> 1> > i&£53t ^3 llil; If : §>1> ">i> 3m33 *OTW1> J" LIBRARY OF CONGRESS,? 2 " „£ I t j*J$a2> \ I , t 5 flTED STATES OF AMERICA.! ■>>>■>> ^ = m^mj*?^' m >3P 3>.V ^1> £> » s 3> ^ >b>X>< ~>3 i>> > } > ' llf H » > y» ii> 2 U > > > ^ 3 > >^r> r>.X>. j > >> > • > > > > ^> > > 5> '^- >:> >> > » > m> z > >>> > > ^ ?^^ia€^-^ >> ^2^ .•;>' ° >> >^> >3^" ">> >: ^2 :> > ^D >j> > j3Bi -» > TS ( NEW REMEDIES: PHARMACEUTICAL!! AND THERAPEUTICALLY CONSIDERED. FOURTH EDITION, WITH EXTENSIVE MODIFICATIONS AND ADDITIONS. ROBLEY DUNGLISON, M.D., profe9sor of the institutes of medicine, etc., in jefferson medical college of Philadelphia; lecturer on clinical medicine and attending physician to the philadelphia hospital; corresponding secretary of the american philosophical society, etc., etc. PRODESSE QUAM CONSPICI. 13 ' V PHILADELPHIA: LEA AND BLANC HARD 1843. ■*7-'4/.V7 ■ft X [Entered, according to Act of Congress, in the year 1843, by Robley Dunglison, M.D., in the Clerk's Office of the District Court of the Eastern District of Fennsyl- PHILADELPHIA : NGTON AND HASWEL1, PRINTERS. PR EFACE TO THE FOURTH EDITION, Since the publication of the third edition of this work in 1841, the Pharmacopoeia of the United States has appeared under the revision of Professors Wood and Bache and the Author. This has rendered it necessary to modify somewhat the nomenclature, and, to a certain extent, the arrangement of the " New Reme- dies." The Author has likewise endeavoured to embody all the new information of a therapeutical or pharmaceutical character, con- tained in the different scientific journals, as well as in the ex professo works on Materia Medica and Pharmacy, that have been published since the appearance of the last edition. Farther and varied opportunities have necessarily occurred for testing the value of many of the agents, and of the methods for preparing them. The results of these observations have been introduced. The labour required to accomplish this has not been trifling : the large amount of matter added — seventy or eighty pages — and the numerous alterations that have been made can only be accurately appreciated, however, by a close examination. The chief recent works consulted have been those of Pereira* Chris- • The Elements of Materia Medica and Therapeutics. By Jonathan Pe- reira, M.D., F.R.S., and L.S., &c., &c. 2d edit. pp. 1926. Lond. 1842; and Amer. edit, by Dr. Carson. 2 vols. Philad. 1843. tison,* Bouchardat,t and Lincke,J but others of a previous date have not been neglected. The additional articles inserted in their proper places in the present edition are : — Alumina Sales, Jlnthrakokali, Cannabis Indica, Corylus Rostrata, Ferri Citras, Ferri et Quinise Citras, FucusJimylaccus,Fuligokali, Gentiana Chirayita,Juglans Re- gia, Matias, Paullinia and Platini Prseparata. Since the article Jlluminse Sales was written, the sulphate of alumina — at the author's suggestion — has been subjected to numerous trials in the surgical wards of the Philadelphia Hos- pital, and has been found a valuable antiseptic and detergent to ulcers. The detailed results of the observations of the resi- dent surgeons on this matter will be published by the author hereafter. ROBLEY DUNGLISON. Philadelphia, March 25, 1S43. * A Dispensatory, or Commentary on the Pharmacopoeias of Great Britain ; comprising the Natural History, Description, Chemistry, Pharmacy, Actions, Uses and Doses of the Articles of the Materia Medica. 8vo. pp. 978. Edinb. 1842. | Annuaire de Therapeutique, de Matiere Medicale etde Pharmacie, conte- nant le resume des travaux therapeutiques publies en 1840, et les formules des medicamens nouveaux, tels que le lactate defer ; l'ecorce de tulipier, le monesia, le guarana, Tanthrakokali, et les preparations nouvelles d'aconitine,de pulsatille, de goudron, de seigle ergote, &c. Paris, 1841. Do. Do. pour 1841. Paris, 1842. ^ Vollstandiges Recept-Taschenbuch in alphabetischer Ordnung nebst Angabe der Wirkung und Anwendung sammtlicher gebrauchlichen Arzneimittel im Allgemeinen, und der Heilformeln im Besonderen, fur praktische Aerzte, Wundarzte u. Apotheker. pp. 816, 913. Leipz. 