parts of lard. Lanolin (unofficinal), the description of which is based on the observations of Liebreich,* by whom it was introduced, Lassar,f Aubert,J W. G. Smith, || Kinner,§ and what we have observed, is the purified fat of sheeps' wool ; chemically, it is a fatty salt of cholesterin. It is not a secretion of the sebaceous glands, but a retrograde metamorphosis of keratin. It is neutral, of slight odor, not readily decomposed, blends easily with glycerin and fats, and has considerable capacity for mixing with water. Liebreich (loc. cit.) states that corrosive sublimate applied to the skin rubbed up with lanolin, soon produces a metallic taste in the mouth. Lassar (loc. cit) has shown, too, that cinnabar mixed with it penetrates more deeply into the skin than with other ointments. Aubert (loc. cit.), on the other hand, affirms that he was unable to obtain the constitutional effects of atropine in lanolin rubbed on the skin; in fact, he considers it retards, rather than accelerates, absorption, so that the matter cannot so far be considered as definitely settled. It is an excellent excipient with which to apply medicines to the skin ; to assist the removal of scales, as in psoriasis ; to Rubricate the cracks and fisures of eczema after the acute stage has been passed, and, in fact, wherever an unirritating, undecomposable ointment is indicated. It may be diluted with other fats and flavored with oil of lavender. Sevum (Suet) is the internal fat of the abdomen of Ovis Aries (the sheep) (Class, Mammalia; Ord., Ruminantia), puri- fied by melting and straining. It is composed almost exclusively of stearin, but also contains some palmitin, olein and hircin. Cetaceum (Spermaceti) is a peculiar concrete fatty sub- stance obtained from Physeter macrocephalus or sperma- ceti whale (Class, Mammalia; Ord., Cetacea). It consists almost entirely of cetyl palmitate (C 16 H3 3 C 16 H 31 02) or cetin, but * Berlin. Klinische Wochen., No. 47, p. 761. f Ibid., No. 5, p. 75. % "Congres de Chirurgie" Paris, 1886, quoted. || Brit. Med. Jour., 1886, p. 1106. \ Journ. of Cutaneous and Venereal Diseases, 1886, p. 270. 542 MATERIA MEDICA TOPICAL MEDICINES. recently has been shown to contain also ethers of stearic, myristic and laurostearic acids ; and of the alcohols, lethal (C^H^O), methal (Ci 4 H 30 O), ethal (C 16 H 34 ) and stethal (C 18 H 3i O). Spermaceti cerate (ceratum cetacei) is made by melting together 10 parts of sper- maceti and 35 parts of white wax, and then adding 55 parts of olive oil, previously heated. Ointment of rose-water (see p. 188) contains spermaceti. Cera Flava ( Yellow Wax) is a peculiar concrete substance ' prepared by Apis mellifica, the honey bee {Class, Insecta ; Ord. Hymenoptera). Cera Alba ( White Wax) is yellow wax bleached. They are used chiefly in making cerates, ointments and plasters. ACIDUM OLEICUM OLEIC ACID. Oleic acid (HC 18 H 33 2 ) exists in nature combined with gly- cerin as olein. It is obtained in an impure state as a secondary product at stearin candle manufactories. To purify the acid, it is cooled to 14 F. and expressed; the solid portion melted and treated with lead protoxide ; the lead oleate is dissolved out by ether, decanted, and shaken with hydrochloric acid, which decomposes it ; the ethereal layer is decanted and evapo- rated. The oleic acid thus obtained is still contaminated with a little oxyoleic acid, which is difficult to separate. Oleic acid is a yellowish oily liquid, which becomes brownish and rancid by exposure to the air, without smell or taste, soluble in alcohol and ether, but insoluble in water. The oleates of the alkaline metals are soft soluble soaps ; those of the earthy metals are insoluble in water, but soluble in alcohol and ether. Oleic acid is used principally in preparing the oleates of vera- trine (vide p. 237) and of mercury {vide p. 413). OLEUM THEOBROM.E OIL OF THEOBROMA. This oil, commonly known as Butter* of Cacao, is the fixed oil expressed from the seed of Theobroma Cacao (Nat. Ord. Sterculiaceae), a handsome tree, from twelve to twenty feet in height, growing in Mexico, the West Indies, Central America and South America. The fruit is an ovate-oblong capsule or berry, half a foot in length, with a thick, coriaceous, ligneous DEMULCENTS GLYCERIN. 543 rind, inclosing a whitish pulp, in which numerous ovate seeds are embedded, about the size of an almond. Separated from the matter in which they are enveloped, these constitute the chocolate-nuts of commerce (see p. 122). They contain fixed oil {cacao butler), theobromine, and other matters. Theobromine is a nitrogenous alkaloid, analogous to caffeine. Cacao butter is obtained by expression, decoction or the action of a solvent. It occurs in whitish or yellowish oblong cakes, of the consist- ence of tallow and of an agreeable odor and taste. It con- tains a large proportion of stearin, also palmitin and olein. It is used in pharmacy for coating pills, and also largely in pre- paring suppositories, for which it is well adapted from its consistence and blandness. It may be used with advantage as an unguent in fevers, to reduce the heat and allay the cutaneous irritation. GLYCERINUM GLYCERIN. This is a substance which exists in oils in combination with the fatty acids (stearic, margaric, oleic, etc.), and is liberated from them when they unite with bases in the process of saponi- fication. It was first obtained in the process for making lead- plaster, by mixing litharge (lead monoxide) with olive oil and boiling water, by which the fatty acid unites with the lead and is precipitated, and the glycerin remains in solution. It is freed from any lead it may contain by means of a stream of sulphuretted hydrogen gas, and is afterward filtered through animal charcoal ; or, as it is now usually made more directly, by decomposing fats and distilling by steam under high pres- sure. Glycerin (C 3 H 5 3HO), or Glyceric Alcohol, is the hydrate of Glyceril, Glycil, or Property I, and is a triatomic alcohol. It is a thick, syrupy liquid, colorless or straw-colored, unctuous to the touch, inodorous, of a sharp, sweet taste, and of neutral reaction. When pure its sp. gr. is 1.260, when it contains 95 per cent, of absolute glycerin ; the Pharmacopoeia directs its sp. gr. to be 1.250. It is soluble in alcohol and water, but is insoluble in ether and chloroform, and does not evaporate when exposed to the air, but absorbs one-half its weight of water. It readily reduces potassium permanganate, with which it is incompatible. It has remarkable solvent properties, dissolving iodine, bromine, the alkalies, tannic and other vegetable acids, 544 MATERIA MED1CA TOPICAL MEDICINES. a large number of neutral salts, and many organic principles. Officinal solutions of medicinal substances in glycerin are termed glyccrites (glycerita). Effects and Uses. — Glycerin is a bland and unirritating sub- stance. It has the capacity of diffusing itself freely over and through organic matter, incorporating itself between organic molecules, by which it is absorbed and appropriated. It has been used internally as a nutrient and demulcent, and has been deemed of value in cachectic, strumous and asthenic conditions in children, but the weight of opinion is against its efficacy as an alterative. It is as a topical application that it is chiefly employed. As an enema in dysentery, to soften hardened mucus in the air passages, in various cutaneous affections, in diphtheria, in deafness attended with dryness of the meatus, and as a vehicle or solvent for active medicines, glycerin is a valuable article. Guzzo * recommends the following treatment to prevent extensive cicatrization following burns : apply to the entire burned surface a piece of lint thickly spread with cold cream and covered with a compress two inches thick saturated with glycerin (freshly wet from three to six times a day ; the whole dressing to be changed daily), and covered with a dry compress and bandage. This treatment failed in only one of fifty-two cases. f Quite recently attention has been called to small rectal injec- tions of glycerin (f<5^- j) as a safe, sure, and speedy means of open- ing the bowels. It seems to act by irritating the sentient rectal nerves, leading to powerful reflex peristalsis, which ends in defe- cation (Althaus, \ Anacher § and Mayer \), The liquid may be introduced by a rubber urethral syringe. Glyceritiim amyli (glycerite of starch) has been already consid- ered (vide p. 540). Glyceritiim vitelli (glycerite of yolk of eggs) (glyconin) is made by mixing thoroughly 45 parts of fresh yolk of egg with 55 parts of glycerin. It is a good vehicle for the administration of cod- liver oil, a few drops of some aromatic being added as a flavor- ing ingredient. * Gaillard's Med. J., March, 1882. f Arch. Dermal., Oct., 1882. %Brit. Med. J., Dec. 24, 1887, p. 1379. I Deals. Med. Wochen., Sept. 15, 1887, p. 823. ^ Med. Nezvs, Feb. 25, 1888, p. 201. DEMULCENTS PYROXYLIN. 545 PETROLATUM. Petrolatum is a mixture of hydrocarbons obtained by distilling the lighter and more volatile portion from American petroleum, and purifying the remainder. Mineral oils have been known from time immemorial, and were obtained by the ancients from Sicily, the Ionian Islands and Persia ; later they were found in various parts of Europe, Asia and North America, but did not become an important article of commerce until 1859, wnen the first oil- well was sunk near Titusville, in Pennsylvania. Petrolatum is a yellowish, transparent, semi-solid fatty substance, melting at from 104 to 124 F., insoluble in water and cold alcohol, more so in boiling absolute alcohol ; readily soluble in ether, chloroform, oil of turpentine, benzin, and the fixed and volatile oils. It consists principally of the hydrocarbons of the marsh-gas series. It has been introduced into the Pharmacopoeia as a substitute for vase- line, cosmoline, and other copyrighted preparations, which consist of mixtures of paraffine and the heavier petroleum oils, and, like them, possesses the advantage over the animal oils and fats of not becoming rancid. Effects and Uses. — When taken internally, in large doses, petro- leum is said to cause giddiness and oppression, with palpitation and headache. It seems to be well borne by the stomach, and causes no diarrhcea. It is principally used externally as an unguent in scarlet fever and cutaneous affections, and forms an admirable basis for other ointments. It is an excellent dressing for wounds. PYROXYLI NUM PYROXYLIN. Pyroxylin, or Soluble Gun Cotton, is made by adding cotton to a mixture of nitric acid gradually added to sulphuric acid, and allowing it to macerate ; it is to be washed first with cold water, and then with boiling water, and after being drained on filtering paper it is dried by means of a water-bath. Pyroxy- lin has the appearance of ordinary cotton, but is harsh to the touch. It is insoluble in water and alcohol, but, when freshly prepared, it dissolves in ether, forming collodion ; it is liable to decomposition if kept for some time. 35 546 MATERIA MEDICA TOPICAL MEDICINES. COLLODIUM COLLODION. This is a solution of pyroxylin (4 per cent.) in stronger ether (70 per cent.) and stronger alcohol (26 per cent.). Collodion is a slightly opalescent, syrupy liquid, with a strong ethereal smell. By long standing it deposits a layer of fibrous matter, and be- comes more transparent ; this layer should be reincorporated by agitation before the collodion is used. When applied to the skin the solvent evaporates, and it forms a colorless, transparent, flexible and strongly contractile film. In this way it proves anti- phlogistic by driving the blood away from a part, limiting effusion and promoting absorption, and at the same time acts as an admi- rable emollient by protecting an inflamed surface from the action of the air. It is a useful application to ulcers, fissures and skin diseases, and erysipelatous parts. Marked improvement has fol- lowed its daily use in that disfiguring keloid of the face which sometimes follows smallpox (H. M.). It is used also in surgery as a substitute for adhesive plaster, and in pharmacy as a vehicle for other medicines. Iodized collodio?i (a very good solution of iodine for external application) contains from ten to twenty grains of iodine in a fluidounce of collodion. Collodium Flexile {Flexible Collodion) is made by mixing 92 per cent, of collodion, 5 per cent of Canada turpentine and 3 per cent, of castor oil. This is a softer, more pliable and more elastic preparation, useful in cases where the strongly contractile power of ordinary collodion is objectionable. It is a good application in eczema. Collodion, in all forms, is to be kept in well-stoppered bottles. Collodium Stypticum {Styptic Collodion) contains 20 per cent, of tannic acid, 5 per cent, of alcohol, 20 per cent, of stronger ether and 55 per cent, of collodion. It is an excellent styptic application. LIQUOR GUTTA-PERCHA SOLUTION OF GUTTA-PERCHA. This is a solution of 9 per cent, of gutta-percha in 91 per cent, of commercial chloroform. In preparing it lead carbonate is employed to free it from coloring matter. It is a clear, colorless or nearly colorless solution, and should be kept in well-stoppered glass vials. By the evaporation of the chloroform, this proves an admirable application to inflamed or abraded parts, in skin DEMULCENTS SUGAR. 547 affections, chaps, etc.; it is also an excellent protective coating to parts threatened with bed-sores or liable to excoriations, and for the retention of medicinal substances upon the skin, in dermal therapeutics, as chrysarobin (q. v.) to ringworm. LIQUOR SODII SILICATIS SOLUTION OF SODIUM SILICATE. This solution (commonly known as Solution of Soluble Glass) is made by fusing together fine sand and dried sodium carbonate, and dissolving the product in hot water. It is a semi-transparent, colorless, viscid liquid, without smell but having a sharp, alkaline taste, which, on drying, becomes a transparent glass-like mass. It has been used as a local application in erysipelas, but is chiefly used in making permanent dressings in the treatment of fracture. For this purpose it should be thoroughly applied on successive layers of the dressing to the part and allowed to harden. SACCHARUM SUGAR. Sugar is a principle diffused through the vegetable world under many forms, all distinguished by a sweet taste. They are divided into two chief groups — Cane Sugar and Grape Sugar. Cane-sugar is the product of Saccharum officinarum {Nat. Ord. Graminaceae), a native of tropical countries, cultivated most suc- cessfully in the West Indies, and to some extent in Louisiana. It has a general resemblance to Indian corn. The juice of the sugar-cane is extracted by crushing and expressing the stalks ; it is then boiled with quicklime, strained, and reduced by evapo- ration to a thick syrup, which is cooled and granulated in shal- low vessels. Raw sugar is refined by the agency of animal charcoal. Cane-sugar is made also in France from the beet-root. When pure, cane-sugar is white, crystallized in translucent, double oblique prisms, very sweet, soluble in one-third its weight of water, in alcohol, but not in ether. At a heat of 220 F. it melts and cools into a glassy, amorphous mass, known as barley- sugar ; from a strong solution it can be made to crystallize slowly upon a string as rock-candy. The uncrystallizable portion, which is drawn off in the granu- lation of sugar, is molasses or treacle, a dark, brownish-black ) syrupy liquid. Grape-sugar is the sugar of grapes and other acid fruits ; it 54-8 MATERIA MEDICA TOPICAL MEDICINES. is also found in the liver and blood of mammalia, and in the urine of diabetes mellitus. It may be procured artificially by acting on starch with diluted sulphuric acid. It occurs as whitish or grayish-white, non-crystalline masses, or as a dense transparent syrup. Cane-sugar (C 12 H 2 20 U ) combines with alkalies to form saccha- rates. Grape-sugar (C 6 H ]2 6 .H 2 0), when boiled with an alkali, is transformed into the acid of molasses, melassic acid ; mixed with solution of potassa and a weak solution of cupric sulphate, it attracts oxygen, and causes the precipitation of a reddish, cuprous oxide (Cu 2 0). Effects and Uses. — Sugar, especially in the form of barley- sugar, is an excellent demulcent to relieve catarrhal irrita- tion ; much of the cough-relieving action of cough-syrups is due to the sugar they contain. It abates thirst, and is used to flavor refrigerant drinks. For pharmaceutical purposes sugar is much employed, for its agreeable taste, and also as a pre- servative of vegetable substances, and to protect mineral medi- cines from oxidation. Molasses is slightly laxative as well as demulcent. Mel {Honey). This saccharine liquid, the familiar product of the bee (Apis mellifica), best used in the form of mel despu- matum {clarified honey) y is a slightly laxative article of food, and is used in pharmacy, and as an agreeable demulcent ingredient in gargles. Saccharum Lactis {Sugar of Milk) (C^f^On-H^O), the saccharine principal of milk, obtained from whey, is used as a bland non-nitrogenous article of diet. It is used in preparing abstracts and to insure the admixture of powders, as in pulvis ipecacuanhce et opii. SACCHARIN* (UNOFFICINAL). This, a recently introduced therapeutic agent, is a product of the coal-tar derivatives, being derived from the aromatic group of hydrocarbons, and is chemically anhydro-orthosulphamin- * Brit. Med. Journ., Oct. 15th, 1887. DEMULCENTS CHARCOAL. 