1840-1. PR EFAC E TO THE FIRST AND SECOND EDITIONS. The information, concerning the remedies of more recent introduction, lies scattered in so many works, that it cannot be accessible to the mass of physi- cians. The author has, consequently, believed, that he would be rendering a service to the profession by concentrating the results of experience within rea- sonable limits, so that they may be readily available to all. The majority of the new agents — it will be found — have been furnished by modern chemistry ; and their employment has been attended with this advantage, that — when pro- perly prepared — they are not liable to uncertainty in their operation; whilst the various plants from which strychnia, emetia, iquinia, &c, are obtained, are liable to irregularity of action, owing to faults iu desiccation, to the season in which they are culled, &c, &c. — objections which cannot apply to the active principles when separated from them. Owing to the difficulty of sifting the results of true from those of false obser- vation, the author has esteemed it proper to give, as far as he was able, the re- corded experience of all who have employed the remedies in question. It need scarcely be said, that to make a correct observer and a good thera- peutist, a knowledge of every department of medical science is demanded. Anatomy, physiology, pathology, and materia medica are, indeed, but introduc- tory to the great object which the practitioner has in view — the alleviation and removal of suffering. Were it otherwise, it would be but necessary to institute empirical trials, in every case of disease, with various articles in and out of the received lists of the materia medica, and from such vague trials to endeavour to deduce what is termed " experience." The erroneous idea prevails too extensively, that every one is capable of pro- fiting by observation, and that, therefore, all who have had the same amount of experience, must be equally capable of treating disease. Setting aside, how- ever, the consideration of the differences that must necessarily result from the varied powers of individuals, it can scarcely be maintained, that he, whose atten- tion has not been properly directed to the study of the preliminary branches, which have been enumerated, and whose mind has not been trained in tracing the relation between cause and effect, can ever duly profit by mere experience in that which has been properly termed " the most inductive of all sciences."* To treat disease methodically and effectively, the nature of the actions of the living tissues, in both the healthy and morbid conditions, must be correctly ap- # Propterea sola experientia absque doctrinaet ratione incertaesl, etconjecturalis. Qui cnim iiovit rhabarbunmi purgnre hilem, nescit tamen quando, quibus, et cui morbo pro- sit, nisi sit medicus docttis et peritus. Primeros. Dc vulgi crroribus in medicina, fib. i. cap. xl. Atnstelod. JG3D. 10 PREFACE. predated ; the effects, which the articles of the materia medica are capable of exerting under both those conditions, must be known from accurate observation, and not until then can the practitioner prescribe with any well-founded prospect of success. Numerous errors would be perpetrated, were we to profess, and to carry out such profession, that we are guided by experience only, unless that ex- perience had been gained by a due consideration of all the physiological, patho- logical, and therapeutical bearings of the subject. In illustration of this, the well-known case, cited by Dr. Paris, in his Life of Sir Humphry Davy, may be adduced. The enthusiastic Beddoes having hypothetically inferred, that the inhalation of the nitrous oxide might be a specific for palsy, a patient was selected for trial, and placed under the care of Davy — at the time assistant to Beddoes. Before administering the gas, Davy thought of ascertaining the temperature of the body by the thermometer placed under the tongue. The paralytic, deeply impressed by Dr. Beddoes with the certainty of the success of the remedy, of which he knew nothing — soon after the thermometer was placed in his mouth, believing this to be the great curative agent — declared that he felt somewhat better. Nothing more was, therefore, done; and he was requested to return on the following day. The same form was then gone through with the same re- sults ; and, at the end of a fortnight, the sick man was dismissed cured, no agent of any kind having been employed except the thermometer. Now, if the reasoning powers were not duly exerted, experience would obvi- ously teach, as the result of this case, that the thermometer is an antiparalytic. The rational therapeutist is not, however, satisfied with this knowledge of the fact, for 4i fact it is." He enquires into the mode in which the effect was induced, and he is not long in referring it to the influence exerted by the moral over the physique ,• and he classes the thermometer with Perkinism, animal magnetism, and their congenerous arts, — amongst articles that act chiefly through the new im- pressions, which they make on the senses. It might seem to those who are unacquainted with medical history, that in periods approaching our own, no such illogical inferences could be deduced, and that it has been the custom with the profession forages, to bestow all due caution and the most rational enquiry in the collection of facts. Such, however, is far from being the case. It is, indeed, humiliating to reflect on the credulity or faulty observation that has existed among nations, who have successfully cultivated many of the other branches of natural science. It ought scarcely to be credited, and yet it is nevertheless true, that the aqua spermatis ranarum, or " water of frog's spawn," was to be found not very long ago in the Pharmacopoeia of Sardinia; and the aqua hirundinum cum castoreo, or " water of swallows with castor," in those of Manheim and Wirtemberg. The latter preparation is directed to be made as follows : — Take of young swalhivs bruised in a mortar, forty ; rue, two bandfuls ; castor, one ounce; white wine, three pints. This disgusting prepara- tion was given in hysteria and epilepsy Again; the bit f ones exsiccati, or "dried toads," were in the Pharmacopoeias of Spain and Wirtemberg, — having been formerly administered in powder, as a diuretic, in dropsy. In another work,* the author has cited many examples as strange as those instanced, and it would be easy to enumerate still more. In a recent French journal, and in an article by M. Ricord — the distinguished physician to the Venereal Hospital of Paris — we have an example of the perti- nacity with which ancient prepossessions and inculcations adhere to us, and how difficult it is to think and to act according to the unbiased suggestions of our owu observation and reflection. In the treatment of blennorrhagic epididymitis, or swelled testicle from gonorrhoea, M. Ricord recommendscompression to be made by the means of the " sparadrap," orplaster of Vigo with mercury- The history ofthis plaster is singular. Although still in the Pharmacopoeia of Paris, it resembles its * General Therapeutics, p. 55. Philad. 1336. [See, also, his General Therapeutics and Mat. Medica, i. 52. Philad. 1843.] PREFACE. 11 prototypes but in name. In the Pharmacopoeia of Wirtemberg, it is directed to be formed of living frogs and living earthworms, boiled with various inert and by us rejected herbs in white wine and vinegar, — the decoction being strained, and added to olive oil, litharge, oil of bayberries, turpentine, yellow wax, olibanum, euphorbium, and liquid storax, all melted together. Yet, it is scarcely possible to conceive, that the frog's spawn could have been supposed to yield a product, on distillation, differing from that of other animal substances, when subjected to the same process; that the swallows — in the preparation cited — added any thing to the antispasmodic virtues of the castor, or that the living frogs and earthworms exerted any efficacy in the sparadrap de Vigo — a plaster employed for compressing tumours, and for which purpose we use one of simple adhesive constituents. They have all been properly rejected, from the lists of our medicinal agents, and are looked upon as irrational ; yet we are compelled to infer from the fact of their having been received, in some countries, into officinal publications — into the pharmacopoeias, which emanate from congregations of those of our profession, who are esteemed learned by educa- tion and by practice — that they were originally admitted under the sanction of fancied experience. In the darker periods of medical history, monstrous and revolting polypharma- cal preparations were introduced, and nothing but the blindest devotion to autho- rity or to established custom could have occasioned their retention. It is not long since the Theriac of Andromachus — itself but a modification of the antidotum Mithridatum — was dismissed from the British Pharmacopoeias. It consisted of seventy-two articles, and was a farrago — as