549 benzoic acid (Fahlberg*). It is a white, crystalline powder, un- alterable at ordinary temperatures, of an acid reaction, slightly soluble in cold water, dissolves in alcohol, glycerin and ether, and unites with the alkalies to form definite salts. Its most characteristic property is sweetness, saccharin being in this re- spect about 300 times greater than that of cane-sugar. Effects and Uses. — When taken internally, even in large quan- tity (5ss-gr. lxxx), it is innocuous. Dogs fed on it together with their ordinary diet, according to Egasse,f did not increase in weight, nor was any alteration either in the quantity, specific gravity, or proportion of urea in their urine, found. It passes through the economy undecomposed, since it can be detected in the urine unchanged, but it has not been discovered in the saliva or feces. In its exit by the kidneys it exerts a decided influence in restraining the alkaline fermentation of the urine. It is chiefly employed as a substitute for sugar in obesity, and in diabetes mellitus, gr. j-ij being sufficient to sweeten the tea, coffee, sugar or food; and as a corrective of the taste of certain bitter medicines, as quinine (q. v.). CARBO LIGNI CHARCOAL. Although not strictly ranking with demulcents, the medicinal uses of charcoal may, perhaps, be appropriately noticed under this head. Charcoal is prepared by the exposure of wood to a red heat without access of air. For medicinal purposes the charcoal prepared from young willow-shoots for the manu- facture of gunpowder is preferred. It is a black, shining, brittle, porous substance, without odor or taste, and insoluble in water. Effects and Uses. — It is employed internally as an absorbent of acrid secretions, in dyspepsia (in which it is often very useful), in gastric irritation, diarrhoea and dysentery ; dose, from one to four teaspoonfuls. Externally it is used with effect to absorb the offensive gases given off from foul sores, in the form of poultice, mixed with flaxseed meal, or with bread-crumb, which is * Amer. Chem. Journ., 1879; Vol. I, p. 436. f Bull. Gen. de Therap., Oct. 30th, 1888, p. 337 ; an elaborate article. 550 MATERIA MEDICA TOPICAL MEDICINES. better from its porosity ; dry charcoal is sprinkled with advan- tage over sloughing ulcers, and appears to promote the separation of the sloughs. ORDER IV. COLORING AGENTS. These are employed exclusively for pharmaceutical pur- poses. The following articles enter into officinal preparations, to which they are intended to communicate their peculiar color : — CROCUS SAFFRON. This is the stigmas of Crocus sativus [Nat. Ord. Iridacese), a small perennial plant, a native of Greece and Asia Minor, but now cultivated all over Europe and in our own country. In Lancaster county, Pennsylvania, it has been raised to consider- able extent. The stigmas are an inch or more in length, of a rich deep orange color, a peculiar aromatic odor and a warm» pungent, bitter taste ; they contain a principle termed saffranin or polychroit (C 48 H 60 O 18 ). Saffron is now admitted to possess little, if any, medicinal activity, and is used only to impart color and flavor to officinal preparations. The tincture contains 10 per cent, of saffron. SANTALUM RUBRUM RED SAUNDERS. This is the wood of Pterocarpus santalinus, a large tree of India and Ceylon (Nat. Ord. Leguminosae). It comes in round- ish or angular billets, internally of a blood-red color, externally brown, of little smell or taste ; in the shops it is found in the form of chips, raspings or coarse powder. It contains a resinoid matter, santal (C 8 H 6 3 ), pterocarpin (C 17 H 16 5 ) and santalic acid. It is employed solely to give color to spirits and tinctures. COCCUS COCHINEAL. This is an insect, termed Coccus cacti (Class, Insecta; Ord. Hemiptera), of Mexico and Central America, naturalized in Teneriffe and other places. The female insect, dried, consti- tutes the article of the shops. It occurs in the form of roundish or somewhat angular grains, about an eighth of an inch in diameter, convex on one side, concave or flat on the other, and wrinkled. Two varieties are distinguished, one ANTHELMINTICS SPIGELIA. 55 I reddish-gray, the other nearly black, known as silver grains and black grains. It has a faint, heavy odor and a bitter, slightly acidulous taste ; its coloring principle is carminic "acid (C 17 H 18 O 10 ). Cochineal has had antispasmodic virtues attributed to it, and has been used in whooping-cough, especially in combination with potassium carbonate; dose, to infants, gr. */} t. d. It is employed chiefly, however, to color tinctures and ointments. ORDER V. ANTHELMINTICS. Anthelmintics are medicines which promote the destruc- tion and expulsion of worms from the alimentary canal. When a medicine simply causes the expulsion of the parasite it is called a vermifuge ; when it causes the death of the worm, a vermicide. They act in different ways ; some weaken or destroy the worms by a direct poisonous influence, others by mechanical means. The drastic cathartics have an anthel- mintic effect from the increased secretion and exhalation which they induce from the alimentary canal. SPIGELIA. Spigelia, called also Pinkroot, is the rhizome and rootlets of Spigelia marilandica, or Carolina Pink {Nat. Ord. Logan- iaceae), an herbaceous indigenous plant, found chiefly in our southern and southwestern States. The rhizome is horizontal, thick, bent, purplish-brown, branched on upper side with cup- shaped stars, on the low r er numerous thin, brittle, light-colored rootlets. It must not be confounded with the under-ground por- tion of the Phlox Carolina, also called Carolina pink. The stems are numerous, from a foot to a foot and a half high, of a purplish color, furnished with sessile, opposite, ovate-lanceolate leaves, and terminate in spikes, bearing funnel-shaped flowers, of a rich carmine color externally and orange-yellow within, which appear from May to July. The rhizome and rootlets, as found in the shops, consist of numerous slender, wrinkled, branching, brownish fibres attached to a dark-brown caudex, and have a faint, peculiar smell and a sweetish, slightly bitter taste; their activity is diminished by time. Boiling water extracts its virtues, 552 MATERIA MEDICA TOPICAL MEDICINES. which are thought to depend upon a bitter principle ; it contains also volatile oil, resin, a little tamiic acid, etc. Effects and Uses. — In ordinary doses spigelia often proves anthelmintic without any sensible effect on the system. In Fig. 47. SPIGELIA MARILANDICA. larger doses it purges and sometimes vomits; and in excessive doses it operates as a narcotic, producing vertigo, dilated pupils, flushing of the face, etc. The following results were obtained by ANTHELMINTICS CHENOPODIUM. 553 Hare* with spigelia on dogs. Three ounces of the fluid extract caused constant retching, pupillary dilatation, internal strabismus, rapid respiration, progressive muscular palsy, coma and death. Injected into the veins it slowed the heart's action, the retarda- tion being chiefly due to central inhibitory stimulation. As death approaches, its depressing action on the respiratory centre is marked. It is less apt to occasion narcotic effects when it acts on the bowels, and hence it is usually combined with or followed by cathartics. As an anthelmintic against lumbrici (or round worms) it is considered the most reliable article we possess. Administration. — Dose of the powdered root, 5j-ij for *an adult; for a child three or four years old, gr. x-xx, to be repeated night and morning for three or four days, and fol- lowed by a brisk cathartic; calomel is sometimes combined with it. The fluid extract may be given in the dose of f5j or more; to a child two years old, ten drops may be given. Under the name of worm-tea, preparations containing spigelia and cathartics are kept in the shops, as in the following formula : spigelia, §ss ; manna, o) ; senna and fennel, each 5ij ; savine, gr. xl; to be infused in Oj of boiling water, and f§ss given to a child two years old, t. d. CHENOPODIUM. Chenopodium, or American Wormseed, is the fruit of Che- nopodium ambrosioides, or Jerusalem Oak {Nat. Ord. Chenopo- diaceae), an indigenous, herbaceous, perennial plant (found most abundantly in the southern States), from two to five feet high, with alternate oblong-lanceolate, sinuated and toothed yellowish- green leaves, with numerous small flowers of the same color arranged in long terminal panicles. Chenopodium, as found in the shops, is in small spherical grains, not larger than a pin's head, of a dull greenish-yellow or brownish color, a peculiar offensive smell, and a rather aromatic, pungent taste. Their sensible and medicinal properties are owing to a volatile oil (Oleum Chenopodii), obtained by distillation. Effects and Uses. — Chenopodium is a very efficient anthelmintic, *Med. A r ews, March 12, 1887. 554 MATERIA MEDICA TOPICAL MEDICINES. particularly adapted to the expulsion of lumbrici from children. Dose, gr. xx-xl for a child two or three years old, in molasses, night and morning, for three or four days, to be followed by a Fig. 48. CHENOPODIUM AMBROSIOIDES. brisk cathartic. The oil is more used than the fruit ; dose, gtt. v-x for a child, in emulsion with sugar. The expressed juice of the leaves and a decoction made with milk are also used. ' SANTONICA. The unexpanded flower-heads of Artemisia maritima {Nat. Ord. Compositse), a native of Persia, and of other species of arte- misia, are used as an anthelmintic (in the dose of gr. x-xxx), under the name of Levant Wormseed. They resemble small seed in ANTHELMINTICS SANTONICA. 555 appearance, are about a line in length, oval, obtuse at both ends, of a greenish-brown color, a strong, somewhat terebinthinate odor, and a bitter, camphoraceous taste. They contain volatile oil, resin, and a peculiar principle termed santonin, which is pre- pared by digesting santonica and lime in diluted alcohol, adding acetic acid, crystallizing, boiling with alcohol, digesting the tinc- ture with animal charcoal, filtering and crystallizing. Santoninum {Santonin) is a neutral principle (C 15 H 18 3 ), and occurs in colorless, shining, flattened prisms, without smell, nearly tasteless at first, but after a time bitter ; it becomes yellow on exposure to the light. It is nearly insoluble in cold water, solu- ble in 250 parts of boiling water, in 40 parts of cold and 3 parts of boiling alcohol, and in 160 parts of ether, and is readily solu- ble in chloroform. This is the anthelmintic constituent of san- tonica, and is a most efficient anthelmintic for lumbrici ; but in large doses it is capable of producing serious if not fatal poison- ing,* gr. vj having killed a child aged 5 years thirty-five minutes after ingestion. Krauss f experimentally ascertained that it was absorbed by the blood, where it exists for a time undecomposed ; he states, too, that it affects the central nervous system, in small doses as a narcotic, in large as a tetanizer, the symptoms being (occasionally but not invariably) vomiting, giddiness, ocular scintillations, incoherence of ideas, stupor, coldness of the skin, with clammy perspiration, and, finally, tetanic convulsions. A remarkable effect of santonin, even in moderate amounts, is a change in the field of vision, so that objects are seen as if through a yellow medium. When allowed to remain in the system, san- tonin is supposed to be converted into a substance termed xan- thopsin, which is eliminated through the kidneys, producing a yellow discoloration of the urine ; and probably it is this trans- formation which gives rise to the poisonous symptoms occasion- ally noticed.^ Hence, santonin is best administered with calo- * " St. Thomas' Hosp. Reports," Vol. x. f Inaug. Diss., Tubingen, 1869., Ueb. d. Wirk. d. Santonins, etc. % Some persons would seem to be peculiarly susceptible to the action of this drug, as the editor has seen all the poisonous effects above described, except the convulsions, produced in a woman 35 years of age, to whom he had administered two doses of gr. ^ of Santonin with gr. j of Calomel, at an interval of 2 hours (H. M.). 55^ MATERIA MEDICA TOPICAL MEDICINES. mel or other purgatives. W. G. Smith* detected santonin in his own urine, but could not find it in the saliva. Dose, gr. ss-v two or three times a day, in the form of syrup, or in pill. Sodii Santoninas {Sodium Santoninate) (2NaCi5H 19 4 .7H 2 0) is made by adding santonin, as long as it is dissolved, to a hot solu- tion of caustic soda and allowing the liquid to evaporate slowly. It is rapidly absorbed after ingestion, appearing in the urine in half an hour. It produces effects similar to those of santonin, but of a milder grade (Krauss, loc. cit.). Trochisci Sodii Santoninatis (Troches of Sodium Santoninate) ; each troche contains gr. j of sodium santoninate, with sugar, tragacanth, and orange-flower water. azedarach. This is the bark of the root of Melia Azedarach, or Pride of China {Nat. Ord. Meliaceae), an Asiatic tree, cultivated exten- sively as an ornamental tree in our southern States. It has a bitter, nauseous taste, and yields its virtues to boiling water. Its effects are said to resemble those of spigelia. The decoction is the preferred form of administration (giv to water Oij, boiled to Oj) ; dose for a child, fSss every two or three hours, till it affects the stomach and bowels ; or night and morning for several days. ASPIDIUM. Aspidium filix-mas, or Male Fern, and A. marginale (Nat. Ord. Filices) are plants found in both hemispheres, from Green- land to Natal, and from Japan to Peru, though not indigenous in the eastern United States. They have a perennial horizontal root, from which spring numerous annual oval, lanceolate, acute, bright-green pinnate fronds or leaves, from a foot to four feet in height, grouped together in the form of a base ; the leaflets are deeply lobate, oval, crenate at their edges, and gradually diminish from the base of the pinna to the apex. The rhizome is the portion used. It is a long, cylindrical caudex, covered with por- tions of the stipes, and as found in the shops it is generally broken into fragments, of a brown color externally, internally yellow- ish-white or greenish, with a peculiar feeble odor and a sweetish, * Dublin Quart. Journ. of Med. Set., 1 870, p. 296. ANTHELMINTICS POMEGRANATE. 557 bitter, astringent, nauseous taste. It deteriorates by keeping. It contains jilicic acid (Ci 4 H 18 5 ), on which its medicinal properties are said to depend ; also volatile oil, fixed oil, resin, tannic and gal- lic acids, etc. ; ether is the best solvent to extract its virtues. Besides the above, Daccomo * has recently isolated a waxy sub- stance (Ci 3 H 26 0), Aspidol (C20H34O), and two resins. He failed to find the essential oil obtained by Schoonbroodt.f Effects and Uses. — Aspidium possesses tonic and astringent properties ; but its chief use is to cause the expulsion of taenia, which it destroys by a specific action. J. Harley % states that it does not kill the entozoon, but simply detaches it from the intes- tinal wall, and causes its evacuation by the force of the peristaltic contractions induced by its action. Its efficacy in this respect has been long and well attested, but it is most used to destroy the Swiss variety of taenia (bothriocephalus latus). Recently a fatal case of poisoning § by aspidium has been reported, with symptoms of choleraic diarrhoea. The patient was given 5j }4, of an ethereal extract by mistake. The post-mortem appearances were intense congestion of the stomach, with ecchymoses beneath the mucous membrane and blood-clots on the mucous surface. Dose, of the powder, 5j-iij, in electuary or emulsion, night and morning for one or two days. The oleo-resin {oleoresina aspidii) is the best preparation ; it is a dark, thick liquid, of a bitterish, nauseous, slighly acrid taste ; dose, f 5ss-j night and morning for a day or two, to be followed by a cathartic. The administration of the taeniacide agents should always be preceded by a twenty- four hours' fast. GRANATUM POMEGRANATE. The bark of the root of Punica Granatum is used for the expulsion of taenia. It contains pelletierine (C 8 H ]5 NO), which, according to the later researches of its discoverer, M. Tanret, || is a compound body, consisting of several alkaloidal principles. In large doses it is said to cause paralysis of the motor nerves, without affecting sensation, and to cause dilatation of the capil- *" Annali di Chimica," Agosto, 1887, p. 69. An elaborate investigation. f Jour, de Med. de Chir. et de Pharm., Bruxelles, 1868, p. 64. X" Royle's Materia Med.," p. 370. \ Lancet, Oct., 1882, p. 630. \Bull. Gen. de Therap., XCVin, p. 316. 558 MATERIA MEDICA TOPICAL MEDICINES. laries. It is an active taeniacide, but is apt to cause nausea and sometimes vomiting. Pelletierine tannate may be given in doses of gr. v-xv on an empty stomach, and is best preceded by a pur- gative. If the drug do not move the bowels, a brisk cathartic should follow its administration. Berenger-Feraud * recently Fig. 49. PUNICA GRANATUM. observes that the exhibition of a drastic, as jalap, or scammony, with pelletierine, decidedly aids this agent in the expulsion of taenia. Besides its tceniacide action, granatum is a powerful styptic. It is given in decoction (§ij to water Oij, boiled to Oj); dose, f 5ij or more. Oleum Terebinthin^e {Oil of Turpentine) (see p. 384) is used as a remedy for taenia and other worms. Dose, fSj, combined with or followed by castor oil. Calomel (see p. 414) is a valuable anthelmintic, given in cathartic doses. Brayera {Koosso). The female inflorescence of Brayera anthelmintica (Nat. Ord. Rosaceae), a native of Abyssinia, have been introduced into European practice as a remedy for taenia, under the name of Koosso, They occur in broken, compressed clusters, of a greenish-yellow color, a fragrant balsamic odor, and a faint taste which after a time becomes acrid and disagree- able. They are said to impart their virtues best to hot water, and to yield gum, resin, fatty matter, tannic acid, and about three per cent, of a peculiar principle termed kosin, a yellow-white crystalline resin, without smell or taste, to which its anthelmintic Bull. Gen. de Therap., Aout. i5*ieme ) p. 120, i< ANTHELMINTICS PUMPKIN-SEED. 559 properties are attributed (Bedell *). They are given best upon an empty stomach, after a previous evacuation of the bowels, in infusion (6 parts of the powder with ioo parts of boiling water). Extr actum Brayerce Fluidum [Fluid Extract of Br ay era) ; dose, f5ij-iv. KAMALA. This is the glands and hairs obtained from the capsules of Mallotus philippinensis {Nat. Ord. Euphorbiaceae), a small tree of Hindostan and the East India islands. It is an orange-red, granular, inflammable powder, with little smell or taste, insol- uble in cold and nearly so in boiling water, forming, with alco- hol, ether or chloroform, red solutions, due to the extraction of the resin. It consists chiefly of resinous substances, to one of which, soluble in ether, and considered the active constituent, the name of rottlerin (C 2 2H2o0 6 ) has been given. Uses. — Kamala (formerly called Rottlerd) is a highly-esteemed tceniacide in India, and has been introduced into Europe and our own . country. Dose of the powder, 5j-ij, suspended in syrup. A tincture (Syj to alcohol Oj) is given in the dose of f 3j-iv. Castor oil should be taken after the medicine. PEPO PUMPKIN-SEED. The seed of Cucurbita Pepo, or common Pumpkin (Nat. Ord. Cucurbitaceae), is probably the most efficacious remedy Fig. 50. CUCURBITA PEPO. A. Divided. B. Entire. known in the expulsion of tape-worm. These seeds are oval, flattish, grooved, 9 lines long by 5 or 6 in breadth, of a light *" Biennial Retrosp., etc., New Syd. Soc.," 1867-8, p. 475. 