Dr. Heberden observed — that had " no better title to the name of Mithridates than — as it so well resembles — the numerous undisciplined forces of a barbarous king, made up of a dissonant crowd collected from different countries, mighty in appearance, but in reality an ineffective multitude, that only hinder each other." The electuarium opiatum polypharmacum, of the Parisian codex — the descendant of the old theriac, with, even an additional number of ingredients — contains acrid substances, 5; astrin- gent, 5 ; bitter, 22 ; indigenous aromatics, 10 ; umbelliferous aromatics, 7 ; balsams and resinous substances, 8 ; fetid ingredients, 6 ; narcotics, 1 ; earthy substances, 1; gummy or amylaceous, 4 ; saccharine, 3. Total, 72 — and one of these the flesh of the viper ,■ a little more than a grain of opium — which may be regarded as a principal effective ingredient — being contained in a dram of the compound. Yet, when the question arose in the London College of Physicians, as to what should be the fate of this " many-headed monster," and when it was proposed by Dr. Heberden, that it should be ejected from the Pharmacopoeia, — on a division, it was found that there were thirteen votes for retaining and fourteen for rejecting it. Its ostracism was determined by a majority of one only, in a learned body, twenty-seven of whose members were present. Such was the fate of a " heterogeneous farrago," which, as Dr. Paris has re- marked, "can be vindicated upon no principle of combination," and yet enjoyed the confidence of physicians for ages — a confidence unquestionably founded, in their belief, on experience, but experience based upon defective observation, and consequently, on erroneous inferences — the results being consecutive rather than consequent, and bearing no relation whatever to the assigned cause. Happily, more correct ideas are beginning to be entertained on the subject of true experience. It is now felt — to employ the language of a distinguished sur- geon — Professor Liston — that the greatest number of well assorted facts on a particular subject constitutes experience, whether these facts have been culled in five years or in fifty. A better system, too, of observation generally prevails, so that we have discarded the absurd and revolting agents, that are still retained in the books of authority of some European countries. Much, however, remains to be done. The catalogue of the Materia Medica is yet overstocked, and the pruning knife has still to be applied to lop off many of the redundancies, which have been proved to be such, by the more accurate attention, that is daily paid to tracing 12 PREFACE. the due relation between cause and effect. "To purchase a clear and war- rantable body of truth," as Sir Thomas Brown has well observed, " we must for- get and part with much we know." Every one will be compelled to admit, that it is the duty of the correct thera- peutist to doubt the existence of qualities in any article until they have been ade- quately proved. When such is the case, no reasoning can set aside facts; but unless the evidence be overpowering, it is equally his duty to remain in doubt, especially should reflection suggest to him strong grounds for believing, that the number of observations has been insufficient, that they have not been properly made, or are inconsequential. To enable the profession to form an accurate estimate of the value of remedies of more recent introduction, or of the older remedies whose use has been revived under novel applications, the present volume was undertaken by the author. In Germany, several works exist on this subject, and that of Riecke — to which the author has repeatedly referred — served as a basis for many of the articles ; his observations, however, do not come down farther than the year 1836. Some of the statements — especially in relation to the observations of certain of the German physicians — are given on Riecke's authority, for he has rarely appended references, by which the correctness of his assertions could be tested.