560 MATERIA MEDIC A TOPICAL MEDICINES. brownish-white color, a sweetish, oily taste, and aromatic smell. They owe their activity to a principle soluble in ether, chloro- form, and especially alcohol. Dose, §j— ij of the fresh seeds, de- prived of their outer envelope, beaten to a paste with finely- powdered sugar, and diluted with water or milk, may be taken after a twenty-four hours' fast, and followed in two or three hours by a dose of castor oil. A fluid extract, made with alco- hol and glycerin, is probably the best preparation; dose, f §ss-j. APPENDIX SIGNS AND ABBREVIATIONS USED IN PRESCRIPTIONS. R , Recipe, take. aa, Ana (ava), of each, lb, Libra, librce, a pound, pounds. 5j , Uncia, uncice, an ounce, ounces. g , Drachma, drachmce, a drachm, drachms. ^ , Scrupulus, scrupuli, a scruple, scruples. O, Octarius, octarii, a pint, pints, f^ , Fluiduncia, fluiduncice, a fluidounce, fluidounces. f 3 , Fluidrachma, fluidrachmcz, a fluidrachm, fluidrachms. TTL, Minimum, minima, a minim, minims. Ad 2 Vic, v^ dW.? z/zV&r, at two takings. Ad Lib., Ad libitum, at pleasure. Add., Adde, addantur, add, let be added. Altern. Horis, Alternis horis, every other hour. Aq. Destil., Aqua destillata, distilled water. Aq. Ferv., Aqua fervens, hot water. Aq. Fluvial., Aquafluvialis, river water. Aq. Font., Aqua fontana, spring water. Aq. Pluv., Aqua pluvialis, rain water. Bis Ind., Bis indies, twice a day. Bull., Bulliat, bulliant, let it or them boil. Cap., Capiat capiendum, let the patient take it ; it must be taken. Chart., Chartula, chartulce, a small paper, or papers. COCHLEAT., Cochleatim, by spoonfuls. Coch. MAG., Cochleare magnum, a tablespoonful. Coch. Med., Cochleare medium, a dessertspoonful. COCH. Parv., Cochleare parvum, a teaspoonful. Col., Cola, coletur, strain, let it be strained. Collyr., Collyrium, an eye- water. Comp., Compositus, compounded. Cong., Congius, Congii, a gallon, gallons. C. M. S., Cras mane sumendus, to be taken to-morrow morning. C. N., Cras node, to-morrow night. Decoc, Decoctum, a decoction. De D. in D., De die in diem, from day to day. Dieb. Alter. , Diebus Alternis, every other day. DiL., Dilue, dilutus, dilute, diluted. Dim., Dimidius, one-half. Div., Divide, divide. D., Dosis, a dose. Elec., Electuarium, an electuary. Enem., Enema, enemata, a clyster, clysters. Exhib., Exhibeatur, let it be administered. F. H., Fiat haustus, let a draught be made. Fil., Filtra, filter. 36 561 562 APPENDIX. Ft., Fiat, Ji ant, let there be made. Garg., Gargarysma, a gargle. Gr., Gramwi, grana, a grain, grains. Gtt., Gutta, guttcE, a drop, drops. Guttat., Gtittatim, by drops. Haust., Hanstus, 2l draught. Ind., Indies, daily. Inf., Infunde, pour in. Infus., Infustim, an infusion. Inj., Injiciatur, let it be injected. Jul., Julepus, julepum, a julep. M., Misce, mix. Mane, in the morning. Mist., Mistura, a mixture. Mic. Pan., Mica panis, crumb of bread. No., Nui7iero, in number. Omn. Hor., Omni hora, every hour. Omn. Bid., 0??ini bidtw, every two days. Omn. Bih., Omni bihora, every two hours. Omn. Man., Omni mane, every morning. Omn. Nocte, Omni node, every night. Omn. Quadr. Hor., Omni quadrante horce, every quarter of an hour. Ph., Pharmacopoeia. Pocul., Poculum, a cup. P. R. N., Pro re nata, as the symptoms may call for. Pl?lv., Pulvis, a powder. Q. P., Quantum placeat, as much as you please. Q. S., Quantum sufficit, enough. Quor., Quorum, of which. Redig. in Pulv., Redigatur in pulverem, let it be reduced to powder. Repet., Repetattir, repetantur, let it or them be repeated. S., Signa, write. S. A., Secundum art em, according to art. Semih., Semihora, half an hour. Sign., Signatura, a label. Ss., Semis, a half, Sum., Sume, sumendus, let it be taken. Tabel., Tabella, a lozenge. Troch., Trochiscus, a lozenge. Trit., Trittira, triturate. INDEX Abbreviations, table of, 561 Abies balsamea, 382 canadensis, 51 1 excel sa, 510 picea, 510 Abscesses ; application of remedies to, Absinthe, 140 Absinthin, 1 40 Absnthium, 140 Absinthol, 140 Abstract of aconite, 232 belladonna, 93 conium, 280 digitalis, 273 hyoscyamus, 97 ignalia, 257 jalap, 344 nux vomica, 257 podophyllum, 347 senega, 380 valerian, 120 Abstracta, 50 Abstracts, 50 Abstractum aconiti, 232 belladonna, 93 conii, 280 digitalis, 273 hyo?cyami, 97 ignatise, 257 jalapse, 344 nucis vomicae, 257 podophylli, 347 senegae, 380 Valerianae, 120 Acacia, 528 Catechu, 182 Verek, 528 Aceta, 56 Acetanilide, 482 Acetaphone, 87 Acetate of ammonium, solution of, 247 copper, 196 iron, solution of, 166 tincture of, 166 lead, 192 morphine, 83 potassium, 366 sodium, 366 zinc, 197 Acetic acid, 249, 353 69 Acetic acid, diluted, 249 glacial, 249 extracts, 57 Acetophenone, 87 Acetum lobeliae, 296 opii, 83 sanguinariae, 315 scillae, 369 Acid, acetic, 249, 353 aconitic, 227 anemonic, 237 angelic, 310 anthemic, 138 arabic, 529 aromatic sulphuric, 170 arsenious, 439, 521 artanthic, 392 benzoic, 397, 398, 475, 485 boheic, 121 boracic, 471 boric, 471 butyric, 353 cafteic, 121 caffeo tannic, 121 cambogic, 351 camphoric, 117 camphoronic, 117 cantharidic, 514 carbolic, 474, 476 carbonic, 528 carminic, 551 catechu-tannic, 183 cathartic, 340 cetraric, 537 chelidoninic, 348 chromic, 520 chrysophanic, 336, 524 cincho-tannic, 143 cinnamic, 217, 397, 398 citric, 249, 250 cocatannic, 122 columbic, 134 copaivic, 388 cornic, 153 cubebic, 390 cyanhydric, 296 diluted acetic, 249 hydrobromic, 291 hydrochloric, 172 hydrocyanic, 296 563 564 INDEX. Acid, diluted muriatic, 172 nitric, 171 nitro-hydrochloric, 173 nitre-muriatic, 173 phosphoric, 174 sulphuric, 170 ergotinic, 262 eruic, 508 eugenic, 218 euonic, 349 ferulaic, 113 filicic, 557 formic, 283 gallic, 180, 186 gelseminic, 305 gentisic, 133 glacial acetic, 249 guaiacic, 362 guaiaconic, 362 guaiaretic, 362 gummic, 529 hippuric, 486 bydrobromic, diluted, 291 hydrochloric, 172 hydrocyanic, 296, 299 igasuric, 252 ipecacuanhic, 313 juglandic, 337 kinic, 143 kino-tannic, 183 kinovic, 143 kramero tannic, 184 lactic, 174 lobelic, 294 margaric, 543 meconic, 74, 76 mercurial nitrate, 410, 423, 522 meta-benzoic, 475 mimo-tannic, 179 muriatic, 172 nitrate of mercury, 410, 423, 522 nitric, 171 nitro-hydrochloric, 1 73 nitro-muriatic, 173 oenanthic, 210 oleic, 542, 543 ophelic, 136 ortho-benzoic, 475 para-benzoic, 47,5 phenic, 476 phosphoric, 174 podophyllinic, 346 polygalic, 379, 380 polygonic, 402 potassium tartrate, 334, 366 sulphate, 508 prussic, 296 pyroligneous, 385, 480 querci-tannic, 185 quillaiac, 380 quinine sulphate, 150 Acid, rheo-tannic, 336 rheumic, 336 ricinic, 324 salicylic, 322, 475, 489 santalic, 550 sclerotic, 261, 266 sphacelinic, 262 stearic, 543 succinic, 130, 348 sulphuric, 169 sulphurous, 470 tannic, 178, 179, 185, 187 tartaric, 250 thebolactic, 74 tiglinic, 353 toxicodendric, 259 tropic, 93 valerianic, 119, 308, 310, 353 Acida mineralia, 169, 523 vegetabilia, 248 Acids, mineral, 169, 523 vegetable, 248 Acidum aceticum, 249 dilutum, 249 glaciale, 249 arseniosum, 439, 521 benzoicum, 485 boricum, 471 carbolicum, 476 crudum, 476 chromicum, 520 citricum, 250 gallicum, 180 hydrobromicum dilutum, 291 hydrochloricum, 172 dilutum, 172 hydrocyanicum dilutum, 296 lacticum, 174 nitricum, 171 dilutum, 171 nitro-hydrochloricum, 173 dilutum, 173 oleicum, 542 phosphoricum, 173 dilutum, 174 salicylicum, 489 sulphuricum, 169 aromaticum, 170 dilutum, 170 sulphurosum, 470 tannicum, 179 tartaricum, 250 Acipenser Huso, 540 Aconine, 227 Aconite, 227 Japanese, 227 Aconitic acid, 227 Aconitine, 227, 232 Duquesnel's, 232 Aconitum, 227 Napellus, 227 INDEX. 565 Acorin, 220 Acorus calamus, 220 Acrinyl sulphocyanide, 508 Actual cautery, 39, 523 Acupuncture, 33, 36 Adeps, 540 benzoinatus, 397, 441 Adhesive plaster, 387 Adonidine, 273 Adonis vernalis, 273 jfLsculin, 305 ^Ether, 103 fortior, 103 African capsicum, 215 kino, 183 Age, influence of, on medicinal effects, 61 Alcohol, 55, 205 amylic, 205, 300 eery lie, 137 Alcohol, diluted, 55, 209 dilutum, 209 Alcoholate of chloral, 283 Alcoholic extract of belladonna, 93 conium, 280 hyoscyamus, 97 extracts, 57 potassa, 519 Aldehyd, benzoic, 299 of ethyl, 85 Alder buckthorn, 342 Ale, 211 Alexandria senna, 340 Algae, 537 Alkali, volatile, 211 Alkalies, 454 Alkaline carbonates, 363, 455 earths, 455 preparations, 455 sulphur ointment, 326 Allium, 381 sativum, 381 Allspice, 218 Allyl oxide, 38 1 sulphide, 381 sulphocyanide, 508 Almond mixture, 529 syrup, 300 Aloe, 337 Barbadensis, 338 capensis, 338 purificata, 339 Socotrina, 337 spicata, 338 vulgaris, 338 Aloes, 337, 399 Barbadoes, 338 Cape, 338 hepatic, 338 purified, 339 Socotrine, 338 Aloin, 338 Alterative diaphoretics, 360 Alteratives, 72, 403 Althaea, 533 officinalis, 533 Alum, 203, 319, 523 ammonio- ferric, 167 dried, 203, 204 whey, 204 A lumen, 203 exsiccatum, 204 Aluminii sulphas, 204 Aluminium sulphate, 204 Amber, 129 American hellebore, 232 hemp, 99 leech, 34 lettuce, 84 silver fir, 382 white turpentine, 382 American wormseed, 553 Amidogen, 474 Ammonia, 211 preparations of, 211 Ammoniac, 115, 399 plaster, 11G with mercury, 116, 409, 412 Ammoniacum, 115, 399 Ammoniae, aqua, 213 fortior, 212,517 linimentum, 213, 510 praeparata, 21 1 spiritus, 213 aromaticus, 213 Ammoniated glycyrrhizin, 535 mercury, 410, 420 tincture of guaiac, 363 valerian, 120 tinctures, 54 Ammonii acetatis, liquor, 247 benzoas, 486 bromidum, 290 carbonas, 213 chloridum, 450 purificatum, 450 iodidum, 430 phosphas, 452 praeparata, 462 valerianas, 120 Ammonio-ferric alum, 167 Ammonium alum, 203 benzoate, 486 bromide, 290 carbamate, 213 carbonate, 213 chloride, 450 iodide, 430 phosphate, 452 preparations, 462 sulphite, 471 valerianate, 120 elixir of, 120 (foot note) 566 INDEX. Amygdalate of tropine, 93 Amygdalin, 300 Amygdalus communis, 299 var. Amara, 299 Amyl hydrate, 300 nitris, 300 nitrite, 300 Amylic alcohol, 205, 300 Amylum, 538 iodatum, 431, 540 Anacardiaces, 383 Anaesthetics, 72, 102 local, 40, 112 Anamirta paniculata, 259 Andira araroba, 524 Anemone patens, 237 pratensis, 237 Pulsatilla, 237 Anemonic acid, 237 Anemonin, 237 Angelic acid, 310 Aniline, 474, 482 Animal fats, 540 Anise, 226 oil, 226 star, 226 water, 226 Anisum, 226 Anodyne, Hoffman's, 130 Anodynes, 72 Antacids, 72, 454 Anthelmintics, 72, 551 Antliemic acid, 138 Anthemis, 138 nobilis, 138 Anthracene, 475 Antidote for aconite, 229 alcohol, 208 antimony, 241 arsenic, 444 atropine, 91 belladonna, 91 boracic acid, 472 boric acid, 472 calabar bean, 282 carbolic acid, 478 chloral, 285 colchicine, 372 conium, 280 copper, 195 corrosive sublimate, 417 daturine, 95 digitalis, 271 duboisine, 98 hyoscine, 97 hyoscyamine, 97 hyoscyamus, 97 iodine, 425 lead, 191 mercury, 417 mineral acids, 169 Antidote for morphine, 78 opium, 78 physostigma, 282 prussic acid, 299 silver salts, 199 stramonium, 95 strychnine, 255 tartar emetic, 241 vegetable acids, 249 veratrine, 237 veratrum viride, 235 zinc, 196 Antidotism, chemical, 49 physiological, 49 Antifebrin, 482 Antilithics, 456 Antimonial ointment, 518 preparations, 241, 357 powder, 244 wine, 243 Antimonii oxidum, 241 et potassii tartras, 241 sulphidum, 243 purification, 243 praeparata, 241 sulphuratum, 243 Antimonius oxide, 241 sulphide, 243 purified, 243 Antimonium and potassium tartrate, 241 Antimony, pills of, compound, 243 preparations of, 241 sulphurated, 243 tartarized, 241 wine of, 243 Antiphlogistics, 404 Antipyretics, 464 Antipyrine, 476, 503 Antiseptic oils, 505 Antiseptics, 72, 464 Antispasmodics, 72, 113 Apiol, 402 Apis mellifica, 542, 548 Apocynaceae, 274, 374 Apocynein, 374 Apocynin, 374 Apocynum, 374 androsaemifolium, 374 cannabinum, 374 Apomorphinoe hydrochloras, 317 Apomorphine, 317 hydrochl orate, 317 Aporetin, 336 Apothecaries' measure, 60 weight, 58 Apple, 320 • Applications of medicines to the skin, 64 to mucous membranes, 65 to serous membranes, 69 to ulcers, wounds, etc., 69 Approximate measures, 61 INDEX. 567 Aqua, 527 ammoniae, 213 fortior, 212, 517 amygdalae amarae, 300 anisi, 226 aurantii florum, 223 camphorae, 1 18 chlori, 467 cinnamomi, 217 creosoti, 482 destillata, 527 foeniculi, 225 menthae piperitae, 224 viridis, 224 rosae, 188 Aquae, 53 Aqueous extracts, 57 Aqueous extract of aloes, 339 Arabic acid, 529 Arabin, 529 Araceae, 220 Araroba, 524 Arbutin, 393, 394 Arctostaphylos uva ursi, 393 Argenti iodidum, 201 nitras, 198 diluius, 201, 519 fusus, 201, 519 oxidum, 201 praeparata, 198 Argol, 334 Argyria, 199 Aricine, 143 Aristolochi a reticulata, 136 serpentaria, 136 Aristolochiaceae, 136 Arnica, 238 montana, 238 flowers, 238 root, 238 Arnicae flores, 238 radix, 238 Arnicin, 238 Aromatic bitters, 132, 136 fluid extract, 220 powder, 220 series of carbon compounds, 473 spirit of ammonia, 213, 462 sulphuric acid, 1 70 syrup of rhubarb, 337 tincture of rhubarb, 337 wine, 140, 224, 225 Aromatics, 205, 214 Arrack, 211 Arseniate of sodium, 447 solution of, 447 Arsenic, 439 eaters, 441 iodide, 448 metallic, 439 preparations of, 439 Arsenic, oxide, 439 trisulphide, 440 white, 439 Arsenii et hydrargyri iodidi, liquor, 448 iodidum, 448 praeparata, 439 Arsenious acid, 439, 521 Arsenite of potassium, solution of, 446 Artanthe elongata, 392 Artanthic acid, 392 Artemisia absinthium, 140 maritima, 554 Arteriotomy, 34 Artificial camphor, 1 1 7 musk, 129 Asafetida, 113, 399 Asafoetida, 113, 399 Asagraea officinalis, 236 Asparagin, 533, 535 Aspidium, 556 filix mas, 556 marginale, 556 Aspidol, 557 Aspiration, 33, 36 Aspirator, 36 Astragalus gummifer, 530 Astringent bitters, 132, 141 Astringents, 72, 178 mineral, 178, 189 vegetable, 178, 179 Atomization of fluids, 66 Atomizers, 66 Sajous' modification, 67 Sass's, 68 Siegele's, 68 Snowden's, 67 Atropa belladonna, 88 Atropina, 88, 93 Atropinae sulphas, 93 Atropine, 88, 93 sulphate of, 93 Aurantiaceae, 223 Aurantii amari cortex, 223 dulcis cortex, 223 Aurantii flores, 223 Auric and sodium chloride, 423 Auri et sodii chloridum, 423 Aveling's apparatus for transfusion, 69 Azedarach, 556 Balm of Gilead tree, 382 Balsam of copaiba, 388 fir, 382 Peru, 398 Tolu, 398 Balsamodendron myrrha, 396 Balsams, 397 Balsamum Peruvianum, 398 Tolutanum, 398 Bandages, 33, 35 568 INDEX. Barbadoes aloes, 338 Barbaloln, 338 Barbary gum, 528 Barilla, 459 Barium sulpho-carbolate, 480 Barley, 211 sugar, 548 Barosma betulina, 393 crenulata, 393 serratifolia, 393 Basham's mixture, 164 Basic quinine sulphate, 150 ferric sulphate, 161 Basilicon ointment, 387 Bassora gum, 529 Baths, 39 cold, 40 hot, 39 air, 39 vapor, 39 warm, 39 of iodine, 428 nitro-hydrochloric acid, 173 sodium arseniate, 447 Battery current, 42 Baunscheidtismus, 36 Bay rum, 211 Bean of St. Ignatius, 257 Calabar, 281 Bearberry, 393 Beberine, 392 Bee, 542 Beet-root sugar, 547 Belladonna, 88 leaves, 88 root, 88 Belladonnse folia, 88 radix, 88 Belladonnine, 89 Bengal kino, 183 Benjamin tree, 396 Benne oil, 533 Benzalcohol, 398 Benzene, 475 Benzine, 474, 476 Benzoate of ammonium, 486 benzyl, 398 lithium, 462 sodium, 486 Benzol, 474, 476 Benzyl-quinine, 476 Benzyl- tropine, 476 Benzoe amygdaloides, 397 in sortis, 397 Benzoic acid, 397 398, 475, 485 aldehyde, 299 Benzoin, 396 Benzoinated lard, 397, 441 ointment, 397, 441 Benzoinum, 396 Benzylic benzoate, 398 Benzylic cinnamate, 398 Berberaceae, 135 Berberidacese, 345 Berberine, 134, 135, 258, 364 hydrochlorate, 135 sulphate, 135 Berzelius-Marsh test for arsenic, 441 Beta-colchicoresin, 370 Bhang, 99 Bicarbonate of potassium, 456, 457 sodium, 460 Bichloride of methylene, no mercury, 409, 416, 468, 522 Bichromate of potassium, 454, 522 Bismuth and ammonium citrate, 202 preparations of, 201 subcarbonate, 202 subnitrate, 201 valerianate, 202 | Bismuthi et ammonii, citras, 202 prseparata, 201 subcarbonas, 202 subnitras, 201 Bisulphate of quinine, 151 Bisulphite of sodium, 471 Bitartrate of potassium, 334 Bitter almond water, 300 cucumber, 350 orange, 223 wine of iron, 167 Bittern, 330 Bitters, aromatic, 132, 136 astringent, 132, 141 simple, 132 Bittersweet, 102 Black draught, 341 drop, 83 ginger, 219 haw, 307 oxide of manganese, 168 mustard, 507 pepper, 216, 511 poppy, 73 snakeroot, 276 wash, 414 Blackberry, 1 88 Blennorrheas, 72, 365, 367, 378, 399 Blistering cerate, 515 Blisters, 506, 512 Bloodletting, 33, 34, 399 Bloodroot, 315 Blue-flag, 348 Blue gum-tree, 137 mass, 354, 355 ointment, 404, 411 pill, 354, 355 stone, 196 vitriol, 196 Boheic acid, 121 Bolus, 52 Bone ash, 175 INDEX. 