* . It has been a great object with the author to furnish exact references to works in which farther information may be obtained, and the number of these will show, that he has devoted no small amount of time and attention to the subject. He has likewise added the results of his own experience in public and in private. The motto which he has selected — prodesse quam conspici — conveys, in epitome, his feelings. His sole object has been, "to be useful" — and if he has succeeded, the reward is ample. ROBLEY DUNGL1SON. Philadelphia, October 15, 1839. * Recently, a second and enlarged edition of Riecke's work has appeared ; but the therapeutical additions to it are by no means as numerous as the author had expected to find them. He has, consequently, made but few extracts from it in the present edition. It is entitled, " Die neuern Arzneimittel, ihrephysischen und chemischen Eigenschafteu, Bereitungsweisen, Wirkungen auf den gesungen und kranken organismus, und thera- peutische Beniitzung, Von Victor Adolf Riecke. Dr. Med., Mitglied des Vereins fur Heilkunde in Preussen, u. s. w. ; zweite, vOllig umgearbeitete Auflage. Stuttgart, IS40." NEW REMEDIES. I. AC'IDUM ACETICUM EMPYREUMAT'ICUM. Synonymes. Acidutn Pyro-aceticum, A. Ligni pyro-oleosum, A. pyrolignosum, Acetum ligneum, Pyroligneous, and Pyrolignic acid. French. Acide pyro-acetique, A. pyrolignique, A. pyroligneux, Vinaigre de bois. German. Brenzliche oder brandige Holssaure ; Holzsaure ; Holzessig. Pyroligneous acid, although brought much into notice — re- vived as it were — in recent times, is by no means the product of those times exclusively. The cedria, with which the Egyptians embalmed the bodies of the dead, it is presumed, was identical with it. Pliny recommends cedria, or the oil of tar, got from the cedar, in toothach,* and Galen unites with him.t The virtues of pyroligneous acid are often also referred to by Boerhaave.J METHOD OF PREPARING. Pyroligneous acid is prepared in chemical laboratories by the dry distillation of wood, especially of hard wood, which is placed in an iron retort heated to redness. First of all, there passes over a light brown or greenish fluid, which contains some empy- reumatic oil ; to this succeeds the pyroligneous acid, which is formed during distillation. If the distillation be continued, more empyreumatic oil passes over, and lastly tar. The chief constituent of pyroligneous acid is vinegar, which can be deprived of its empyreumatic constituents by rectification * Hist. Nat. xxxiv. 11. f De Simpl. Medic. Facult. lib. vii. See Cormack on Creosote, p. 59. Edinburgh, 1836; or the American edit, in Dunglison's American Medical Library. X Riecke, Die neuern Arzneimittel. u. s. w. S. 6. Stuttgart, 1 1837. 2 14 ACIDTJM ACETICUM EMPYRETJM ATTCUM. with fine porous animal charcoal. Besides vinegar, it contains empyreumatic oil (py retain); ernpyreumatic resin (pyrretin), a peculiar matter containing azote, and similar to an extract (an empyreumatic extract), and spirit of tar (spiritus pyrotignicus). Of late years, Reichenbach has discovered in it a new substance, creasote,* which seems to be the most important ingredient, its medicinal efficacy appearing to be dependent upon that substance. Impure pyroligneous acid is of a brownish colour, and of an acid smoky smell and taste. This is the preparation which is generally used externally ; but, by chemical means, the acid may be purified so as to furnish the aciclum aceticum empyreumati- cum rectification. This differs from the impure pyroligneous acid in containing less empyreumatic resin and extract, and crea- sote. The London College, again, prepare from it a stronger acid, the acidum aceticum fortius, which is extremely volatile and pungent, and is used as a revellent. EFFECTS ON THE ECONOMY IN HEALTH. From experiments instituted on animals, it would appear, that the administration of pyroligneous acid in large doses occasions vomiting of a considerable quantity of a frothy fluid, having a strongodouroftheacid; tremors of the limbs, convulsions,tetanus, protrusion of the eyes, insensibility, paralysis of the limbs, dys- pnoea, croupy cough, hoarseness, &c. The death of the animal supervenes with symptoms of suffocation, and the fatal termina- tion is often rapidly induced. Inspection after death exhibits manifest venous congestion in the brain, spinal marrow, lungs, liver, and spleen, and in the right side of the heart, — with, at times, inflammation of the stomach. According to Berres, it occasions marked narcotic effects. In by no means considerable doses, he found it to cause violent pain in the stomach and bowels, nausea and vomiting, general weakness, heaviness, vertigo, convulsions, and even death, without exhibiting any decided effect upon the vascular system. In smaller doses, it is said to produce a sensa- tion of burning in the stomach, and after a time to quicken the pulse, and augment the cutaneous and renal depurations. Others — and the best observers, we think — deny it any narcotic pro- perties.! As an antiseptic,its efficacy is undoubted, and this has been long known. Creasote is, doubtless, a main agent in producing this result ; and wherever the administration of creasote is indicated, the use of pyroligneous acid may be proper. * See the article Creasote. t Richter's Specielle Therapie. S. 255, Berlin, 1828. ACIDUM ACETICUM EMPYREUMATICUM. 15 EFFECTS ON THE ECONOMY IN DISEASE. Possessed of the properties described above, pyroligneous acid was at once suggested in cases of gangrene and sphacelus, in which it was successfully used, as well as in cachectic conditions brought on by the misuse of mercury, and in herpetic, flabby, fungous, and sloughing ulcers, mporrigo, and in toothach pro- duced by caries — the acid being dropped upon cotton and applied to the hollow tooth. In most of these cases, it was generally ex- hibited both internally and externally. Numerous experiments have been made with it in various affections by different ob- servers ; but its use has been more especially extolled in cases of gangrene, in which it corrects foetor, and promotes the sepa- ration of the dead parts.* The physicians of the Berlin Charite experimented with it in cases of sloughing gangrenous sores with such success, that they pronounced it an antiseptic of the highest order.t Besides the cases mentioned, it has been advised in excoriated nipples, mixed with white of egg jj in cancerous and scrophulous affections, in cancrum oris, in caries of the bones, and as a gargle in scarlet fever. It has, moreover, been recommended by Buchanan§ in deafness caused by deficient secretion of the cerumen of the ear, and in discharges of an of- fensive character from the meatus auditorius, as well as from other outlets ; in chronic inflammation of the tarsal edges of the eyelids, and in scabies. In gastromalacia it has been re- commended by Pitschaft|| and Teufel jf in phthisis by Harless, and in dropsy, diarrhoea, putrid nervous fevers, &c, by Am- pach ;** yet, as was before remarked, it is rarely employed in- ternally ; indeed, both externally and internally, it has been greatly supplanted by creasote. MODE OF ADMINISTRATION. The inequality in the strength of the preparation renders it difficult to fix upon any precise dose. Of the impure pyrolig- neous acid, Sachs administered from five to thirty drops, three or four times a day, in simple or aromatic water. * Dr. T. Y. Simons, in American Journal of the Medical Sciences, vol. v. f Riecke, Op. cit. S. 9. % Dr. Bursharat, in Gazette M^dicale, and Amer. Journ. of the Medical Sciences, Feb. 1833, p, 503. § Illustrations of Acoustic Surgery, Lond. 1825. || Med. Chirurg. Zeitung, No. 7, 1825. 4" Annal. flir die gesammte Ileilkund. unter der Redact, d. Mitglied. der Badensch. Sanitatsk. 2ter Jahrg. 1825. +* Rust's Magazin, B. xvi. H. 2. S. 353, and Richter, Op. cit. B. x. S. 257, Berlin, 1828. 16 ACIDUM ACETICFJNI EMPYKETJMATICTJM. Externally, it is applied both in a pure and dilute state ; in the former case to ulcers, by means of a pencil, several times in the day. It is generally diluted with simple water; but in cases of cancrum oris, sugared water has commonly formed the diluent. It. is also applied at times in the way of cataplasm. As a ivash in porrigo, and as an injection, it may be diluted with six or eight parts of water ; as a collyrium, the proportion may be one part of the acid to twelve of water, and it may be em- ployed, of about the same strength, as a gargle. Heim has recommended the following application in cancrum oris. Mel acidi acctici empyreumatici. Honey of pyrol igneous acid. R. Acid. acet. empyreum. crud. f.^iss. Mellis rosee, 3J. M. To be applied by means of a pencil. Buchanan advises the following form of injection in cases of purulent discharges from the meatus auditorius. In jectio acidi acetici cinpyrenmatici. Injection ofpyroligneous acid. R. Acid, acetic, empyreum. f.^ij. Aquse destillata;, f-Syj. M. Fiat injectio bis die utenda. The following drops he recommends in cases where the ceru- men is deficient in quantity. Guttfe acidi acetici empyreumatici. Drops of pyroligneous acid. R. Acidi acet. empyreum. crud. Olei. terebinth, rectif. Sp. aetheris sulphur, comp. aa. partes sequales. M. Two drops of this compound are to be dropped every night into the meatus auditorius. ACIDUM HYDROCYANICUM. 