569 Bone-ash phosphate of calcium, 448 Boneset, 139 Boracic acid, 471 Borate of sodium, 473 Borated cotton, 268 Borax, 473 Bordeaux turpentine, 382 Boric acid, 471 Borneo camphor, 116 Boro-cotton, 268 Botany Bay kino, 183 Bran, 320 Brandy, 210 Brayera, 558 anthelmintica, 558 Brazilian sarsaparilla, 360 Brimstone, 325 British barilla, 459 Bromide of ammonium, 290 calcium, 291 ethyl, 112 lithium, 291 sodium, 291 potassium, 286 zinc, 291 Bromides, 286 Bromine, 470, 521 Bromism, 288 Bromum, 470, 521 Broom, 275, 377 Brown mixture, 536 Brucine, 252, 253, 257 Bryonia, 344 alba, 344 dioica, 344 Bryonin, 345 Bryony, 344 Buchu, 393 Buckthorn, 342 Burgundy pitch, 510 plaster, 511 spurious, 510 Burnett's disinfectant fluid, 198 Burseracese, 396 Butea frondosa, 183 Butter, melted, 325 of cacao, 542 Butternut, 337 Butyric acid, 353 Cacao butter, 542 Caffea, 121 Caffeic acid, 121 Caffeina, 122 Caffeine, 121, 122, 128 citrate, 122 valerianate, 122 Caffeo-tannic acid, 121 Cajeput oil, 218 Cake gamboge, 351 Calabar bean, 281 Calabarine, 281 Calamus, 220 Calcii bromidum, 291 carbonas praecipitatus, 463 chloridum, 450 hypophosphis 449 phosphas prgecipitatus, 448 prseparata, 462 Calcined magnesia, 329 Calcium bromide, 291 chloride, 450 hypophosphite of, 449 phosphate, precipitated, 448 precipitated carbonate of, 463 phosphate of, 448 preparations of, 462 sulphide, 327 sulphite, 327, 471 sulpho-carbolate, 480 Calendula, 364 officinalis, 364 Calendulin, 364 Calisaya bark, 142 Calomel, 354. 355, 409, 414, 558 Howard's, 414 Jewell's, 414 Calor, 39 Calumb, 134 Calumba, 134 Calx chlorata, 467 sulphurata, 471 Cambogia, 351 Cambogic acid, 351 Campeachy-wood, 185 Camphor, 1 16 artificial, 117 Borneo, 116 cerate, 118 China, 116 crude, 116 Dutch, 116 Japan, 116 laurel, 116 liniment, 118 mixture, Hope's, 118 monobromated, 119 refined, 116 Sumatra, 116 water, 118 Camphora, 116 Camphora Cinnamomum, 116 monobromata, 119 Camphorated tincture of opium, 83 Camphoric acid, 117 Camphoronic acid, 117 Canada balsam, 382 fleabane, 373 moonseed, 364 pitch, 511 plaster, 511 57o INDEX. Canada turpentine, 382 Canadian hemp, 373 Candy, rock, 548 Cane sugar, 547, 548 Cannabinine, 100 Cannabin, 100 Cannabis Americana, 99 Indica, 99 sativa, 99 Cannabene, 100 hydride, 1 00 Cantharidal collodion, 516 liniment, 516 Cantharidin, 514, 518 Cantharides, 377, 399, 513 cerate of, 515 paper of, 517 Cantharidic acid, '514 Cantharis, 377, 513 vesicaloria, 513 viltata, 517 Cape aloes, 338 Caprifoliacese, 307 Capsaicin, 215 Capsicum, 215, 510 African, 215 fastigiatum, 215 Capsules, gelatin, 52 Caraccas kino, 183 Caraway, 226 Carbo ligni, 549 Carbolate of potassium, 480 quinine, 151 sodium, 480 Carbolic acid, 474, 476 crude, 476 ointment of, 480 Carbolized cotton, 268 Carbon-compounds, aromatic series of, 474 Carbonate of ammonium, 213, 462 calcium, precipitated, 463 iron, pill of, 160 saccharated, 160 lead, 194 lithium, 461 magnesium, 330, 462 potassium, 456, 457 pure, 457 sodium, 459 dried, 460 zinc, precipitated, 197 Carbonates of sodium, 459-460 Carbonic acid water, 528 Carboxyl, 475 Cardamom, 219 Cardamomum, 219 Carica papaya, 157 Carminatives, 205, 214 Carminic acid, 551 Carolina pink, 551 jasmine, 304 Carrageenin, 538 Carron oil, 463 Carthagena barks, 143 Carum, 226 carvi, 226 Caryophyllin, 218 Caryophyllus, 218 aromaticus, 218 Cascara sagrada, 342 Cascarilla, 141 Cascarillin, 141 Cassia, 339 acuti folia, 340 sethiopica, 340 cinnamon, 216 elongata, 340 Fistula, 323 lanceolata, 340 obovata, 340 Castanea, 189 vesca, 189 Castor oil, 323 Cataplasmata, 58, 526 Cataplasms, 50, 58 Catechin, 183 Catechu, 182 red, 183 Catechu-tannic acid, 183 Cathartic acid, 340 Cathartics, 72, 319 Catharto-mannit, 341 Caustic potassa, 519 soda, 520 Cauterants, 518 Cauterization, 39 Cautery, actual, 39, 523 galvano, 45 Cayenne pepper, 215 Cedar, red, 400 Celandine, 347 Celastraceae, 348 Centigram, 59 Cephaelis Ipecacuanha, 312 Cera alba, 542 flava, 542 Cerata, 57 Cerate, 57, 541 blistering, 515 camphor, 118 cantharides, 515 carbonate of zinc, 196, 197 extract of cantharides, 5^ Goulard's, 193 Cerate, lead, subacetate, 193 savine, 400 spermaceti, 542 resin, 387 compound, 387 Cerates, 50, 57 Ceratum, 57, 541 camphors, 1 18 INDEX. 571 Ceratum, cantharidis, 515 cetacei, 542 extracti cantharidis, 516 plumbi subacetatis, 193 resinge, 387 sabinae, 400 Cerii oxalas, 202 Cerite, 202 Cerium, nitrate, 203 oxalate, 202 Cerylic alcohol, 137 Cetacea, 541 Cetaceum, 541 Cetin, 541 Cetraria, 536 islandica, 536 Cetraric acid, 537 Cetrarin, 537 Cetyl palmitate, 541 Ceylon cinnamon, 216 Chalk, 464 mixture, 464 powder, compound, 464 prepared, 464 troches of, 464 Chalybeates, 157, 403 Chamomile, 138 German, 139 Champagne, 210 Chapman's copaiba mixture, 389 (foot- note) Charcoal, 549 poultice, 527 Chart a cantharidis, 517 potassii nitratis, 246 sinapis, 509 Chartse, 52 Chelerythrine, 348 Chelidonine, 348 Chelidoninic acid, 348 Chelidonium, 347 majus, 347 Chemical antidotism, 49 Chenopodiaceae, 553 Chenopodium, 553 ambrosioides, 553 Chestnut, 189 Chian turpentine, 382, 383 Chimaphila, 394 maculata, 394 umbellata, 394 Chimaphilin, 394 China camphor, 116 cinnamon, 216 musk, 129 Chinese oil of peppermint, 224 rhubarb, 335 Chinocine, 475 Chinoidin, 152 Chinoidinum, 152 Chinoline, 475, 498 Chirata, 135 Chiratin, 136 Chittem bark, 342 Chloral, 283 alcoholate, 283 hydrate, 283 Chlorate of potassium, 452 sodium, 454 Chlorhydric acid, 272 diluted, 272 Chloride of ammonium, 450 calcium, 450 gold and sodium, 423 iron, 162 solution of, 163 tincture of, 163 lime, 467 mercury ; corrosive, 409, 416, 468 mild, 354,355,409, 414 zinc, 198, 522 solution of, 197 Chlorinated lime, 467 soda, solution of, 468 Chlorine, 467 water, 467 Chlorodyne, 1 10 (foot-note) Chloroform, 102, 107 commercial, 107 liniment, no purified, 107 Chloroformum, 107 purificatum, 107 venale, 107 Chocolate, 122 Chocolate nuts, 543 Choke-cherry, 154 Cholagogues, mercurials as, 354, 417 Choline, 100 Chondodendron tomentosum, 392 Chondrus, 537 crispus, 537 mammilosus, 538 Chrome-ironstone, 454 Chromic acid, 520 anhydride, 520 Chromium, 454 Chiomogene, 267 Chrysarobin, 336, 524 Chrysarobinum, 524 Chrysophan, 336, 341 Chrysophanic acid, 336, 524 Churrus, 99 Cicuta, 280 Cimicifuga, 276 racemosa, 276 Cinchona, 141 calisaya, 142 flava, 142 micrantha, 142 officinalis, 142 ovata, 142 572 INDEX. Cinchona, rubra, 142 succirubra, 142 Cinchonese, 141 Cinchonicine, 143 Cinchonidina, 143, 144 Cinchonidinse sulphas, 152 Cinchonidine, 143, 144 sulphate, 152 Cinchonina, 143 Cinchoninse sulphas, 152 Cinchonine, 143, 144 sulphate, 152 Cincho-tannic acid, 143 Cinnabar, 404, 422 Cinnamate of benzyl, 398 Cinnamein, 398 Cinnamic acid, 217, 397, 398 Cinnamomum, 216 zeylanicum, 216 Cinnamon, 216 cassia, 216, 217 Ceylon, 216 China, 216 water, 217 Circumstances modifying the effects of medicines, 4g Cissampeline, 392 Citrate of bismuth and ammonium, 202 caffeine, 122 iron, 165 wine, 167 and ammonium, 167 and quinine, 166 solution of, 167 and strychnine, 167 solution of, 165 lithium, 461 magnesium, solution of, 331 granulated, 331 potassium, 247 mixture of, 247 solution of, 247 quinine, 151 Citric acid, 250 syrup of, 250 Citrine ointment, 410, 423 Citrullus Colocynthis, 350 Citrus aurantium, 223 Limonum, 250 vulgaris, 223 Clarified honey, 548 Classification of medicines, 70 Claviceps purpurea, 260 Climate, influence of, on medicinal effects, 63 on plants, 49 Cloves, 218 Club moss, 536 Clysters, 68 Coca, 122 Cocaine, 122, 123 Cocaine, hydrochlorate, 123 Cocatannic acid, 122 Coccoloba uvifera, 183 Cocculus Indicus, 259. palmatus, 134 Coccus, 550 cacti, 550 Cochineal, 550 Codamine, 74 Codeina, 75, 84 Codeine, 74, 75, 84 Cod-liver oil, 436 phosphorated, 439 Coffea arabica, 121 Coffee, 121 Cohosh, 276 Colchiceine, 370 Colchici radix, 369 semen, 369 Colchicine, 370, 373 Colchico-resin, 370 Colchicum, 369 autumnale, 369 root, 369 seed, 369 Cold, 38, 40 bath, 40 compresses, 41 cream, 188 douche, 40 injections, 41 liquids, 41 pack, 40 wet sheet, 40 Coleoptera, 513 Colica Pictonum, 190 Collodion, 546 flexible, 546 iodized, 546 styptic, 546 with cantharides, 516 Collodium, 546 flexile, 546 stypticum, 546 cum cantharide, 516 Collyria, 66 Colocynth, 350 Colocynthin, 350 Colocynthis, 350 Colocynthitin, 350 Colombin, 134 Cologne water, 225 Coloring agents, 72, 550 Columbian bark, 143 Columbic acid, 134 Columbo, 134 Combe, 274 Commercial chloroform, 107 quinidine, 145 sodium bicarbonate. 460 zinc oxide, 197 INDEX. 573 Common cod, 436 Composite, 84, 138, 139, 140, 238, 308, 3 6 4, 373. 375. 401, 554 Compound cathartic pills, 352 chalk powder, 464 decoction of sarsapar ilia, 361 effervescing powder, 335 extract of colocynth, 350, 351 fluid extract of sarsaparilla, 362 glycyrrhiza mixture, 536 powder, 341 infusion of senna, 341 iron mixture, 161, 396 pills, 161, 396 jalap powder, 344 liquorice mixture, 536 liniment of mustard, 509 mixture of glycyrrhiza, 536 iron, 161, 396 liquorice, 536 pills of antimony, 243 galbanum, 115, 396 iron, 161, 396 rhubarb, 337 powder of glycyrrhiza, 341 jalap, 344 liquorice, 341 morphine, 84 rhubarb, 337 resin cerate, 387 solution of iodine, 427 spirit of ether, 130 juniper, 377 syrup of sarsaparilla, 361 squill, 369, 380 tincture of benzoin, 397, 399 cardamom, 220 catechu, 183 cinchona, 149 gentian, 134 iodine, 427 lavender, 223 Compressed pills, 52 Compresses, cold, 41 Condition of alimentary canal influences action of medicine, 63 Condy's fluid, 467 Confectio rosae, 188 . sennae, 341 Confection, rose, 188 senna, 321, 323, 341 Confectiones, 52 Confections, 50, 52 Conhydrine, 279 Conidia, 261 Coniferse, 376, 382, 400, 510, 51 1 Conine, 278 hydrate, 279 Conium, 278 maculatum, 278 Conserves, 52 Continuous electrical current, 42 Convolvulaceae, 343, 349 Convolvulin, 344 Convolvulus Scammonia, 349 Copaiba, 387 Copaifera, 387 Langsdorffii, 387 Copaivic acid, 388 Copper acetate, 196 preparations of, 195 sulphate of, 196, 318, 523 Copperas, 161 Coriander, 226 Coriandrum, 226 sativum, 226 Corn ergot, 266 smut, 266 Cornaceae, 153 Cornic acid, 153 Cornin, 153 Cornutin, 263 Cornus, 153 circinata, 153 florida, 153 sericea, 153 Corpuscles of Laveran, 148 Corroborants, 13 1 Corrosive chloride of mercury, 409, 416, 468, 522 mercurial chloride, 409, 416, 468, 522 sublimate, 409, 416, 468, 522 Cosmoline, 545 Cotton, 268 borated, 268 boro-, 268 carbolized, 268 iodo-, 268 iodoform, 268 root, bark of, 268 salicylated, 268 seed oil, 532 sublimated, 268 Couch-grass, 376 Court-plaster, 540 Cowling's scheme for doses, 63 Cox's hive syrup, 369 Cracked wheat, 320 Cranesbill, 186 Cream of tartar, 250, 251, 334, 366 Creasol, 480 Creasote, 385, 480 water, 482 Creasotum, 480 Cresol, 480 Creta praeparata, 464 Crocus, 550 sativus, 550 Croton-chloral hydrate, 286 Croton Eluteria, 141 oil, 353, 5*8 Tiglium, 353 574 INDEX. Crowfoot, 1 86 Cruciferae, 318, 507 Crude carbolic acid, 476 camphor, 1 1 6 liquorice, 534 quinine, 152 sulphur, 325 tartar, 334 Cryolite, 459 Cryptopine, 74, 76 Cubeb, 389 Cubeba, 389 officinalis, 389 Cubebic acid, 390 Cubebin, 390 Cubic centimeter, 59 nitre, 246 Cuca, 122 Cucaine, 123 Cucumber, bitter, 350 squirting, 352 Cucurbita pepo, 559 Cucurbitaceae, 344, 350, 352, 559 Cultivation, influence of, on plants, 49 Culver's root, 34 1 physic, 341 Cupping, 35 dry, 35 glasses, 35 wet, 35 Cupri acetas, 196 praeparata, 195 sulphas, 196, 523 Cupric sulphate, 196, 523 Cups, 33, 35 Cupulilerae, 181, 185, 189 Curare, 306 Curarine, 306, 307 Curine, 306 Cut cups, 35 Cyanide of potassium, 299 mercury, 410, 421 Cyanhydric acid, 296 Cydonia vulgaris, 534 Cydonium, 534 Cymene, 225 Cymol, 117, 137 Cymylic phenol, 505 Cynips quercusfolii, 181 Cypripedium, 120 parvifiorum, 120 pubescens, 120 Dandelion, 375 Daphne mezereum, 363 Daphnin, 363 Darkness, 39 Datura stramonium, 94 Daturine, 95 Deadly nightshade, 88 Decagram, 59 Decigram, 59 Decimal system, 59, 60 Decocta, 54 Decoction of azedarach, 556 althaea, 534 aspidium, 558 broom, 377 cetraria, 537 chondrus, 538 geranium, 187 glycyrrhiza, 535 haematoxylon, 185 Iceland moss, 537 Irish moss, 538 liquorice- root, 535 logwood, 185 marsh-mallow, 533 oak, 186 poppies, 73 sarsaparilla, compound, 361 stillingia, 365 Decoctions, 50, 54 Decoctum cetrariae, 537 sarsaparillae compositum, 361 Deer berry, 220 Delphinine, 240 Delphinium staphisagria, 240 Delphinoidine, 240 Delphisine, 240 Demulcents, 72, 525 Denarcolized opium, 82 Deodorized tincture of opium, 83 Depresso-motors, 251, 278 Derivatives of phenyl, 473 Deshler's salve, 387 Deuteropine, 74 Dewberry, 188 Dewees's carminative, 336 Diachylon, 194 ointment, 194 Dialysis, 54 Dialyzed iron, 167, 444 Dialyzer, 54 Diaphoretics, 72, 356, 365, 399 alterative, 360 nauseating, 357 refrigerant, 357, 365 stimulating, 357, 367 Diastase, 539 Dichloromeihane, 1 10 Dieulafoy's aspirator, 36 Diffusible stimulants, 205 Digestion, 53 influence on medicinal effect, 63 Digestive ferments, 155 Digitalein, 269 Digitalin, 269 Digitalis, 268, 367 purpurea, 268 Digitonin, 269 INDEX. 575 Digitoxin, 269 Diluents, 525 Diluted acetic acid, 249 alcohol, 55, 209 hydrobromic acid, 291 hydrochloric acid, 172 hydrocyanic acid, 296 muriatic acid, 172 nitric acid, 171 nitro-hydrochloric acid, 173 nitro-murlatic acid, 173 phosphoric acid, 174 solution of subacetate of lead, 193 silver nitrate, 201, 519 sulphuric acid, 170 Diplolepis gallse tinctorise, 181 Dipterocarpaceae, 116 Disease, influence of, on medicinal ef- fects, 63 Disinfecting fluid, Burnett's, 198 Condy's, 467 Le doyen's, 194 solution, Labarraque's, 468 Dispensatory, 47 Displacement, 53 Distilled oils, 214 water, 527 waters, 53 Diuretics, 72, 365 Dobell's solution, 67 Dogsbane, 375 Dogwood, 153 round leaved, 153 swamp, 153 Dolomite, 330 Donovan's solution, 448 Dorema ammoniacum, 115, 310 Doses, modifying effects of, 49 of medicines, 63 Douche, 40 Dover's powder, 82, 315, 357 Drachm, 58, 59 Drastic cathartics, 319, 343 Drastics, 319 Draught, black, 341 effervescing, 247 Scud am ore's, 372 Dried alum, 204 ferrous sulphate, 162 sodium carbonate, 460 Drops, 60 Dryobalanops camphora, 116 Duboisia, 98 myoporoides, 98 Duboisine, 98 Dulcamara, 102 Dulcamarin, 102 Dupuytren's pomatum, 517 Duquesnel's aconitine, 232 Dutch camphor, 116 Dynamite, 302 East India kino, 183 Ecballium Elaterium, 352 Eccritics, 72, 310 Ecgonine, 123 Effects of medicines, 49 the potassium salts, 245 Effervescing draught, 247 powder; compound, 335 Effleurage, 45 Egyptian opium, 74 Elaidin, 422 Elaterin, 352 Elaterinum, 352 Elaterium, 352 Electric bath, 41 battery, 41, 42 elements, 42 machine, 41 shock, 41 spark, 41 Electricitas, 41 Electricity, $8, 41 faradic, 41, 42 frictional, 41 galvanic, 41 induced, 41, 42 magnetic, 41, 42 static, 41 voltao- magnetic, 41, 42 Electro-magnetic machine, 42 Electrodes, 42 Electrolysis, 44 Electuaries, 52 Elettaria Cardamomum, 219 Elixir of ammonium valerianate, 120 (foot- note) aurantii, 223 of orange, 223 of vitriol, 170 simple, 223 Ellis's magnesia, 329 Elm, 532 Elutriation, 51 Emetics, 72, 310 local, 310 mineral, 318 systemic, 310 vegetable, 312 Emetine, 313 Emmenagogues, 72, 3gg Emodin, 336, 342 Emollients, 525 Emplastra, 58 Emplastrum ammoniaci, 116 cum hydrargyro, 116, 409, 41 1 arnicae, 238 asafcelidae, 1 15 Emplastrum belladonnae, 93 capsici, 216, 510 feiri, 161 galbani, 115 576 INDEX. Emplastrum hydrargyri. 409, 411 ichthyocollae, 540 opii, 82 picis Burgundicae, 511 Canadensis, 511 cum cantharide, 511 plumbi, 58, 194 resinae, 387 saponis, 194 Emulsin, 300 Emulsions, 52 Endermic application of medicines, 64 Enemata, 68, 355 cathartic, 355 forced, 356 laxative, 355 nutritive, 68 Enepidermic application of medicines, 64 English rhubarb, 335 Epidermic application of medicines, 64 Epispastics, 377, 506, 512 Epsom salt, 330 Ergot, 260 of rye, 260 corn, 266 Ergot a, 260 Ergotin, 266 Ergotinic acid, 262 Ergotinine, 263 Ericaceae, 220, 393, 394 Ericolin, 393 Erigeron canadense, 373 Errhines, 66 Eruic acid, 508 Erythroretin, 336 Erythroxylaceae, 122 Erythroxylon, 122 coca, 122 Eschar, 518 Escharotics, 506, 518 Eserine, 281, 283 salicylate, 283 Essence of lemon, 250 mirbane, 482 peppermint, 224 spearmint, 224 Essential oils, 214 Ethal alcohol, 542 Ether, 103 methylic, in cenanthic, 210 stronger, 103 Ethereal anaesthetics, 102 oil, 130 refrigerants, 248, 366 tinctures, 55 Ethyl, 103 aldehyd, 85 bromide, 1 12 carbamate, 87 hydrate, 205 Ethyl, nitrite, 248 oxide, 103 Eucalyptol, 137, 138 Eucalyptus, 137 globulus, 137 resinifera, 183 Eugenia caryophyllata, 218 Pimenta, 218 Eugenic acid, 218 Eugenin, 218 Eugenol, 218 Euonic acid, 349 Euonymin, 349 Euonymus, 348 atropurpureus, 348 Eupatorin, 140 Eupatorium, 139 aromaticum, 140 perfoliatum, 139 teucrifolium, 140 Euphorbiaceae, 141, 323, 353, 365, 559 European leech, 34 opium, 74 rhubarb, 335 Evacuants, 310, 399 Excito-motors, 251 Exogonium Purga, 343 Expectorants, 378 Expressed oil of almond, 323 Extract, aromatic fluid, 220 of aconite, 232 fluid, 232 aloes, aqueous, 339 American hellebore, fluid, 236 arnica root, 238 fluid, 238 belladonna, alcoholic, 93 root, fluid, 93 bitter-orange peel, fluid, 223 bittersweet, fluid, 102 blackberry, fluid, 189 brayera, fluid, 559 broom, fluid, 377 buchu, fluid, 393 butternut, 337 calabar bean, 283 calamus, fluid, 220 calumba, fluid, 135 cannabis indica, 99 fluid, IOI castanea, fluid, 189 capsicum, fluid, 216 cascara sagrada, fluid, 343 chestnut leaves, fluid, 189 chimaphila, fluid, 395 chirata, fluid, 136 cimicifuga, fluid, 278 cinchona, 149 fluid, 149 Extract of coca, fluid, 123 colchicum root, acetic, 373 INDEX. 577 Extract of colchicum, fluid, of root, 373 of seed, 373 colocynth, 351 compound, 350, 351 columbo, fluid, 135 conium, 280 fluid, 280 cornus, fluid, 154 cotton-root bark, fluid, 268 couch grass, fluid, 376 cubeb, fluid, 391 cypripedium, fluid, 120 dandelion, 376 fluid, 376 digitalis, 273 fluid, 273 dogwood, fluid, 154 dulcamara, fluid, 102 ergot, 266 fluid, 266 erythroxylon, fluid, 123 eucalyptus, fluid, 137 euonymus, 349 eupatorium, fluid, 140 frangula, fluid, 342 gelsemium, fluid, 306 gentian, 134 fluid, 134 geranium, fluid, 187 ginger, fluid, 219 glycyrrhiza, 535 fluid, 535 refined, 535, 536 Goulard's, 193 grindelia, fluid, 309 guarana, fluid, 128 hsematoxylon, 185 hamamelis, fluid, 188 hemp, 99 fluid, 101 hydrastis, fluid, 259 hyoscyamus, alcoholic, 97 fluid, 97 Indian hemp, 99 fluid, 101 ipecac, fluid, 315 iris, 348 fluid, 348 jaborandi, fluid, 360 juglans, 337 koosso. fluid, 559 krameria, 184 fluid, 184 lactucarium, fluid, 84 leptandra, 342 fluid, 342 liquorice root, 535 fluid, 535 refined, 535, 536 lobelia, fluid, 296 logwood, 185 37 Extract of lupulin, fluid, 102 malt, 211 matico, fluid, 392 May-apple, 347 fluid, 347 mezereon, 363 fluid, 363 nux vomica, 257 fluid, 257 opium, 82 pareira, fluid, 392 pepo, fluid, 560 physostigma, 283 pilocarpus, 360 pipsissewa, fluid, 395 podophyllum, 347 fluid, 347 prunus virginiana, fluid, 155 pumpkin-seed, fluid, 560 quassia, 133 fluid, 133 rhatany, 184 fluid, 184 rhubarb, 336 fluid, 336 rhus glabra, fluid, 188 rose, fluid, 188 rubus, fluid, 189 sanguinaria, fluid, 317 sarsaparilla, fluid, 362 fluid, compound, 362 savine, fluid, 400 Scutellaria, fluid, 121 senega, fluid, 380 senna, fluid, 341 serpentaria, fluid, 137 spigelia, fluid, 553 squill, fluid, 369 stillingii, fluid, 365 stramonium, 95 fluid, 95 sumach, 188 taraxacum, 376 fluid, 376 triticum, fluid, 376 uva ursi, fluid, 394 valerian, fluid, 1 20 veratrum viride, fluid, 236 virburnum, fluid, 308 wahoo, 349 witchhazel, fluid, 188 wild cherry, fluid, 155 yellow jasmine, fluid, 306 Extracta, 57 fluida, 56 Extracts, 50, 57 fluid, 50, 56 watery, 57 alcoholic, 57 acetic, 57 Extractum aconiti, 232 578 INDEX. Extractum aconiti fluidum, 232 aromaticum fluidum, 220 aloes aquosum,339 arnicae radicis, 238 fluidum, 238 aurantii amari fluidum, 223 belladonnas alcoholicum, 93 fluidum, 93 bray eras fluidum, 559 buchu fluidum, 393 calami fluidum, 220 calumbse fluidum, 135 Cannabis indicas, 99 fluidum, 101 capsici fluidum, 216 castaneas fluidum, 189 chimaphilae fluidum, 395 chiratae fluidum, 136 cimicifugas fluidum, 278 cincbonae, 149 fluidum, 149 cokhici, 373 radicis fluidum, 373 semims fluidum, 373 colocyntbidis, 351 compositum, 351 conii alcoholicum, 280 fluidum, 280 cornus fluidum, 154 cubebae fluidum, 391 cypripedii fluidum, 120 digitalis, 273 fluidum, 273 dulcamarae fluidum, 102 ergotae, 266 fluidum, 266 erythroxyli fluidum, 123 eucalypti fluidum, 137 euonymi, 349 eupatorii fluidum, 140 frangulae fluidum, 342 gelsemii fluidum, 306 gentianae, 134 fluidum, 134 geranii fluidum, 187 glycyrrbizae, 535 fluidum, 535 purum, 535, 536 gossypii radicis fluidum, 268 grindeliae fluidum, 309 guaranae fluidum, 128 haematoxyli, 185 bamamelidis fluidum, 188 bydrastis fluidum, 259 byoscyami alcoholicum, 97 fluidum, 97 ipecacuanhas fluidum, 315 iridis, 348 fluidum, 348 juglandis,337 krameriae, 184 Extractum krameriae fluidum, 184 lactucarii fluidum, 84 leptandrae, 342 fluidum, 342 lobeliae fluidum, 296 lupulini fluidum, 102 malti, 211 matico fluidum, 392 mezerei, 363 fluidum, 363 nucis vomicae, 257 fluidum, 257 opii, 82 pareirae fluidum, 392 physostigmatis, 283 pilocarpi fluidum, 360 podophylli, 347 fluidum, 347 pruni Virginanas fluidum, 155 quassias, 133 fluidum, 133 rhei, 336 fluidum, 336 rhois glabrae fluidum, 189 rosae fluidum, 188 rubi fluidum, 189 sabinae fluidum, 400 sanguinariae fluidum, 317 sarsaparillae fluidum, 362 compositum fluidum, 362 scillae fluidum, 369 Scutellariae fluidum, 121 senegas fluidum, 380 sennas fluidum, 341 serpentarias fluidum, 137 spigelias fluidum, 553 stillingias fluidum, 365 stramonii, 95 fluidum, 95 taraxaci, 376 fluidum, 376 tritici fluidum, 376 uvae ursi fluidum, 394 Valerianae fluidum, 120 veratri viridis fluidum, 236 viburni fluidum, 308 zingiberis fluidum, 219 Eye-washes, 66 False angustura bark, 251 Farad ic electricity, 41, 42 Faradization, 41,42 Fasting, influence on medicinal effect, 63 Fat manna, 321 Fennel, 225 oil, 225 water, 225 Fern, male, 556 Ferri carbonas saccharatus, 1 60 carbonatis, massa, 161 INDEX. 579 Ferri chloridi, liquor, 163 tinctura, 163 chloridum, 162 citras, 165 citratis, liquor, 165 et ammonii acetatis, mistura, 164 et ammonii citras, 167 et ammonii sulphas, 167 et ammonii tartras, 167 et potassii tartras, 164 et quininae citras, 166 liquor, 167 et strychninse citras, 167 hypophosphis, 165, 450 iodidi, syrupus, 164 iodidum saccharatum, 164 lactas, 166 nitratis, liquor, 165 oxalas, 166 oxidum hydratum, 160, 444 cum magnesia, 160, 444 phosphas, 165 praeparata, 157 pyrophosphas, 165 subsulphatis, liquor, 162 sulphas, 161 exsiccatus, 162 praecipitatus, 162 Ferri tersulphatis, liquor, 162 valerianas, 167 Ferric acetate, solution of, 166 tincture of, 166 chloride, 162 solution of, 163 tincture of, 163 citrate, 165 solution of, 165 citro-chloride, 163 hydrate, 160,444 hypophosphite, 165, 450 nitrate, solution of, 165 oxide, 159 hydrated, 160,444 with magnesia, 160, 444 phosphate, 165 pyrophosphate, 165 sulphate, 162 solution of basic, 162 normal, 162 valerianate, 167 Ferrous bromide, syrup of, 166 carbonate, 160 mass of, 161 saccharated, 160 iodide, pills of, 164 Ferrous iodide, saccharated, 164 syrup of, 164 lactate, 166 oxalate, 166 sulphate, 161 dried, 162 P'errous sulphate, precipitated, 162 Ferruginea, 157, 399 Ferrum, 157 dialysatum, 167 reductum, 160 Ferula galbaniflua, 115 Narthex, 113 Scorodosma, 113 Sumbul, 309 Ferulaic acid, 113 Ficus, 320 Fig, 320 Filices, 556 Filicic acid, 557 Filix mas, 556 Fir, balsam of, 382 silver, 382 Flake manna, 321 \ Flax, common, 530 Flaxseed, 530 meal, 531 oil, 325, 53 1 poultice, 531 Flexible collodion, 546 Flour of mustard, 507 Flowers of orange, 223 of sulphur, 325 Fluid, Burnett's disinfecting, 198 Condy's disinfecting, 467 extract, aromatic, 220 of aconite, 232 arnica root, 238 belladonna, 93 bitter orange peel, 223 blackberry, 189 bray era, 559 broom, 377 buchu, 393 calamus, 220 calumba, 134 cannabis Indica, 101 capsicum, 215 cascara sagrada, 342 castanea, 189 chestnut leaves, 189 chimaphila, 395 chirata, 136 cimicifuga, 278 cinchona, 149 coca, 123 colchicum root, 373. seed, 373 conium, 280 cornus, 154 cotton-root, 268 couchgrass, 376 cubeb, 391 cypripedium, 120 dandelion, 376 digitalis, 273 dogwood, 154 580 INDEX. Fluid extract, dulcamara, 102 ergot, 266 erythroxylon, 123 eucalyptus, 137 eupatorium, 140 frangula, 342 gelsemium, 306 gentian, 134 geranium, 187 ginger, 219 glycyrrhiza, 535 gossypium, 268 grindelia, 309 guarana, 128 hamamelis, 188 heartsease, 348 Hydrastis, 259 hyoscyamus, 97 ipecac, 315 iris, 348 jaborandi, 360 koosso, 559 krameria, 184 lactucarium, 84 leptandra, 342 lobelia, 296 lupulin, 102 matico, 392 mezereon, 363 nux vomica, 257 pareira, 392 pepo, 560 pilocarpus, 360 pipsissewa, 395 podophyllum, 347 prunus Virginiana, I pumpkin-seed, 560 quassia, 133 rhubarb, 336 rhus glabra, 188 rose, 188 rubus, 189 sanguinaria, 317 sarsaparilla, 362 compound, 362 savine, 400 Scutellaria, 121 senega, 380 senna, 341 serpentaria, 137 skullcap, 121 spigelia, 553 squill, 369 stillingia, 365 stramonium, 95 sumac, 188 taraxacum, 376 triticum, 376 uva ursi, 394 valerian, 120 veratrum viride, 236 55 Fluid extract, viburnum, 308 wild cherry, 155 witchhazel, 188 extracts, 50, 56 Ledoyen's disinfecting, 194 Fluidounce, 60 Fluidrachm, 60 Fluigram, 60 Fly, potato, 517 Spanish, 513 Foeniculum, 225 vulgare, 225 Fomentation, 39 Fonticuli, 35 Foreign leech, 34 Formic acid, 283 Forms in which medicines are used, 49 Formyl, terchloride of, 102 teriodide of, 431 Fowler's solution, 446 Foxglove, 268 Frangula, 342 Frangulin, 342 Fraxin, 321 Fraxinus ornus, 321 rotundifolia, 321 Freezing mixtures, 112 Fresh herbs, tinctures of, 55 Friction electricity, 41 Frictions, 33, 35 Frigus, 40 Fumigation, mercurial, 409, 416, 422 Fungi, 261, 266 Fused silver nitrate, 201, 519 diluted, 201, 519 Fusel oil, 205, 300 Gadida, 436 Gaduin, 437 Gadus Morrhua, 436 Galbanum, 115, 399 Gall-oak, 181 Galla, 181 Gallic acid, 180, 186 Gallon, 60 Galls, 181 black, 182 white, 182 Galvanic electricity, 41 Galvanism, 41 Gal vano- cautery, 45 Gamboge, 351 cake, 351 lump, 351 Pipe, 351 Garcinia Hanburii, 351 Gargarismata, 66 Gargles, 66 Garlic, 381, 511 Gas, nitrous-oxide, ill INDEX. 581 Gas, laughing, ill Gases, 50, 58 Gaultheria, 220 procumbens, 220 Gaultherilene, 221 Gelatin, 540 capsules, 52 Gelatinous magnesia, 444 Gelsemine, 305 Gelseminic acid, 305 Gelsemium, 304 sempervirens, 304 General bloodletting, 33 Gentian, 133 yellow, 133 Gentiana, 133 lutea, 133 Gentianaceas, 133, 135 Gentianin, 133 Gentiopicrin, 133 Gentisin, 133 Gentisic acid, 133 Geraniaceae, 186 Geranium, 186 maculatum, 618 German chamomile, 139 Giant powder, 302 Gill, 61 Gin, 210 Ginger, 219, 51 1 black, 219 Jamaica, 219 white, 219 Gingerol, 219 Glauber's salt, 332 Glonoin, 302 Glyceric alcohol, 543 Glyceril hydrate, 543 Glycerin, 543 Glycerinum, 543 Glycerita, 56, 544 Glycerite of borate of sodium, 473 sodium borate, 473 starch, 540, 544 yolk of eggs, 544 Glycerites, 50, 56, 544 Glyceritum amyli, 540, 544 vitelli, 544 Glyceryl nitrate, 302 Glycil hydrate, 543 Glyconin, 544 Glycyrrhetin, 535 Glycyrrhiza, 534 echinata, 534 glabra, 534 glandulifera, 535 Glycyrrhizin, 535 Glycyrrhizin, ammoniated, 535 Glycyrrhizinum ammoniatum, 535 Gnoscopine, 74 Goa- powder, 524 Gold and sodium chloride, 423 Golden seal, 258 Gondret's vesicating ointment, 518 Gossypii radicis cortex, 267 Gossypium, 268 herbaceum, 267, 532 Goulard's cerate, 193 extract, 193 Grains, 58, 59 Gram, 59 Graminaceae, 211, 260, 266, 376, 539, 548 Granataceae, 557 Granatum, 557 Granulated effervescing salts, 51 magnesium citrate, 331 Granulation, 51 Granville's lotion, 518 Grape sugar, 547 , 548 Gray powder, 409, 412 Green iodide of mercury, 410, 420 mercurial iodide, 410, 420 soap, 523 vitriol, 161 Griffith's anti-hectic mixture, 161 Grindelia, 308 robusta, 308 Grindelin, 308 Ground flaxseed, 531 Ground-holly, 394 Guaiac, 362, 399 wood, 362 beta-resin, 362 Guaiaci lignum, 362 resina, 362 Guaiacic acid, 362 Guaiaconic acid, 362 Guaiacum, 362 officinale, 362 sanctum, 362 wood, 362 Guaiaretic acid, 362 Guarana, 128 Guatemala sarsaparilla, 361 Gum, 528 ammoniac, 1 15 arabic, 528 Barbary, 528 Bassora, 528 India, 528 Kordofan, 528 pectoral, 530 Senegal, 528 tragacanth, 530 Turkey, 528 Gummic acid, 529 Gun cotton, 545 Gunjah, 99 Guttiferae, 351 Gutta-percha solution, 546 582 INDEX. Habit, influence of, on medicinal effects, 63 Hematics, 72, 403 Hematein, 185 Hematinics, 72, 403 Haematomonas malariae, 148 Hematoxylin, 185 Haematoxylon, 185 campechianum, 185 Hamamelaceae, 187, 397 Hamamelis, 187 virginica, 187 Hashish, 99 Haw, black, 307 Heartsease, 322 Heat, 38, 39 Heavy magnesia, 329 Hectogram, 59 Hedeoma, 225 pulegioides, 225 Hedeomol, 225 Hellebore, American, 232 swamp, 232 Hemiptera, 550 Hemlock, 278 gum, 511 spruce, 5 1 1 pitch plaster, 511 Hemp, American, 99 Canadian, 374 Indian, 99 Henbane, 95 Henry's magnesia, 329 Hepatic aloes, 338 Herapathite, 144 Herapath's test, 144 Hesperidin, 223 Hippuric acid, 486 Hircin, 541 Hirudo decora, 34 medicinalis, 34 Hive-syrup, 369 Hoffman's anodyne, 130 Hog, 541 Homatropine, 93 Honduras sarsaparilla, 360 Honey, 56, 320, 548 bee, 542, 548 clarified, 548 of rose, 188 of sodium borate, 473 Honeys, 50, 56 Hope's camphor mixture, 118 Hops, 101 Hordeum distichum, 211 Horehound, 225 Hot-air bath, 39 bath, 39 bottles, 39 bricks, 39 foot bath, 39 Hot iron, 39 vapor bath, 39 water, 39 Howard's calomel, 414 Humulus, 1 01 Lupulus, 1 01 Husband's magnesia, 329 Huxham's tincture, 137, 149 Hydragogues, 319 Hydrargyri chloridum corrosivum, 409, 416, 468, 522 mite, 354, 355. 4°9, 414, 47° cyanidum, 410, 421 iodidum rubrum, 410, 420, 470 viride, 410, 420 oxidum flavum, 409, 413 rubrum, 409, 412 nitratis, unguentum, 410, 422 liquor, 410, 423, 522 . prseparata, 404 subsulphas flavus, 410, 421 sulphidum rubrum, 410, 422 Hydrargyrum ammoniatum, 410, 421 cum creta, 409,412 Hydrastine, 258 Hydrastis, 258 canadensis, 258 Hydrate of chloral, 283 croton-chloral, 286 phenyl, 476 potassa, 519 propenyl, 543 Hydrated oxide of iron, 160, 444 with magnesia, 160, 444 Hydride of phenyl, 474 Hydrobromate of quinine, 15 1 Hydrobromic acid, diluted, 291 Hydrochinone, 475, 489 Hydrochlorate of apomorphine, 317 cocaine, 123 morphine, 83 pilocarpine, 360 quinine, 151 Hydrochloric acid, 172 diluted, 172 Hydrocotarnine, 74 Hydrocyanic acid, 296, 299 diluted, 296 Hydroquinone, 475, 489 Hydroxyl, 474 Hygienic remedies, ^ Hymenoptera, 542 Hyoscine, 96 hydrochlorate, 98 Hyoscyami folia, 95 Hyoscyaminae sulphas, 97 Hyoscyamine, 89, 96 sulphate, 96, 97 Hyoscyamus, 95 leaves, 95 niger, 95 INDEX. 583 Hyphae, 261 Hypnone, 87 * Hypnotics, 72 Hypodermic application of medicines, 65 Hypophosphite of calcium, 449 iron, 165, 450 potassium, 449 sodium, 449 Hypophosphites, 449 syrup of, 449 with iron, syrup of, 450 Hyposulphite of sodium, 471 Ice, 41 bag, 40 Iceland moss, 536 Ichthyocolla, 540 Idiosyncrasy, influence of, on medicinal effects, 63 Igasuric acid, 252 Igasurine, 252 Ignatia, 257 Ilex Paraguaiensis, 128 Illicium, 226 anisatum, 226 Imagination, influence of, 63 Imponderable remedies,^, 38 Imported leech, 34 Incompatibility, 50 India gum, 528 opium, 74 senna, 340 Indian corn, 266 hemp, 99 meal, 320 poke, 232 tobacco, 294 Induced electricity, 41, 42 Inee, 274 Inflatin, 294 Infusa, 53 Infusion of apocynum, 375 bray era, 559 calamus, 220 cascarilla, 141 chamomile, 138 cinchona, 149 cypripedium, 120 dandelion, 375 digitalis, 273 eupatorium, 140 fennel, 225 gaultheria, 222 hops, 102 koosso, 559 lobelia, 296,. magnolia, 141 prunus Virginiana, 155 quassia, 133 senna, compound, 341 Infusion of serpentaria, 137 tobacco, 294 wild cherry, 155 Infusions, 50, 53 Infusum brayerae, 559 cinchonas, 149 digitalis, 273 pruni Virginianae, 155 sennas compositum, 341 Ingluvin, 156 Inhalation, 58 Injection, 68 intravenous, 69 Inosit, 269 Insecta, 513, 542, 550 Insufflation, 66 Intravenous injections, 69 Inulin, 238, 376 Iodide of ammonium, 430 arsenic, 448 and mercury, 448 iron, 164, 431 lead, 193, 43 1 mercury, 410, 420, 431 potassium, 428 silver, 201 sodium, 431 starch, 43 1 sulphur, 431 zinc, 198, 431 Iodine, 404, 424, 470 ointment, 428 Iodism, 425 Iodized collodion, 546 starch, 431, 540 Iodo-cotton, 268 Iodoform, 431 cotton, 268 Iodoformum, 431 Iodol, 434 Iodum, 424, 470 Ioduretted potassium iodide, 428 Ipecac, 312, 357 black, 312 gray, 312 red, 312 Ipecacuanha, 312 Ipecacuanhic acid, 313 Ipomcea turpethum, 421 Iridaceae, 348, 550 Iridin, 348 Iris, 348 versicolor, 348 Irish moss, 537 Iron, 157 and ammonium citrate, 167 acetate, mixture of, 164 sulphate, 167 tartrate, 167 potassium tartrate, 164 quinine citrate, 1.66 584 INDEX. Iron and quinine citrate, solution of, 167 strychnine citrate, 167 bitter wine of, 167 bromide, syrup of, 166 by hydrogen, 160 carbonate, 160 mass of, 161 saccharated, 160 chloride, 162 citrate, 165 solution of, 165 compound pills of, 161 dialyzed, 167, 444 dried sulphate of, 162 hydrate, 160, 444 with magnesia, 160, 444 hypophospbite, 165, 450 iodide, pills of, 164 saccharated, 164 syrup, 164 lactate, 166 mixture, compound, 161 nitrate, 162 solution of, 165 oxalate, 166 oxide, 159, 160 pills, compound, 1 61 phosphate, 165 pills of aloes and, 168, 339 of iodide of, 164 plaster, 161 precipitated sulphate of, 162 preparations of, 157, 399, 403 pyrophosphate, 165 syrup of, 165 Quevenne's, 160 quinine and strychnine phosphates, syrup of, 167 reduced, 160 saccharated carbonate, 160 iodide, 164 solution of acetate of, 163 chloride of, 163 citrate of, 165 nitrate of, 165 subsulphate of, 162 tersulphate of, 162 sulphate, 161 dried, 162 precipitated, 162 syrup of bromide of, 166 iodide of, 164 tincture of acetate, 163 chloride, 163 troches, 1 61 valerianate, 167 wine of citrate of, 167 with magnesia, hydrated oxide of, 160 Irritants, 72, 377, 506 Isinglass, 540 Issues, S3, 35 Jaborandi, 357 Jaborine, 358 Jalap, 343 Jalapa, 343 Jamaica ginger, 219 kino, 183 sarsaparilla, 360 James' powder, 244 Jamestown weed, 94 Japaconine, 228 Japaconitine, 228 Japan camphor, 1 16 Japanese aconite, 227 Jasmine, Carolina, 304 yellow, 304 Jateorrhiza Calumba, 134 Jerusalem oak, 553 Jervine, 232, 233 Jesuit's powder, 147 Jewell's calomel, 414 Juglandaceae, 337 Juglandic acid, 337 Juglans, 337 cinerea, 337 Juglone, 337 Juices, 50 Jujube paste, 530 Juniper, 376 Juniperus, 376 communis, 376 Sabina, 400 virginiana, 400 Kairin, 476, 499 Kamala, 559 Kelp, 424, 459 Kilogram, 59 Kinic acid, 143 Kino, 183 red, 183 tannic acid, 183 Kinoiin, 183 Kino vie acid, 143 Kombe, 274 Kosin, 558 Koosso, 558 Kordofan gum, 528 Krameria, 184 tomentosa, 184 triandra, 184 Kramero tannic acid, 184 Labarraque's liquid, 468 Labiatse, 120, 223 Lac asafcetidae, 115 sulphuris, 326 INDEX. 