17 Cataplasma acidi acetici empyreumatici. Cataplasm of pyro ligneous acid. R. Furfur, tfess. Pulv. sem. lin. gj. M. bene et adde Acid, acetic, empyreum crud. q. s. ut fiat cataplasma. To be applied in cases of foul ulcers. Linimentum acidi acetici empyreumatici. Liniment of pyroligneous acid. R. Acid. acet. empyreum. |jss. Myroxyl. gij. Vitell. ovi, q. s. ut fiat linimentum. To be applied on lint three times a day to sloughs and ulcers. Collntorium acidi acetici empyreumatici. Mouth-wash of pyroligneous acid. R. Acid. acet. empyreum. rectif. f.^ss. Aquae cinnamomi f.Jiv. Syrup, mori, f.^ij. M. Dr. Phobus advises this as a wash for the mouth in cases of cancrum oris. It should be kept in a glass vessel covered with black paper to prevent decomposition. II. ACIDUM HYDROCYANICUM. Synonymes. Acidum Prussicum, Acidum Borussicum, A. Zooticum, A. Zootinicum, Hydrocyanic, Prussic, Cyanohydric or Cyanhydric Acid. French. Acide Hydrocyaniqtie, Acide Prussique. German. Blausaure, WasserstorTblaus-iuro, Hydrocyansiiure, Cyanwasser- stoffsaure. This acid can scarcely be looked upon as new : yet it is only in recent times that its application to pathologicalconditions has been well appreciated. It was discovered by Scheele, in 1780; but its 2* IS ACIDUM HYDROCYANICUM. preparation m a state of purity, and its exact chemical constitu- tion, were not understood until Gay-Lussac published the results of his investigations on the subject in the year 1815.* METHOD OF PREPARING. The three chief modes for preparing hydrocyanic acid, at one time received into the pharmacopoeias, were those of Scheele, Gay-Lussac, and Vanquelin ; the first of which was adopted by the framers of the United States' Pharmacopoeia of lS20,and by those of Belgium, Paris, and Ferrara ; the second, by the Phar- macopoeias of Paris and Ferrara ; and the third, by those of Belgium, Paris, and the United States. -— (Edition of 1830.) 1. Selicele's Method. — Take of Prussian blue, 128 parts ; Red oxide of mercury, 64 parts ; Distilled water, 105 parts. Boil for a quarter of an hour, constantly shaking ; strain, filter, and Avash the residuum with Boiling water, 128 parts. Mix the two liquids together; introduce them into a flask, and add, Porphy- rised iron filings, 96 parts ; Sulphuric acid (66°), 24 parts : diluted with Distilled water, 24 parts. Shake the mixture, and keep the flask for an hour in cold water ; pour the decanted liquor into a tubulated retort placed in a sand bath, to the neck of which is attached an adapter that passes into a tubulated receiver, whence a curved tube issues that passes into a flask filled with water; lute the apparatus; cover the receiver with wet rags ; raise the heat until the liquid boils, and until there have passed into the receiver — 192 parts. Add to this liquid, of Carbonate of lime, 8 parts. Distil again, and draw off 12S parts, which must be kept in a bottle covered with black paper. This process of Scheele always affords an acid mixed with a variable quantity of water. 2. Gay-Lussac's Method. — Take Cyanuret of mercury, at pleasure. Introduce it into a tubulated retort, the neck of which is furnished with a wide tube of glass filled with broken marble and chloride of calcium, which tube communicates, through a smaller one, with a bell glass surrounded by a freezing mixture. Pour on muriatic acid sufficient to rise above the cyanuret to the height of a finger • heat gradually and moderately, and receive the condensed product into the bell glass. The acid, obtained in this way, is anhydrous, and of the specific gravity .700. * Annales de Chimie, lorn, lxvii. p. 128, and torn. xcv. p. 136. ACIDUM HYDROCYANICUM. 19 t Vauquelin's Method. — Take of Cyanuret of mercury, 1 part ; Distilled water, 8 parts. Pass a currrent of sulpho- hydric acid gas into the solution, until the gas is in excess ; pour into the liquid pulverised subcarbonate of lead in sufficient quantity to remove the excess of sulpho-hydric acid ; shake the mixture constantly, and when it has no longer the smell of putrid eggs, and ceases to blacken paper impregnated with acetate of lead, filter and preserve it carefully. The product of this operation has been considered to approxi- mate to the average density of the acid of Scheele.