585 Lactate of iron, 166 Lactic acid, 174 Lacto-phosphate of lime, syrup of, 448 Lactosin, 380 Lactuca virosa, 84 elongata, 84 Lactucarium, 84 English, 84 German, 84 Lactucin, 84 Ladies' slipper, 120 Lady Webster pill, 339 Lanthopine, 74 Lard, 540 benzoinated, 397, 541 oil, 541 Lartigue's pills, 372 (foot-note.) Laudamine, 74 Laudanosine, 74 Laudanum, 83 Lanolin, 541 Laughing-gas, ill Lauracese, 116, 216, 364 Laurostearic ether, 542 Lavements, 68 Lavendula, 223 vera, 223 Lavender, 223 Laxatives, 319, 320 Lead acetate, 192 arthralgy, 190 carbonate, 194 cerate of subacetate, 193 colic, 190 diacetate, 193 iodide, 193 ointment of, 193 liniment of subacetate, 193 nitrate, 194 ointment of, carbonate, 194 iodide, 193 oxide, 194 paralysis, 191 plaster, 58 poisoning, 190 preparations of, 189 solution of subacetate, 193 diluted, 193 sugar of, 192 subacetate, cerate of, 193 liniment of, 193 solution of, 193 diluted, 193 sulphate, 190 sulphide, 190 sulpho-carbolate, 480 water, 193 white, 194 Ledoy en's disinfecting fluid, 194 Leeches, 34 Leguminosse, 182, 183, 185, 275, 28] 321, 323, 339, 377,387, 398, 5M, 530, 534, 55o Lemon-juice, 250 essence, 250 oil, 250 peel, 250 rind, 250 spirit, 250 syrup, 250 Lenitives, 525 Leopard's-bane, 238 Lepidolite, 461 Leptandra, 341 virginica, 341 Leptandrin, 341 Lethal alcohol, 542 Lettuce-opium, 84 Levant worm seed, 554 Leyden jar, 41 Licebane, 240 Lichenes, 536 Lichenin, 537 Light, 38 magnesia, 329, 444 Lignum vitse, 362 Liliaceae, 337, 367, 381 Lima bark, 143 Lime-juice, 250 Lime chloride, 450 chlorinated, 467 liniment, 463 solution, 462, 463 sulphurated, 471 syrup, 463 water, 462, 463 Limonis cortex, 250 succus, 250 Linaceae, 530 Liniment, lime, 463 of ammonia, 213, 510 belladonna, 93 calcium, 463 camphor, 118 cantharides, 516 chloroform, no lead subacetate, 193 mustard, compound, 509 turpentine, 385 soap, 118 volatile, 213, 510 Linimenta, 57 Liniments, 50, 57 Linimentum ammoniae, 213, 510 belladonnse, 93 calcis, 463 camphorae, 1 18 cantharidis, 516 chloroformi, no plumbi subacetatis, 193 586 INDEX. Linimentum saponis, 118 sinapis compositum, 509 terebinthinse, 384 Linseed oil, 325,531 Linum, 530 usitatissimum, 530 Liquidambar orientalis, 397 Liquids, 50, 52 Liquor acidi arsenici, 447 ammonii acetatis, 247 arsenii et hydrargyri iodidi, 448 calcis, 462, 463 ferri acetatis, 166 chloridi, 163 citratis, 165 et quininae citratis, 167 nitratis, 165 subsulphatis, 162 tersulphatis, 162 gutta-perchae, 546 hydrargyri nitratis, 410, 423 iodi compositus, 427 magnesii citratis, 331 pepsini, 156 plumbi subacetatis, 193 dilutus, 193 potassae 456, 457 potassii arsenitis, 446 citratis, 247 sodae, 459 chloratae, 468 sodii arseniatis, 447 silicatis, 547 zinci chloridi, 197 Liquores, 52 Liquorice, 534, 535 powder, compound, 341 root, 534 Liquors, malt, 211 Litharge, 194 plaster, 58 Lithii benzoas, 462 bromidum, 291 carbonas, 461 citras, 461 praeparata, 461 salicylas, 492 Lithium benzoate, 462 bromide, 291 carbonate, 461 citrate, 461 preparations, 461 salicylate, 492 Lithontriptics, 456 Liver of sulphur, 326 Lobelia, 294, 318 inflata, 294 Lobeliaceae, 294 Lobelic acid, 294 Lobeline, 294 Local anaesthetics, 112 Local bloodletting, 33, 34 emetics, 310 Loganiaceae, 251, 257, 304, 551 Logwood, 185 London paste, 520 Long-leaved pine, 382 Lotion, Granville's, 518 Loxa bark, 143 Lozenges, 50, 52 Lugol's solution, 427 Lump gamboge, 351 Lunar caustic, 201, 519 Lupulin, 1 01, 102 Lupulinum, 1 01, 102 Lupulite, 101 Lux, 38 Lycopodiaceae, 536 Lycopodium, 536 clavatum, 536 Lytta vesicatoria, 513 Mace, 217 Maceration, 53 Macis, 217 Madeira wine, 210 Magendie's solution, 84 Magistery of bismuth, 201 Magnesia, 329, 444, 462 alba, 330 calcined, 329 Ellis's, 329 heavy, 329 Henry's, 329 Husband's, 329 ponderosa, 329 Magnesian limestone, 330 Magnesii carbonas, 330, 462 citras granulatus, 331 citratis, liquor, 331 praeparata, 462 sulphas, 330 sulphis, 471 Magnesite, 330 Magnesium carbonate, 330, 462 citrate, granulated, 331 solution of, 331 hydrate, 330 preparations, 462 sulphate, 330 sulphite, 471 sulpho-carbolate, 480 Magnetic electricity, 41, 42 Magnolia, 141 acuminata, 141 glauca, 141 tripetala, 141 umbrella, 141 Magnoliaceae, 141, 226 Magnolin, 141 Maisch's table, 62 INDEX. 587 Male fern, 556 Mallotus philippinensis, 559 Malt, 211 extract of, 211 liquors, 211 Malvaceae, 267, 533 Mammalia, 128, 541 Mandrake, 345 Manganese, 168 oxide, 168 preparations of, 168, 399 sulphate, 168, 332 Mangani oxidum nigrum, 168 praeparata, 168 sulphas, 168, 332 Manna, 321 cannulata, 321 fat, 321 in flakes, 321 in sorts, 321 Mannit, 321, 341 Margaric acid, 543 Marigold, 364 Marjoram, 225 Marrubium, 225 vulgare, 225 Marshmallow, 533 Marsh's test for arsenic, 440 antimony, 241 Martial preparations, 157 Mass, blue, 354, 355 of copaiba, 389 ferrous carbonate, 161 mercury, 354, 355, 404, 405 Massa copaibae, 389 ferri carbonatis, 161 hydrargyri, 355 Massage, ^8, 45 a friction, 45 Mate, 128 Materia Medica, definition of, 33, 47 Matico, 392 Matricaria, 139 chamomilla, 139 May-apple, 345 Meadow-saffron, 369 sweet, 489 Measures and weights, 58 apothecaries' 58, 60 approximate, 61 troy, 58 wine, 60 Mecca senna, 340 Mechanical remedies, 33 Mechano-therapy, 45 Meconic acid, 74, 76 Meconidine, 74 Meconin, 74 Medicated poultices, 447 syrups, 56 waters, 50, 53 Medicines, classification of, 70 definition of, 46 internal, 47 local, 47 Mel, 548 despumatum, 548 rosae, 188 Melaleuca cajuputi, 218 Melanthaceae, 232, 236, 369 Melia azedarach, 556 Meliaceae, 556 Mellita, 56 Melted butter, 334 Menispermaceae, 134, 135, 259, 364, 392 Menispermine, 260 Menispermum, 364 canadense, 364 Mentha piperita, 223 viridis, 223 Menthol, 223, 224 Menthylene, 224 Mercurial cathartics, 319, 354 chloride, 354, 355 corrosive, 409, 416, 468, 522 mild, 354, 355, 409, 414, 558 fever, 404 fumigation, 409,416, 422 injection, 409 inunction, 409 iodide, green, 409, 420 red, 409, 420, 470 mass, 409, 411 ointment, 409, 411 oleate, 409, 413 oxide, red, 409, 412 yellow, 409, 413 plaster, 409, 411 tremor, 404 Mercurials, 319,400, 404 Mercuric chloride, 409, 416, 468, 522 cyanide, 410, 421 iodide, 4ro, 420, 470 nitrate, solution of, 460, 423, 522 oxide, red, 409, 412 yellow, 409, 413 subsulphate, 319, 4io,*42i sulphide, 404, 410, 422 Mercurous chloride, 354, 355, 409, 414, 558 iodide, 410, 420 oxide, 414 black, 414 Mercury, ammoniated, 410, 421 corrosive chloride of, 409, 416, 468, 522 cyanide, 410, 421 fumigation with, 409, 416, 422 green iodide, 410, 420 injection of, 409, 419 inunction with, 409 iodide of, green, 410, 420 588 INDEX. Mercury, iodide of, red, 410, 420, 470 mass of, 354, 355, 409, 410 metallic, 404, 409 mild chloride of, 354,355, 4°9> 4 J 4> 558 nitrate of, 410, 422 ointment of, 404, 411 ammoniated, 410, 421 nitrate of, 410, 421 red iodide, 410, 420 oxide, 409, 412 yellow oxide, 409, 413 oleate of, 409, 413 preparations, 404 red oxide of, 409, 412 iodide of, 410, 420, 470 solution of nitrate of, 410, 423, 522 subsulphate of, 319, 410, 421 sulphide of, 404, 410, 422 with chalk, 409, 412 yellow oxide of, 409, 413 subsulphate of, 319 Metallic arsenic, 439 mercury, 404, 409 Meta-benzoic acid, 475 Meta-oxyphenol, 475 Meter, 59 Methal alcohol, 542 Methenyl choloride, 107 Methyconine, 279 Methylene bichloride, no Methyl ethylic ether, 1 1 1 nonyl-ketone, 401 salicylate, 221 Methylic ether, in Methy-theobromine, 1 21 Metrical system of weights, 59 compared with troy weights, 60 Mezereon, 363 Mezereum, 363 Mild acrid cathartics, 319, 335, 399 chloride of mercury, 354, 355, 409, 414, 558 Milk of asafetida, 1 15 of sulphur, 326 sugar of, 548 Milkweed, 374 Milligram, 5g Mimo-tannic acid, 179 Mindererus, spirit of, 247 Mineral acids, 169, 523 astringents, 178, 189 emetics, 318 oils, 545 tonics, 131, 157 Minims, 60 Mint, 223 camphor, 223, 224 Mirbane, essence of, 482 Mistura ammoniaci, 1 16 amygdalae, 529 Mistura asafcetidae, 1 15 chloroformi, 1 10 cretae, 464 ferri composita, 161, 396 et ammonii acetatis, 164 glycyrrhizae composita, 536 magnesiae et asafcetidae, 1 15 Mistura potassii citratis, 247 rhei et sodae, 336 Misturae, 52 Mitscherlich's test for phosphorus, 177 Mixture, almond, 529 ammoniac, 116 asafcetida, 115 Basham's, 164 brown, 536 chalk, 464 chloroform, 1 10 copaiba, Chapman's 389 (foot-note) Hope's camphor, 118 neutral, 247 of glycyrrhiza, compound, 536 of iron and ammonium acetate, 164 of iron compound, 161, 396 of liquorice, compound, 536 of magnesia and asafetida, 115 of potassium citrate, 247 of rhubarb and soda, 336 Mixtures, 50, 52 Moccasin plant, 120 Modus operandi of medicines, 48 Molasses, 320, 547 Monobromated camphor, 119 Monkshood, 227 Monsel's solution, 162 Montpelier scammony, 349 Moonseed, Canada, 364 Morphina, 74, 75 Morphinae acetas, 83 hydrochloras, 8^ sulphas, 83 Morphine, 74, 75 acetate, 83 hydrochlorate, 83 meconate, 74 sulphate, 8^ Morrhuol, 437, 438, 439 Mortar, 51 Moschus, 128 moschiferus, 128 Moss, Iceland, 536 Irish, 537 Motor-depressants, 251, 278 excitants, 251 Moulded silver nitrate, 201 Moxa, 39, 523 Mucilage, 529 of acacia, 529 of cydonium, 534 of gum arabic, 529 of slippery elm, 532 INDEX. 589 Mucilage, of sassafras pith, 533 of tragacanth, 530 Mucilago acaciae, 529 cydonii, 534 sassafras, 533 tragacanth oe, 530 ulmi, 532 Mucous membranes ; application of medi- cines to, 65 Muriatic acid, 172 diluted, 172 Musk, 128 artificial, 129 China, 129 deer, 128 Russia, 129 Mustard, 318, 507 black, 318, 507 flour, 507 paper, 509 seed, 507 whey, 509 white, 318, 507 Mycelium, 261 Mydriatic alkaloids, 98 Myrcia acris, 211 Myriagram, 59 Myristic ether, 542 Myristica, 217 fragrans, 217 Myristicaceae, 217 Myristicerie, 217 Myristicol, 217 Myronate of potassium, 508 Myrosin, 508 Myroxylon Pereirae, 398 toluifera, 398 Myrrh, 396 Myrrha, 396 Myrtaceae, 137, 183, 218 Naphthaline, 475, 495 Naphthol, 497 Narceine, 74, 75 Narcotics, 72 Narcotine, 74, 75 Natal oin, 338 Natron, 459 Nauseants, 310 Nauseating diaphoretics, 357 Nebulization of fluids, 66 Neurotics, 72 Neutral mixture, 247 Nicotine, 292 Nicotiana tabacum, 292 Nicotianin, 292 Nightshade, black, 102 deadly, 88 woody, 102 Nitrate of cerium, 203 Nitrate of glyceryl, 302 lead, 194 mercury, 410, 422 potassium, 244 silver, 198 diluted, 201 fused, 201 sodium, 246 Nitre, 244 crude, 244 cubic, 246 papers, 246 refined, 244 sweet spirit of, 248 Nitric acid, 171 diluted, 171 Nitrite of amyl, 300 potassium, 303 sodium, 303 Nitro-benzine, 474, 482 Nitroglycerin, 302 Nitroglycerinum, 302 Nitro- hydrochloric acid, 173 diluted, 173 Nitro-muriatic acid, 173 diluted, 173 Nitrous oxide gas, 1 1 1 powders, 246 papers, 246 Nitroxyl, 474 Normal quinine sulphate, 150 ferric sulphate, 162 Norway spruce, 510 Nucin, 337 Nutgall, 181 Nutmeg, 217 Nux vomica, 251 Oak, Jerusalem, 553 white, 185 Oak- red, 185 Oatmeal, 320 Occupation, influence of, 63 CEdema arsenicalis, 442, 446 CEnanthic acid, 210 ether, 210 Officinal, definition of term, 47 Oil cake, 532 canon, 463, 531 castor, 323 cotton seed, 532 cod- liver, 436 phosphorated, 439 croton, 353, 518 ethereal, 130 flaxseed, 325, 531 fusel, 205, 300 lard, 541 linseed, 325, 531 olive, 223 59Q INDEX. Oil phosphorated, 178 of almond, expressed, 323 amber, 129 allspice, 218 anise, 225 benne, 533 bitter almond, 299 cajeput, 218 camphor, 117 Canada erigeron, 373 carraway, 226 cardamom, 220 caryophyllus, 218 chenopodium, 553 cinnamon, 217 cloves, 218 copaiba, 387, 389 coriander, 226 cubeb, 390 cypripedium, 120 erigeron, 373 eucalyptus, 138 fennel, 225 flaxseed, 325, 531 garlic, 381 gaultheria, 221, 489 ginger, 219 hedeoma, 225 illicium, 226 juniper, 376 lavender, 223 flowers, 223 lemon, 250 linseed, 325, 531 mace, 218 marjoram, 225 mustard, volatile, 508, 509 neroli, 223 nutmeg, 218 orange flowers, 223 peel, 223 pennyroyal, 225 peppermint, 224 Chinese, 224 pimenta, 218 rosemary, 224 rue, 401 sandal -wood, 391 santal, 391 sassafras, 364 savine, 400 spearmint, 224 tansy, 401, 402 tar, 385 theobroma, 122,542 thyme, 225, 505 tobacco, 292, 294 turpentine, 382, 384, 510, 558 valerian, 120 vitriol, 169 wine, 130 Oil of wormseed, 553 phosphorated, 178 sweet, 323 Oils, distilled, 214 essential, 214 mineral, 545 volatile, 214 Ointment, 57, 541 alkaline sulphur, 326 basilicon, 387 benzoinated/541 blue, 409, 411 citrine, 410, 422 diachylon, 194 Gondret's vesicating, 518 sulphur, 326 of ammoniated mercury, 410, 421 antimony, 518 belladonna, 93 carbolic acid, 480 carbonate of lead, 194 chrysarobin, 525 gallic acid, 181 galls, 182 iodide of lead, 193 potassium, 430 sulphur, 430 iodine, 428 iodoform, 432 lead carbonate, 194 iodide, 193 mercuric nitrate, 410, 422 oxide, red, 409, 413 yellow, 409, 413 mercury, 409, 411 mezereon, 364 nitrate of mercury, 410, 422 nutgall, 182 oxide of zinc, 197 potassium iodide, 430 red mercuric oxide, 409, 413 oxide of mercury, 409, 413 precipitate, 409, 413 rosewater, 188 stramonium, 95 sulphur, 326 iodide, 430 sulphurated potassa, 326 tannic acid, 180 tansy, 401 tar, 386 tobacco, 254 veratrine, 237 yellow mercuric oxide, 409, 413 oxide of mercury, 409, 413 precipitate, 409, 413 zinc oxide, 197 Ointments, 50, 57 Olea Europcea, 323 volatilia, 214 Oleaceae, 321, 323 INDEX. 591 Oleata, 57 Oleate of mercury, 409, 413 veratrine, 237 Oleates, 50, 57 Oleatum hydrargyri, 409, 413 veratrinae, 237 Oleic acid, 542 Olein, 532, 541 Oleoresin of aspidium, 557 black pepper, 216 capsicum, 216, 510 cubeb, 390 cypripedium, 120 filix mas, 557 ginger, 219 Oleoresin, lupulin, 102 male fern, 557 Oleoresina aspidii, 557 capsici, 216, 510 cubebse, 390 lupulini, 102 piperis, 216 zingiberis, 219 Oleoresinae, 56, 367 Oleoresins, 50, 56 Oleum adipis, 541 aefhereum, 130 amygdalae amarae, 299 expressum, 323 anisi, 226 aurantii corticis, 223 florum, 223 cajuputi, 218 cari, 226 caryopbylli, 218 chenopodii, 553 cinnamomi, 217 copaibae, 387, 389 coriandri, 226 cubebse, 390 erigerontis, 373 eucalypti, 138 fceniculi, 225 gaultheriae, 221 gossypii seminis, 532 hedeomae, 225 juniperi, 376 lavandulse, 223 florum, 223 limonis, 250 Hni, 531 menthae piperitae, 224 viridis, 224 morrhuae, 436 myristicae, 218 olivae, 323 phosphoratum, 178 picis liquidae, 385 pimentae, 218 ricini, 323 rosmarini, 224 Oleum rutae, 401 sabinae, 400 santali, 391 sassafras, 364 sesami, 533 sinapis, volatile, 508, 509 succini, 129 terebinthinae, 384, 510, 558 theobromae, 122, 542 thymi, 225, 505 tiglii, 353, 5i8 Valerianae, 120 Olive oil, 323 tree, 323 Ophelia chirata, 135 Ophelic acid, 136 Opii pulvis, 82 Opium, 73 denarcotisatum, 82 plaster, 82 powder, 82 Orange flower, 223 water, 223 peel, 223 Orchidaceae, 120, 226 Ordeal bean, 281 Origanum, 225 vulgare, 225 Ortho-benzoic acid, 475 Ortho-oxyphenol, 475 Ounce, 58, 59 Ovis aries, 541 Oxalate of cerium, 202 iron, 166 Oxide of allyl, 381 antimony, 241 arsenic, 439 ethyls, 103 iron, hydrated, 160 with magnesia, 160 lead, 194 manganese, 168 silver, 201 zinc, 197 Oxynarcotine, 74 Pack, cold, 40 Painter's colic, 190 Pale rose, 188 Palas, kino, 183 Palma Christi, 323 Palmitin, 324, 532 Pancreatin, 156 saccharated, 156 Pancreatinum, 156 Pansy, 322 Papain, 157 Pa paver, 73 somniferum, 73 Papaveraceae, 73, 315, 3+7 592 INDEX. Papaverine, 74, 76 Papaya, 157 Papayacese, 157 Paper of cantharides, 517 mustard, 509 potassium nitrate, 246 Papers, 50, 52 Para-benzoic acid, 475 Paraguay tea, 128 Paraffme, 545 Paraldehyd, 85 Paramenispermin, 260 Paramorphine, 74, 76 Para- oxy phenol, 475 Paregoric elixir, 83 Pareira, 392 brava, 392 Paricine, 143 Parillin, 361 Parsley camphor, 402 Partridge-berry, 220 Parts to which medicines are applied, 64 Pasque-flower, 237 Paste, Jujube, 530 London, 520 Vienna, 520 Paullinia, sorbilis, 128 Pay tine, 143 Peach, 320 Pearlash, 457 Pearl white, 201 Pectin, 269 Pedeliaceae, 533 Pelletierine, 557 tannate, 558 Pelosine, 392 Pennyroyal, 225 Pepo, 559 Pepper, black, 216 cayenne, 215 red, 215 white, 216 Peppermint, 223 water, 224 Pepsin, 155 Pepsinum, 155 saccharatum, 155, 156 Percolation, 53 Percolator, 53 Permanganate of potassium, 169, 399, 466 Persian opium, 74 Pestle, 51 Petrissage, 45 Petrolatum, 57, 545 Petroleum oils, 545 ointment, 545 Petroselinum sativum, 402 Phaeoretin, 336 Pharmaceutical modifications, 49 Pharmacological remedies, 33, 46 Pharmacology, 46 Pharmacopoeia, 47 Pharmacy, definition of, 47 Phenic acid, 476 Phenol, 474, 476 cymylic, 505 Phenyl, 474 derivatives, 473 hydrate, 476 hydride, 474, 476 methylacetone, 87 Phlebotomy, 33 Phlox Carolina, 551 Phormine, 74 Phosphate of ammonium, 452 calcium, 448 iron, 165 quinine, 151 sodium, 332 Phosphide of zinc, 178 Phosphorated cod-liver oil, 439 oil, 178 Phosphoric acid, 174 diluted, 174 Phosphorus, 175 Physeter macrocephalus, 541 Physiological antidotism, 49 Physostigma, 281 venenosum, 281 Physostigminse salicylas, 283 Physostigmine, 281 salicylate, 283 Phytolacca, 239 berries, 239 decandra, 239 root, 229 Phytolaccaceae, 239 Phytolacca bacca, 239 radix, 239 Phytolaccin, 239 Picraconitine, 227 Picrsena excel sa, 132 Picropodophyllin, 346 Picrosclerotin, 263 Picrotoxin, 260 Picrotoxinum, 260 Pill of iron carbonate, 161 machine, 51 tile, 51 Pills, 50, 51 blue, 354, 355 compound cathartic, 352 compressed, 52 Lady Webster, 339 Lartigue's gout, 372 (foot-note) of aloes, 339 and asafetida, 115, 339 and iron, 168, 339, 396 and mastic, 339 and myrrh, 339 antimony, compound, 243 asafetida, 115 INDEX. 593 Pills of ferrous iodide, 164 galbanum, compound, 115, 396 iodide of iron, 164 iron, compound, 161, 396 iodide, 164 opium, 82 phosphorus, 178 rhubarb, 337 compound, 337 Plummer's, 243 Rufus's, 339 sugar-coated, 52 Pilocarpene, 358 Pilocarpinae hydrochloras, 360 Pilocarpine, 356 hydrochlorate, 360 Pilocarpus, 357 pennatifolius, 357 Pilulse, 51 aloes, 339 et asafcetidae, 115, 339 et ferri, r68, 339 et mastiches, 339 et myrrhae, 339, 396 antimonii compositae, 243 asafoetidae, 115 catharticae compositae, 352 ferri compositae, 161, 196 iodidi, 164 galbani compositae, 115, 396 opii, 82 phosphor i, 178 rhei, 337 compositae, 337 Pimenta, 218 Pimpinella anisum, 226 Pine, long leaved, 382 pitch, 382 yellow, 382 Pinitus succinifer, 129 Pinkroot, 551 Pint, 60 Pinus australis, 382 palustris, 385 taeda, 382 Pipe gamboge, 351 Piper, 216 nigrum, 216 Piperaceae, 216, 389, 392 Piperina, 216 Piperine, 216 Pipsissewa, 394 spotted, 394 Pisces, 436, 540 Pistachia, terebinthus, 383 Pitch pine, 382 plaster with cantharides, 51 1 Pix Burgundica, 510 Canadensis, "5 1 1 liquida, 385 Plasma, 540 38 Plasmodium malariae, 148 Plaster, adhesive, 387 court, 540 of ammoniac, 116 ammoniac with mercury, 1 16, 409, 412 arnica, 238 asafetida, 1 1 5 belladonna, 93 Burgundy pitch, 511 Canada pitch, 511 capsicum, 216, 510 galbanum, 115, 511 hemlock pitch, 511 iron, 161, 511 lead, 58, 194 litharge, 58, 194 mercury, 404, 411 opium, 82, 511 pitch with cantharides, 511 resin, 387 soap, 194 spice, 512 sticking, 387 warming, 511 Plasters, 50 Plumbi acetas, 192 carbonas, 194 iodidum, 193 nitras, 194 oxidum, 194 praeparata, 189 subacetatis, liquor, 193 Plummer's pills, 243 Pneumatic aspiration, 36 Podophyllin, 346 Podophyllinic acid, 346 Podophyilotoxin, 346, 347 Podophyllum, 345 peltatum, 345 Poison-nut, 251 Poison-oak, 259 Poke-berries, 239 root, 232, 239 Polychroit, 550 Polygala senega, 378 Polygalaceae, 378 Polygaleae, 184 Polygalic acid, 379, 380 Polygonaceae, 183, 335, 402 Polygonic acid, 402 Polygonum hydropiperoides, 402 Pomatum, Dupuytren's, 438 Pomegranate, 557 Poppy, black, 73 white, 73 Porphyroxin, 74 Port wine, 210 Porter, 211 Potassa 519 alcoholic, 519 594 INDEX. Potassa, cum calce, 520 hydrate, 519 solution of, 456, 457 sulphurata, 326 with lime, 520 Potassii acetas, 366 bicarbonas, 456, 457 bichromas, 454, 522 bitartras, 334 bromidum, 286 carbonas, 456, 457 pura, 456, 457 chloras, 452 citras, 247 cyanidum, 299 et sodii tartras, 334 hypophosphis, 449 iodidum, 428 nitras, 244 permanganas, 169, 399, 466 prseparata, 456 sulphas, 333 sulphis, 471 tartras, 334 Potassio- tartrate of iron, 164 Potassium acetate, 366 alum, 203 and sodium tartrate, 344 bicarbonate, 456, 457 bichromate, 454, 522 bitartrate, 334 bromide, 286 carbolate, 480 carbonate, 456, 457 chlorate, 452 chromate, 454 citrate, 247 mixture of, 247 solution of, 247 cyanide, 299 hydrate, 519 hypophosphite, 449 iodide, 428 ioduretted, 428 ointment of, 430 myronate, 508 nitrate, 244 nitrite, 303 permanganate, 169, 399, 466 preparations, 456 effects of, 244 sulphate, 333 acid, 508 sulphide, 326 sulphite, 471 sulpho- carbolate, 4^0 tartrate, 334 Potato, 102 flies, 517 spirit, 205, 300 Poultices, 39, 58, 526 Poultices, charcoal, 527 medicated, 527 yeast, 527 Pound, 58, 59 Powder, antimonial, 244 aromatic, 220 compound chalk, 464 effervescing, 335 glycyrrhiza, 341 jalap, 344 Dover's, 82, 315, 357 gray, 409, 412 James's, 244 Jesuits', 147 nitrous, 246 of ipecac and opium, 82, 315, 357 jalap, compound, 344 morphine, compound, 84 opium, 82 rhubarb, compound, 337 Tully's, 84 Powders, 50 Seidlitz, 250, 335, 460 Precipitated calcium carbonate, 463 phosphate, 448 ferrous sulphate, 162 sulphur, 326 zinc carbonate, 197 Precipitation, 51 Preparations, martial, 157 of ammonia, 211 ammonium, 462 antimony, 241, 357 arsenic, 439 bismuth, 201 calcium, 462 copper, 195 iron, 157, 399, 403 lead, 189 lithium, 456 magnesia, 462 manganese, 168, 399 mercury, 404 potassium, 456 silver, 201 sodium, 458 zinc, 196 Prepared chalk, 464 Pride of China, 556 Proof spirit, 55, 2og Propenyl hydrate, 543 Protopine, 74 Prune, 320 Prunum, 320 Prunus serotina, 154 Virginkna, 154 Prussic acid, 296 Pseudaconine, 227 Pseudaconitine, 227 Pseudojervine, 233 I Pseudomorphine, 74 INDEX. 595 Psychotria emetica, 313 Pterocarpin, 550 Pterocarpus erinaceus, 183 marsupium, 183 santalinus, 550 Pulsatilla, 237 Pulveres, 50 Pulverization of fluids, 66 Pulvis antimonialis, 244 aromaticus, 220 cretae compositus, 464 effervescens compositus, 335 glycyrrhizae compositus, 341 ipecacuanha et opii, 82, 315 jalapae Compositus, 344 morphinae compositus, 84 rhei compositus, 337 Pumpkin, 559 seed, 559 Punica granatum, 557 Purgatives, 319 Purging cassia, 323 Purified aloes, 339 Purple foxglove, 269 Pyridine, 475, 497 Pyrocatechin, 183, 475 Pyroligneous acid, 385, 480 Pyrophosphate of iron, 165 of sodium, 333 Pyroxylin, 545 Pyroxylinum, 545 Quaker button, 251 Quassia, 132 amara, 133 Quassin, 132, 133 Queen's delight, 365 Querci-tannic acid, 185 Quercitrin, 183 Quercus alba, 185 infectoria, 1 81 lusitanica, 181 Quevenne's iron, 160 Quicksilver, 404 Quillaia, 380 Saponaria, 380 Quillaiac acid, 380 Quinamine, 143 Quince seed, 534 Quinicine, 143 Quinidinae sulphas, 152 Quinidine, 143, 144 commercial, 144 sulphate, 144, 152 Quinina, 143 Quininae bisulphas, 151 hydrobromas, 151 hydrochloras, 15 1 sulphas, 143, 150 valerianas, 151 Quinine, 143 bisulphate, 151 crude, 152 carbolate, 151 citrate, 15 1 hydrobromate, 151 hydrochlorate, 151 iodosulphate, 144 phosphate, 151 salicylate, 15 1 sulphate, 143 sulphocarbolate, 151 sulphovinate, 151 valerianate, 151 Quinocine, 476 Quinoidin, 162 Race, influence of, 63 Rain-water, 527 Raisin, 320 Ranunculaceae, 135, 227, 237, 240, 258, 273, 276 Red bark, 142 cedar, 400 chromate of potash, 454 iodide of mercury, 410, 420, 470 mercurial iodide, 410, 420 sulphide, 410, 422 mercuric oxide, 409, 412 oxide of mercury, 409, 412 pepper, 215, 510 precipitate, 409, 412 ointment, 409, 413 rose, 188 saunders, 550 sulphide of mercury, 410,422 wine, 210 Reduced iron, 160 Refrigerant diaphoretics, 357 Refrigerants, 226, 247, 366 Reinsch's test for arsenious acid, 441 Relations between sp. gr. and bulk of liquids, 59 Remedies, definition of, 33 division of, 33 hygienic, 33 imponderable, 33, 38 mechanical, 33 pharmacological, ^^, 46 Resin, 382, 386 cerate, 387 of copaiba, 388, 389 jalap, 344 May apple, 347 podophyllum, 347 scammony, 350 plaster, 387 Resina, 386 copaivae, 388, 389 jalapae, 344 59 6 INDEX. Resina, podophylli, 347 scammonii, 350 Resolvents, 404 Resorcin, 113, 115, 116, 475, 487 Rhamnaceae, 342 Rhamnus Frangula, 342 purshiana, 342 Rhatanic red, 184 Rhatany, 184 Rheotannic acid, 336 Rheotome, 42 Rheum, 335 officinale, 335 rhaponticum, 336 Rheumic acid, 336 Rhceadine, 74 Rhubarb, 335 Chinese, 335 European, 335 Russian, 335 stick, 336 Turkey, 335 Rhus glabra, 188 toxicodendron, 259 Ricinic acid, 324 Ricinine, 324 Ricinolein, 324 Ricinus communis, 323 Rio Negro sarsaparilla, 360 Risus sardonicus, 257 Riverius, salt of, 247 Rochelle salt, 334 Rock candy, 547 Roll sulphur, 325 Rosa centifolia, 188 gallica, 188 Rosacese, 154, 188, 299, 380, 534, 558 Rose, red, 188 white, 188 Rose-water, 188 Rosemary, 224 Rosin, 386 Rosmarinus, 224 officinalis, 224 Rottlera, 559 Rottlerin, 559 Rubefacients, 204, 214, 506 Rubiaceae, 121, 141,312 Rubijervine, 232 Rubus, 188 Canadensis, 188 trivialis, 188 villosus, 188 Rue, 401 Rufus's pills, 339 Rules for converting troy weight into grams, 60 apothecaries' measure into cubic centimeters, 60 Rum, 210 bay, 211 Ruminantia, 128, 541 Russian musk, 129 rhubarb, 335 Ruta graveolens, 401 Rutacese, 357, 393, 401 Rye, 260 Sabina, 400 Saccharated ferrous carbonate, 160 iodide. 164 pancreatin, 156 pepsin, 156 Saccharin, 548 Saccharum, 547 lactis, 548 officinarum, 547 Saturni, 192 Saffranin, 550 Saffron, 550 Sage, 225 Sajous' pharyngeal atomizer, 67 Sal ammoniac, 450 diureticus, 366 prunelle, 244 Salicacese, 154 Salicin, 154, 489 Salicinum, 154 Salicylate of lithium, 492 methyl, 221 physostigmine, 283 quinine, 151 sodium, 492 Salicylated cotton, 268 Salicylic acid, 322, 475, 489 Salicylic-phenol- ether, 492 Saline cathartics, 319, 327 diuretics, 365 refrigerants, 247, 366 Salix, 154 alba, 154 Helix, 154 Salkowski's test for carbolic acid, 477 Salol, 492 Salt, Epsom, 330 Glauber's, 332 Rochelle, 334 of Riverius, 247 of tartar, 457 Saltpetre, 244 Salve, Deshler's, 387 Salvia, 225 officinalis, 225 Sandal wood, 391 Sanguinaria, 315 canadensis, 315 Sanguinarine, 315 Sanguisuga officinalis, 34 Santal, 391, 550 Santalaceae, 391 Santalic acid, 550 INDEX. 597 Santalum album, 391 rubrum, 550 Santonica, 554 Santonin, 555 Santoninate of sodium, 556 Santoninum,555 Sapindacese, 128 Sapo viridis, 523 Saponin, 341, 379, 380 Sapotoxin, 380 Sarothamnus scoparius, 275, 377 Sarsaparilla, 360 Brazilian, 360 Guatemala, 361 Honduras, 360 Jamaica, 360 Rio Negro, 360 Vera Cruz, 360 Sass' modification of the atomizer, 68 Sassafras, 364 medulla, 364, 533 officinale, 364, 533 pith, 364, 533 Saunders, red, 550 S a vine, 400 Scammonin, 349 Scammonium, 349 Scammony, 349 Montpellier, 349 Virgin, 349 Scarifications, 34, 35 Scarificator, 35 Scilla, 367, 382 Scillain, 368 Scillin, 368 Scillipicrin, 368 Scillitoxin, 368 Sclererytherin, 263 Sclerocrystallin, 263 Scleroiodin, 263 Scleromucin, 263 Sclerotic acid, 261, 266 Sclerotium, 260 Scleroxanthin, 263 Scoparin, 377 Scoparius, 377 Scrophulariaceae, 269, 341 Scruple, 58, 59 Scudamore's draught, 372 Scutellaria, 120 integrifolia, 1 21 laterifolia, 120 pilosa, 121 Seaside grape, 183 Season of gathering, influence of, on plants, 49 Secale cereale, 260 Sedatives, 72, 226 Seidlitz powder, 251, 335, 460 Semi-solids, 50, 57 Senega, 378, 399 Senega snakeroot, 378 Senegal gum, 528 Senegin, 379, 380 Senna, 329 Alexandria, 340 India, 340 Mecca, 340 Tinnevelly, 340 Tripoli, 340 Sennacrol, 341 Sennit, 341 Serous membranes, application of medi- cine to, 59 Serpentaria, 136 Sesamum indicum, 533 Setacea, 35 Setons, 33, 35 Sevum, 541 Sex, influence of, on medicinal effects, 63 Sheep, 541 Sherry wine, 210 Siegele's atomizer, 68 Signs and abbreviations, 56,1 Silver fir, 510 iodide, 201 nitrate, 198 diluted, 201 moulded, 201 oxide, 201 preparations of, 198 Simarubaceae, 132 Simple bitters, 132 syrup, 56 Sinapine sulphate, 508 Sinalbin, 508 Sinapis, 318, 507 alba, 318, 507 nigra, 318, 507 Sinapism, 509 Sinnigrin, 508 Skin, application of medicines to, 64 Skullcap, 120 Slippery elm, 532 bark, 532 Sloe, 307 Smartweed, 402 Smelling salts, 214 Smilacese, 360 Smilacin, 361 Smilax officinalis, 360 medica, 360 Smyrna opium, 74 Snakeroot, black, 276 seneka, 378 Virginia, 136 Snowden's atomizer, 67 Soap bark, 380 green, 523 liniment, 118 plaster, 194 59 8 INDEX. Soap wort, 380 Socalo'in, 338 Socotrine aloes, 338 Soda, 520 caustic, 5 20 chlorinated, solution of, 468 solution of, 459 Sodii acetas, 366 arsenias, 447 benzoas, 486 bicarbonas, 460 venalis, 460 bisulphite, 470 boras, 473 bromidum, 291 carbonas, 459 exsiccata, 460 chloras, 454 hypophosphis, 449 hyposulphis, 471 iodidum, 431 nitras, 246 phosphas, 332 praeparata, 458 pyrophosphas, ^33 salicylas, 492 santonin as, 556 sulphas, 332 sulphis, 470 sulpho-carbolas, 480 Sodium acetate, 366 and aluminium fluoride, 459 arseniate, 447 solution of, 447 benzoate, 486 bicarbonate, 460 bisulphite, 470 borate, 473 bromide, 291 carbonate, 459 dried, 460 carbolate, 480 chlorate, 454 hypophosphite, 449 hyposulphite, 471 iodide, 431 nitrate, 246 nitrite, 303 phosphate, 332 preparations, 458 pyrophosphate, 333 salicylate, 492 santoninate, 556 sulphate, 332 sulphite, 470 sulpho carbolate, 480 Soil, influence of, on plants, 49 Solanaceae, 88, 94, 95, 98, 102, 215, 292 Solanine, 102 Solanum Dulcamara, 102 nigrum, 102 Solanum tuberosum, 102 Solids, 50 Solubility, influence of, on medicines, 49 Soluble glass, solution of, 547 gun-cotton, 545 tartar, 334 Solution, Condy's, 467 Dobell's, 68 Donovan's, 448 Fowler's, 446 Labarraque's disinfecting, 468 Lugol's, 427 Magendie's, 84 Monsel's, 162 of ammonium acetate, 247 arsenic and mercuric iodide, 448 arsenic chloride, 447 arsenious acid, 447 chlorinated soda, 468 gutta percha, 546 iodine, compound, 427 iron, acetate, 166 and quinine citrate, 167 chloride, 163 citrate, 165 nitrate, 165 subsulphate, 162 tersulphate, 162 lead subacetate, 193 diluted, 193 lime, 462, 463 magnesium citrate, 331 mercuric nitrate, 410, 423, 522 pepsin, 156 potassa, 456, 457 potassium arsenite, 446 citrate, 247 soda, 458 sodium arseniate, 447 silicate, 547 soluble glass, 547 zinc chloride, 197 Solutions, 50, 52 Soporifics, 72 South American kino, 183 Spanish fly, 513 Sparteine, 275, 377 sulphate, 276 Spastics, 251 Spearmint, 223 water, 224 Special diuretics, 367 Spermaceti, 541 cerate, 542 whale, 541 Sphacelinic acid, 262 Spice plaster, 512 Spiced syrup of rhubarb, 337 Spigelia, 551 _ marilandica, 551 Spinants, 72, 251 INDEX. 599 Spiraea ulmaria, 484 Spirit of ammonia, 213, 462 aromatic, 213, 462 anise, 226 camphor, 118 chloroform, 1 10 cinnamon, 217 ether, compound, 130 gaultheria, 221 juniper, 210, 377 compound, 377 , lavender, 223 lemon. 250 Mindererus, 247 myrcia, 211 nitre, sweet, 248 nitrous ether, 248 nutmeg, 218 orange, 223 peppermint, 224 spearmint, 224 turpentine, 384 proof, 55, 209 Spirits, 50, 55 Spiritus, 55 aetheris compositus, 130 nitrosi, 248 ammoniae, 213, 462 aromaticus, 213, 462 anisi, 226 aurantii, 223 campboiae, 118 chloroformi, no cinnamomi, 217 frumenti, 210 gaultheriae, 221 juniperi, 210, 377 compositus, 377 lavandulae, 223 limonis, 250 menfhae piperitae, 224 viridis, 224 Mindereri, 247 myrciae, 211 myristicae, 218 odoratus, 225 sac char i, 210 vini Gallici, 210 Spongio-piline, 58 Spotted pipsissewa, 394 Spruce hemlock, 511 Norway, 510 Spurious Burgundy pitch, 511 Squill, 318, 367, 382 Squirting cucumber, 352 St. Ignatius' bean, 257 Staphisagria, 240 Staphisain, 240 Star anise, 226 Starch, 538 Static electricity, 41 Stavesacre, 240 Stearic acid, 543 ether, 542 Stearin, 541 Sterculiaceae, 542 Sternutatories, 66 Stethal alcohol, 542 Stick-rhubarb, 336 Stilbene, 398 Stillingia, 365 sylvatica, 365 Stimulants, 72, 204 aromatic, 205, 214 diffusible, 205 Stimulating diaphoretics, 357 diuretics, 399 Styptic cotton, 162 Stomach, influence of condition, 66 Stomachics, 205 Storacin, 397 Storax, 397 Stramonii folia, 94 semen, 94 Stramonium, 94 leaves, 94, 95 seed, 94, 95 Stronger ether, 103 water of ammonia, 212, 517 white wine, 210 Strophantin, 274 Strophantus, 274 hispidus, 274 Strychnina, 252, 257 Strychninae sulphas, 257 Strychnine, 252, 257 Strychnine sulphate, 257 Strychnos nux vomica, 25 1 Ignatii, 257 toxifera, 306 Sturgeon, 540 Sturiones, 540 Styptic collodion, 546 Styraceae, 396 Styrax, 397 Benzoin, 396 Styrol, 398 Subacetate of lead, solution of, 193 Subcarbonate of bismuth, 202 Sublimated cotton, 268 Sublimation, 51 Sublimed sulphur, 325 Submtrate of bismuth, 2CI Subsulphate of mercury, yellow, 319 Succinic acid, 130, 348 Succinum, 129 Succus limonis, 250 Sudorifics, 356 Suet, 541 Sugar, 547 barley, 548 beet root, 547 6oo INDEX. Sugar cane, 547 grape, 547 of lead, 192 milk, 548 raw, 547 refined, 547 Sulphate of aluminium, 204 and ammonium, 203 potassium, 203 atropine, 93 berberine, 135 cincbonine, 152 cinchonidine, 152 copper, 196, 318, 523 iron, 161 dried, 162 precipitated, 162 and ammonium, 167 magnesium, 330 manganese, 168, 332 morphine, 8^ potassium, 333 quinine, 144, 150 quinidine, 152 sodium, 332 sinapine, 508 sparteine, 276 strychnine, 225 zinc, 318 Sulphide of ammonium, 471 antimony, 243 of calcium, 471 of mercury, red, 410, 422 Sulphides, 327, 471 Sulphite of ammonium, 471 calcium, 327, 471 magnesium, 471 potassium, 471 sodium, 470 Sulphites, 470, 471 Sulphocarbolate of quinine, 151 calcium, 480 lead, 480 magnesium, 480 potassium, 480 sodium, 480 Sulphocarbolates, 480 Sulphocarbolic acid, 480 Sulphocyanide of allyl, 508 acrinyl, 508 Sulphovinate of quinine, 151 Sulphur, 325 crude, 325 flowers of, 325 iodide, 431 lotum, 325 praecipitatum, 326 sublimatum, 325 washed, 325 Sulphuretted antimony, 243 lime, 471 Sulphuretted potassa, 326 Sulphuric acid, 169 aromatic, 170 diluted, 170 ether, 103 Sulphuris iodidum, 431 Sulphurous acid, 470 Sumach, 188 Sumatra camphor, 116 Sumbul, 309 Suppositoria, 57 Suppositories, 50, 57, 68 Suppurants, 506, 518 Sus scrofa, 541 Swamp dogwood, 133 hellebore, 232 Swedish movement cure, 46 Sweet flag, 220 oil, 323 orange peel, 223 spirit of nitre, 248 tincture of rhubarb, 337 Sydenham's laudanum, 83 Syrup, 56 Cox's hive, 369 of acacia, 529 almond, 300 althaea, 533 blackberry, 189 calcium lactophosphate, 448 citric acid, 250 garlic, 382 ginger, 219 gum arabic, 529 hypophosphites, 449 with iron, 168, 450 ipecac, 315 iron bromide, 166 iodide, 164 pyrophosphate, 165 quinine and strychnine phosphates, 187 krameria, 184 lactucarium, 84 lemon, 250 lime, 463 marshmallow, 533 orange, 223 flowers, 223 poppies, 73 prunus Virginiana, 155 rhatany, 184 rhubarb, ^^J aromatic, 337 spiced, 337 rose, 188 sarsaparilla, compound, 361 senega, 380 senna, 341 simple, 56 squill, 369 INDEX. 60 1 Syrup of squill, compound, 369, 380 tar, 386 tolu, 399 wild cherry, 155 Syrupi, 56 Syrups, 50, 56 medicated, 56 Syrupus, 56 acacias, 529 acidi citrici, 250 allii, 382 altheas, 533 amygdalae, 300 aurantii, 223 florum, 223 calcis, 463 lactophosphatis, 448 ferri bromidi, 166 iodidi, 164 quininae et strychninas phospha- tum, 167 hypophosphitum, 449 cum ferro, 168, 450 pyrophosphatis, 165 ipecacuanhas, 315 kramerias, 184 lactucarii, 84 limonis, 250 picis liquidas, 386 pruni Virginianas, 155 rhei, 337 aromaticus, 337 rosas, 188 rubi, 189 sarsaparillae compositus, 361 scillae, 369 compositus, 369 senegas, 380 sennas, 341 tolutanus, 399 zingiberis, 219 Systemic emetics, 310 Tabacum, 292 Table for converting c. c. into f 3 , 61 apothecaries' weights and measures into gram weights, 62 of decimal with troy weights, com- parative, 60 Tablespoon, 61 Tamarind, 320, 321 Tamarindus, 321 indica, 321 Tanacetin, 401 Tanacetum, 401 vulgar e, 401 Tannic acid, 178, 179, 185, 186 Tansy, 401 Tar, 385 Tapotement, 45 Taraxacerin, 376 Taraxacin, 376 Taraxacum, 375 Dens leonis, 375 Tartar, 250 cream of, 250, 251, 334, 366 crude, 332 emetic, 241, 318 salt of, 457 soluble, 334 Tartaric acid, 249 Tartarized antimony, 241, 318 Tartrate of antimony and potassium, 241 iron and ammonium, 167 and potassium, 164 potassium, 334 and sodium, 334 Tea, 122 Paraguay, 128 worm, 553 Teaberry, 220 Teacup, 61 Teaspoon, 61 Teleostia, 436 Temperament, influence of, on medicinal effects, 63 Terebinth aceas, 259 Terebinthina, 382 canadensis, 382 Ternstromiaceas, 121 Terra japonica, 182 Test for acacia, 529 aconite, 227 aconitine, 227 antimony, 241 arsenic, 439 atropine, 89 bismuth, 202 carbolic acid, 477 cinchouidine, 145 cinchonine, 144 colchicine, 370 copper, 195 corrosive sublimate, 417 creasote, 481 cyanohydric acid, 257 digitalis, 271 gallic acid, 181 guaiac, 362 hydrochloric acid, 172 hydrocyanic acid, 296 iodine, 424 lead, 190 mercury, 417 morphine, 75 nitric acid, 171 opium, 75 phosphorus, 177 prussic acid, 296 quinicine, 144 quinidine, 144, 145 602 INDEX. Test for quinine, 144 salicylic acid, 490 silver, 198 starch, 539 strychnine, 252 sulphuric acid, 170 tannic acid, 179 veratrine, 236 zinc, 196 Berzelius- Marsh, 441 Herapath's, 144 Marsh's, 241, 440 Mitscherlich's, 177 Plugge's, 477 Reinsch's, 441 Salkowski's, 477 Thalleioquin, 144 Trapp's, 236 Tetanocannabine, 100 Tetra-iodo-pyrol, 434 Tetterwort, 347 Thalleioquin, 144 Thalline, 476, 500 Thea, 121 chinensis, 121 Thebaine, 74, 76 Thebolactic acid, 74 Theine, 121 Theobroma, 122 cacao, 542 Theobromine, 122, 543 Therapeutics, definition of, 47 Thornapple, 94 Thoroughwort, 139 Thymelaceas, 363 Thymene, 225 Thymol, 225, 505 Thymus vulgaris, 225, 505 Tiglinic acid, 353 Time of administration influences action of remedies, 63 Tinctura aconiti, 232 aloes, 339 aloes et myrrhae, 339 arnicas florum, 238 radicis, 238 asafcetidae, 115 aurantii amari, 223 dulcis, 223 belladonnas, 93 benzoini, 397 composita, 397 bryonias, 345 calendula?, 364 calumbae, 135 cannabis Indicae, 101 cantharidis, 378 capsici, 215, 510 cardamomi, 220 composita, 220 catechu composita, 183 Tinctura chirata, 136 cimicifugae, 278 cinchonas, 149 composita, 149 cinnamomi, 217 colchici, 373 conii, 280 croci, 550 cubebae, 391 digitalis, 273 ferri acetatis, 166 chloridi, 163 gallae, 182 gelsemii, 306 gentianae composita, 134 guaiaci, 363 ammoniata, 363 humuli, 102 hydrastis, 259 hyoscyami, 97 ignatias, 257 iodi, 427 ipecacuanhas et opii, 83, 315 kino, 184 krameriae, 184 lavandulas composita, 223 lobelias, 296 matico, 392 moschi, 129 myrrhas, 396 nucis vomicae, 257 opii, 83 camphorata, 83 deodorata, S^ physostigmatis, 283 quassias, 133 rhei, 337 aromatica, 337 dulcis, 337 sanguinarias, 317 saponis viridis, 524 scillae, 369 serpentarias, 137 stramonii, 95 sumbul, 310 tolutana, 399 Valerianae, 120 ammoniata, 120 vanillas, 226 veratri viridis, 236 zingiberis, 219 Tincturae, 54 herbarum recentium, 55 Tincture of aconite, 232 aloes, 339 and myrrh, 339 American hellebore, 236 arnica flowers, 238 root, 238 asafetida, 115 belladonna, 93 INDEX. 603 Tincture of benzoin, 397 compound, 397, 399 bitter orange peel, 223 bloodroot, 317 bryony, 345 calabar bean, 283 calendula, 364 calumba, 135 cannabis Indica, IOI cantharides, 378 capsicum, 215, 510 cardamom, 220 compound, 220 catechu, compound, 183 chirata, 136 chloride of iron, 163 cimicifuga, 278 cinchona, 149 compound, 149 cinnamon, 217 colchicum, 373 columbo, 135 conium, 280 crocus, 550 cubeb, 391 cypripedium, 120 digitalis, 273 ferric acetate, 166 chloride, 163 galls, 182 gelsemium, 306 gentian, compound, 134 ginger, 219 green soap, 523 guaiac, 363 _ ammoniated, 363 hops, 102 Huxham's, 137, 149 hydrastis, 259 hyoscyamus, 97 ignatia, 257 Indian hemp, 101 iodine, 427 compound, 427 ipecac and opium, 83, 315 iron chloride, 163 kamala, 559 kino, 184 krameria, 184 lavender, compound, 223 lobelia, 296 matico, 392 musk, 129 myrrh, 396 nutgall, 182 nux vomica, 257 opium, 83 camphorated, 83 deodorized, 83 orange peel, 223 physostigma, 283 Tincture of quassia, 133 rhatany, 184 rhubarb, 337 and aloes, 337 and gentian, 337 and senna, 337 aromatic, 337 sweet, 337 rottlera, 559 saffron, 550 sanguinaria, 317 serpentaria, 137 squill, 369 stillingia, 365 stramonium, 95 sumbul, 310 sweet orange peel, 223 tolu, 399 valerian, 120 ammoniated, 120 vanilla, 226 veratrum viride, 236 yellow jasmine, 306 Tinctures, 50, 54 ammoniated, 54 ethereal, 55 of fresh herbs, 55 Tinnevelly senna, 340 Tobacco, 292, 318 Indian, 294, 318 Tolene, 398 Tolerance to medicines in disease, 63 narcotics in disease, 72 established by habit, 63 Tolu, balsam of, 398 Tonics, 72, 131 mineral, 131, 157 vegetable, 131, 132 Topical medicines, 72, 464 Toxicodendric acid, 259 Toxicodendron, Rhus, 259 Tragacanth, 530 Tragacantha, 530 Tragacanthin, 530 Transfusion of blood, 69 Aveling's apparatus for, 69 Trapp's test for veratrine, 236 Treacle, 547 Treatment of poisoning by acetic acid, 250 aconite, 229 alcohol, 208 antimony, 241 arsenic, 444 atropine, 91 belladonna, 91 boracic acid, 472 boric acid, 472 calabar bean, 282 camphor, 117 carbolic acid, 478 604 INDEX. Treatment of poisoning by chloral, 285 colchicine, 372 conium, 280 copper, 195 corrosive sublimate, 417 creasote, 48 1 cyanhydric acid, 298 daturine, 95 digitalis, 271 duboisine, 98 essence of merbane, 482 gold salts, 423 hydrochloric acid, 172 hydrocyanic acid, 298 hyoscine, 97 hyoscyamine, 97 hyoscyamus, 97 iodine, 425 iodoform, 432 lead, 191 mercury, 417 mineral acid, 169 morphine, 78 nitric acid, 171 nitro-benzine, 482 nux vomica, 255 opium, 78 phosphoric acid, 173 phosphorus, 176 physostigma, 282 potassium nitrate, 246 prussic acid, 298 silver, 199 squill, 368 stramonium, 95 strangury from cantha- rides, 516 strychnine, 255 sulphuric acid, 170 tartar emetic, 241 tobacco, 293 veratrine, 237 veratrum viride, 235 zinc, 196 Tremor mercurialis, 404 Trimethylamine, 437 Trinitroglycerin, 302 Tripoli senna, 340 Triticin, 376 Triticum, 376 repens, 376 vulgare, 376, 538 Trituratio elaterini, 353 Trituration of elaterin, 353 Trituration es, 50 Triturations, 51 Troches, 52 of ammonium chloride, 452 bicarbonate of sodium, 460 catechu, 183 chalk, 464 Troches, chlorate of potassium, 452 cubeb, 391 ginger, 219 glycyrrhiza and opium, 82 ipecac, 315 iron, 161 krameria, 184 magnesia, 462 morphine and ipecac, 84, 315 peppermint, 224 potassium chlorate, 453 sodium bicarbonate, 460 santoninate, 556 tannic acid, 180 Trochisci, 52 acidi tannici, 180 ammonii chloridi, 452 catechu, 183 cretae, 464 cubebae, 391 ferri, 161 glycyrrhizae et opii, 82 ipecacuanhas, 315 kramerise, 184 magnesiae, 462 menthae piperitae, 224 morphinae et ipecacuanhas, 84, 315 potassii chloratis, 452 sodii bicarbonatis, 460 santoninatis, 556 zingiberis, 219 Tropic acid, 93 Tropine amygdalate, 93 Troy weight, 58 Tully's powder, 84 Turkey gum, 528 opium. 74 rhubarb, 335 Turpentine, 382 American, 382 Bordeaux, 382 Canada, 382, 383 Chian, 382, 383 Venice, 382 white, 382, 383 Turpeth mineral, 319, 410, 421 Tutty, 197 Ulcers, application of medicines to, 69 Ulmus, 532 fulva, 532 Umbelliferae, 113, 1 15, 225, 278, 309 402 Umbelliferon, 113, 1 15 Unguent a, 57 Unguentum, 57, 540 acidi carbolici, 480 gallici, 181 tannici, 180 antimonii, 518 INDEX. 605 Unguentum, aquae rosae, 188 belladonnae, 93 chrysarobini, 525 diachyli, 194 gallae, 182 hydrargyri, 404, 411 ammoniati, 410, 421 nitratis, 410, 422 oxidi flavi, 409, 413 oxidi rubri, 409, 413 iodi, 428 iodoformi, 434 mezerei, 364 picis liquidae, 386 plumbi carbonatis, 194 iodidi, 193 potassii iodidi, 430 stramonii, 95 sulphuris, 326 alkalinum, 326 veratrinae, 237 * zinci oxidi, 197 Urethan, 87 Urginea scilla, 367 Ursone, 393 Urticacese, 99, 101, 532 Ustilago, 266 maydis, 266 Uva ursi, 393 Valerian, 119 Valeriana, 119 officinalis, 119 Valerianaceae, 1 19 Valerianate of ammonium, 120 elixir of, 120 (foot note) bismuth, 202 caffeine, 122 iron, 167 quinine, 15 1 zinc, 198 Valerianic acid, 119, 308, 310, 353 Vallet's ferruginous mass, 161 Vanilla, 226 planifolia, 226 Vanillin, 226 Vapor bath, 39 Vapors, 50, 58 Vaseline, 57, 545 Vegetable acids, 248 astringents, 178, 179 emetics, 312 tonics, 131, 132 Veins, injections into, 69 of medicines into, 69 Venesection, 33 Venice turpentine, 382 Vera Cruz sarsaparilla, 360 Veratrina, 233 Veratrine, 233 Veratroidine, 232, 233 Veratrum album, 232 viride, 232 Vermicide, 551 Vermifuge, 551 Vermilion, 422 Vesicants, 204, 506, 512 Vesicating taffetas, 516 ointment, Gondret's, 518 Vesication, 3g Viburnin, 308 Viburnum, 307 prunifolium, 307 Vienna paste, 520 Vina, 56 Vinegar, 250 ofbloodroot, 317 lobelia, 296 opium, 83 sanguinaria, 317 squill, 369 Vinegars, 50, 56 Vinum, 209 album, 210 fortius, 210 aloes, 339 antimonii, 243 aromaticum, 140, 224, 225 colchici radicis, 373 seminis, 373 ergotae, 266 ferri amarum, 167 citratis, 167 ipecacuanhse, 315 opii, 83 *hei,337 rubrum, 210 Viola tricolor, 322 Violaceae, 322 Virgin scammony, 349 Virginia snakeroot, 136 tobacco, 292 Vitriol, blue, 196 elixir of, 170 green, 161 oil of, 169 white, 196 Volatile alkali, 211 liniment, 510 oil of mustard, 508, 509 oils, 214 Voltaic electrical current, 42 electricity, 41, 42 Von Hebra's green soap, 523 Wahoo, 348 Warm bath, 39 Warming plaster, 511 Warner's gout cordial, 337 Wash, black, 414 6o6 INDEX. Wash, yellow, 409, 413 Washed sulphur, 325 Water, 527 bath, 39 cold, 40 hot, 39 warm, 39 carbonic acid, 528 chlorine, 467 cologne, 225 distilled, 527 lead, 193 lime, 462, 463 rain, 527 snow, 527 of ammonia, 213 stronger, 212, 517 anise, 225 bitter almonds, 300 camphor, 118 cinnamon, 217 creasote, 482 fennel, 225 orange flower, 223 peppermint, 224 rose, 188 spearmint, 224 Water-pepper, 402 Waters, distilled, 53 medicated, 53 Watery extracts, 57 Wax, 542 Weights and measures, 58 apothecaries', 60 metrical, 59 troy, 58 Wet sheet, cold, 40 Whale, spermaceti, 541 Whiskey, 210 White arsenic, 439 ginger, 219 lead, 194 mustard, 318, 507 oak, 185 pepper, 216 poppy, 74 precipitate, 410, 421 rose, 188 turpentine, 382 vitriol, 196 wax, 542 willow, 154 wine, 210 stronger, 210 Wild cherry, 154 lettuce, 84 valerian, 119 Willow, 154 Wine, 209 aromatic, 140, 224, 225 Madeira, 210 Wine, measure, 60 of aloes, 339 antimony, 243 colchicum root, 373 seed, 373 ergot, 266 ipecac, 315 iron, bitter, 167 citrate, 167 opium, 8^ rhubarb, ^37 port, 210 red, 210 sherry, 210 white, 210 stronger, 210 Wineglass, 61 Wine whey, 210 Wines, 50, 56 Wintergreen, 394 Wistar's cough lozenges, 82 Witch hazel, 187 Wolfsbane, 227 Woody nightshade, 102 Woorali, 306 Woorara, 306 Woorari, 306 Worm tea, 553 Wormseed, American, 553 Levant, 554 Wormwood, 140 Wounds, application of medicines to, 69 Xanthopuccine, 258 Yeast poultice, 527 Yellow bark, 142 chromate of potash, 454 gentian, 133 jasmine, 304 mercurial subsulphate, 319, 410, 421 mercuric oxide, 409, 413 oxide of mercury, 409, 413 parilla, 364 pine, 382 precipitate, 409, 413 root, 258 wash, 363 wax, 542 Young's scheme for doses, 61 Zea mays, 266 Zinc, acetate, 197 bromide, 291 carbonate, 196, 197 chloride, 196, 198 solution of, 197 iodide, 198 INDEX. 607 Zinc nitrate, 196 oxide, 196, 197 commercial, 197 ointment of, 197 phosphide, 178 precipitated carbonate, i< preparations, 196 sulphate, 196 valerianate, 198 Zinci acetas, 197 bromidum, 291 carbonas praecipitatus, 19 Zinci chloridum, 198, 522 iodidum, 198 oxidum, 197 venale, 197 praeparata, 196 phosphidum, 178 sulphas, 196, 318 valerianas, 198 Zingiber, 219 officinale, 219 Zingiberaceae, 217,219 Zygophyllacese, 362 FEBRUARY, 1889. 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Pelvic Organs. 12.00 Scanzoni. Sexual Organs of. 4.00 Tilt. Change of Life. - 1.25 Winckel, by Parvin. Manual of. Illus. Clo., 3.00; Sh. 3.50 A NEW TEXT-BOOK JUST PUBLISHED. DISEASES OF THE SKIN. BY T. MCCALL ANDERSON, M.D., Professor of Clinical Medicine in the University of Glasgow. ASSISTED BY Dr. James Christie, Sec'y London Epidemiological Society for Indian Ocean and East Africa; Mem, Medical Soc. of Bombay, etc. Dr. Hector C. Ca'meron, Surgeon and Lecturer to Western Infirmary, Glasgow; Surgeon to Glasgow Hospital for Children, etc. William Macewen, m.b., m.d., Lecturer on Systematic and Clinical Surgery, Royal Infirmary ; Surgeon to Royal Infirmary and Children's Hospital, Glasgow, etc. WITH COLORED PLATES AND NUMEROUS WOOD ENGRAVINGS. Octavo. 650 Pages. Cloth, $4.50 ; Leather, $5.50. A treatise on Diseases of the Skin, with reference to Diagnosis and Treatment, including an Analysis of 11,000 Consecutive Cases. Thoroughly illustrated by new and handsome wood engravings, and several colored and steel plates prepared, under the direction of the author, from special drawings by Dr. John Wilson. PARTICULARLY STRONG IN TREATMENT. J^° Special attention is given to the Differential Diagnosis of Skin Diseases and to the treatment. There are over 150 prescriptions, which will serve as hints to the physician in dealing with obstinate and chronic cases. There has been no complete treatise on Dermatology issued for several years ; Professor Anderson has, therefore, chosen an opportune time to publish his book. Illustrating one of the Diseases of the Hair {See Fig. b,page 7). For nearly twenty-five years Professor Anderson has been a general practitioner and a hospital physician, with unusual opportunities for the study of this class of diseases, though not a "specialist," as the term is understood. His experience is, therefore, of great value, and the physician will feel that, in consulting this work, he is reading the expe- riences of a man situated as himself — with the same difficulties of diagnosis and treatment, and who has surmounted them successfully. We believe this to be a valuable feature of the book that will be recognized at once ; for it is undoubtedly a fact that a work like the present contains much practical information and many hints not to be found else- where. Professor Anderson is particularly happy in illustrating the impor- tant relations subsisting between the general economy and its covering, and his ideas of pathology and therapeutics, including a consideration of all the general and local manifestations of the common diseases of the economy which are manifested upon the surface, will find many appreciative readers. Diseases of the hair receive full systematic treatment. 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Great care has been taken in selecting the leather for the covers and in each detail of manufacture. SIZES AND PRICES. Tucks, pockets and Pencil, $i.oc " . " " 1.25 " " " 1.50 " '* " 2.00 For 25 Patients weekly. 50 75 " 100 50 2.50 3.00 For 25 Patients weekly 50 50 3.00 INTERLEAVED EDITION. Interleaved, tucks and Pencil, 1.25 1.50 2 Vols f Jan. to June 1 2 vols. jj ulytoDec .J PERPETUAL EDITION, without Dates. $gg~Can be com7nenced at any time, and used until full. Similar in style, con- tents and arrangement to the regular edition. No. 1. Containing space for over 1300 names, with blank page opposite each Visiting List page. Bound in Red Leather cover, with Pocket and Pencil, #1.25 No. 2. Containing space for 2600 names, with blank page opposite each Visiting List page. Bound like No. 1, with Pocket and Pencil, . . . . 1.50 These lists, without dates, are particularly useful to young physicians unable to estimate the number of patients they may have during the first years of Practice, and to physicians in localities where epidemics occur frequently. " For completeness, compactness, and simplicity of arrangement it is excelled by none ; n the market." — N. Y. Medical Record. " The book is convenient in form, not too bulky, and in every respect the very best Visiting List published."— Canada Medical and Surgical Journal. After all the trials made, there are none superior to it." — Gaillard's Medical Journal. „ » 1 bec ° me Standard." —Southern Clinic. „ |; e .2 ula r as tn e seasons comes this old favorite." — Michigan Medical News. ,, ip 1S °i u ' te convenient for the pocket, and possesses every desirable quality." — Medical Herald. »X. he , most P°P} llarVisitin g List extant."— 5z^«/^ Medical and Surgical Journal. „ We . nav e used it for years, and do not hesitate to pronounce it equal, if not superior, to any." — Southern Clinic. " This Visiting List is too well known to require either description or commendation from us." — Cincinnati Medical News. JUST READY. THE SEVENTH REVISED AND ENLARGED EDITION OF ROBERTS' PRACTICE. THE THEORY AND PRACTICE OP MEDICINE. By F RED T. Roberts, m.d., k.r.c.p., Professor of Materia Medica and Therape^ tics at Un.vers.ty Hospital, Physician to Universe College Hosp.ta e 2 Seventh Edition. Revised and Enlarged. One V0 .:J, 8V S S merou, I, us.rat.ons. cloth Binding, fc . so / Leather ' 6 50 The present edition has been fully revised through on t » n A ■ arranged. While an endeavor has ZnZZe oZt^ZZlTl* "^ " ~ special attention has been given to the question, of t!. S " bjeC ' n P' date ln aI1 "s aspects, no,ce infant therapeutists or S^ch hTb^ SJS^T*" ^ rec^dTX^nteeXta :^ **** "T^ pnbhshers are in receipt of nun^s t^tZTT^ t "** " * TeX '- b °° k - The favorably of it, and below they ! I Z [ZZfZ^ Pf^ * h °° h > ^"Z -^i::z^:-;rz:j hi> "• *> - 4' > • <— « »• «-.- ril o™""" * "' "°' k th " "" '""*" "" - b — " ■ "»i-«- <- — - BY THE SAME AUTHOR. NOTES ON MATERIA MEDICA AND PHARMACY. ESPECIALLY ARRANGED FOR THE USE OF STUDENTS. 16mo, Cloth, $2.00. by^rptblisWs B ° 0kSeIIerS ; ° r WiU be SCnt by if- P°^- on receipt of price P. Blaihston, Son & Co., ioi 2 Walnut Street, Philadelphia. "IT STANDS WITHOUT AN EQUAL AS THE MOST COMPLETE WORK ON PRACTICE IN THE ENGLISH LANGUAGE."— New York Medical Journal. FAGGE'S PRACTICE OF MEDICINE. Two Large Royal Octavo Volumes. Containing over 1900 Pages. PRICE, HANDSOMELY BOUND IN CLOTH, $8.00. The Principles and Practice of Medicine, By CHARLES HILTON FAGGE, M.D., F.R.C.P., F.R.M.C.S., Examiner in Medicine, University of London ; Physician to, and Lecturer on Pathology in, Guy' s Hospital; Senior Physician to Evelina Hospital /or Sick Children, etc. EDITED AND ARRANGED FOR THE PRESS By P. H. Pye-Smith, M.D., F.R.C.P., Lecturer on Medicine in Guy's Hospital, London, etc., WITH A SECTION ON CUTANEOUS AFFECTIONS, BY THE EDITOR, A CHAPTER ON CAR- DIAC DISEASES, BY SAMUEL WlLKES, M. D., F. R. S., AND TWO INDEXES, ONE OF AUTHORS AND ONE OF SUBJECTS, BY ROBERT EDMUND CARRINGTON. Two Volumes. Royal Octavo. 1900 Pages. Price in Cloth, $8.00. Full Leather, $10.00. Half Morocco, $12.00. Half Russia, $12.00. It is based on laborious researches into the pathological and clinical records of Guy's Hospital, London, during the twenty years in which the author has held office there as Medical Registrar, as Pathologist, and as Physician. Familiar beyond most, if not all, of his contemporaries, with modern medical literature, a diligent reader of French and German periodicals, Dr. Fagge, with his remarkably retentive memory and methodical habits, was able to bring to his work of collection and criticism almost unequaled opportunities of extensive experience in the wards and dead house. The result is that which will probably be admitted to be a fuller, more original, and more elaborate text-book on medicine than has yet appeared. It is the first of importance emanating from Guy's Hospital, and the only two-volume work on the Practice of Medicine that has been issued for a number of years. Several subjects, such as Syphilis, that are usually omitted or but slightly spoken of in a general work of this character, receive full attention. Dr. Walter Moxon, one of Dr. Fagge's contemporaries, and a great personal friend, writes of him, in a recent number of the London Lancet : — " Fagge was, to my mind, the type of true medical greatness. I believe he was capable of any kind of excellence. His greatness as a physician became evident to observers of character very soon after his brilliant student career had placed him on the staff of Guy's Hospital; he did not merely group already known facts, but he found new facts. Former volumes of Guy's Hospital Reports contain ample and most valuable proof of his greatness as a physician. His power of observation was sustained by immense memory, and brought into action by vivid and constant suggestiveness of intelligence. He was a physician by grace of nature, and being gifted with a quickness of perception, a genius for clinical facts and a patience in observation, he was at once recognized as a successful practitioner and a leading figure in the hospital and among the profession. I