* The variable density of the acid prepared after Scheele's method has prevented it from being generally used in medicine. The acid of Gay-Lussac is most commonly employed ; but as its degree of concentration renders it dangerous, it is diluted with distilled water. Robiquet has proposed to bring its density to .900, by adding two parts of water to it. Thus reduced, it re- sembles the acid of Scheele, with the advantage, that there is a constant and known ratio between the pure or anhydrous acid, and the quantity of water united with it. Magendie adds to it six times its bulk, or eight and a half times its weighfrof distilled water, and calls the mixture Acide ptrussique medicinal^ Medi- cinal prussic or Medicinal hydrocyanic acid. Others have advised the employment of a mixture of three parts of water, and one part of acid, under the name of Jlcide hydrocyanique au quart, or " Hydrocyanic acid of quarter strength.";); Dr. Bache asserts, that he had the process (Proust's or Vau- quelin's). of the United States' Pharmacopoeia (1830) repeated, when he found the acid obtained to have the specific gravity .998. In the last edition of the Pharmacopoeia of the United States (1842), the following form was introduced. It is essentially that of the London Pharmacopoeia. Take oi F err o cyanuret of potassium, §ij. ; Sulphuric acid, Siss. ; Distilled water, a sufficient quantity. Mix the acid with four fluid ounces of distilled water, and pour the mixture, when cool, into a glass retort. To this add the Ferrocyanuret of potas- sium, previously dissolved in ten fluid ounces of distilled water. Pour eight fluid ounces of distilled water into a cooled receiver, and, having attached this to the retort, distil, by means of a sand bath, with a moderate heat, six fluid ounces. Lastly, add to * See Not^s on Hydrocyanic; acid, by Dr. R. E. Griffith, in Philad. Journ. of Pharmacy, iv. 17. Philad; 1833; also, Pereira, Elements of Materia Medica, 2d edit. i. 429. Lond. 1842. The Dispensatory of the United States of America, by Drs. Wood and IJache, 4th edit. p. 748. Philad. 1839, and Mr. David Stewart, Maryland Medical and Surgical Journal, April, 1840, p. 2G4. | Fornoulaire pour la preparation etc. de plusieurs nouveaux medicamens. \ Pharmacopce Universale, par Jourdan, i. 31. .Paris, 1828. 20 ACIDTJM HYDROCYANICUM. the product five fluid ounces of distilled water, or as much as may be sufficient to render the hydrocyanic acid of such a strength, that 12.7 grains of nitrate of silver, dissolved in dis- tilled water, may be accurately saturated by 100 grains of the acid. When hydrocyanic acid is wanted for immediate use, the fol- lowing formula is recommended : — Take of Cyanuret of silver, fifty grains and a half ; Muriatic acid, forty-one grains ; Dis- tilled water, a fluid ounce. Mix the muriatic acid with the distilled water, add the cyanuret of silver, and shake the whole in a well-stopped vial. When the insoluble matter has subsided, pour off the clear liquor and keep it for use. No matter how prepared, hydrocyanic acid should be kept in well-stopped bottles from which the light is excluded. The characters that hydrocyanic acid should possess, accord- ing to the forms last given, are as follows: — It is colourless, of a peculiar odour, and wholly volatilizable by heat. One hun- dred grains of it produce, with solution of nitrate of silver, a white precipitate, which, when washed and dried, weighs ten grains, and is readily dissolved by boiling nitric acid. The acid of the Pharmacopoeia of the United States contains iwo per cent. of pure anhydrous acid.* EFFECTS ON THE ECONOMY IN HEALTH. Hydrocyanic acid is usually classed amongst the narcotic poisons,t yet there is reason for believing, that its ordinary effects are purely sedative. Whilst the agents belonging to the class of narcotics produce, first of all, excitation in the organic actions, followed sooner or later, when the agent is in sufficient dose, by signs of sedation, this acid would seem to occasion the latter results only. It is the most powerful of our poisons,producing,in an adequate dose, the fatal result so suddenly, that the animal experimented upon can scarcely be removed from the lap of the experimenter before all signs of life are extinct. This rapidity of action is unfavourable to the idea, that the acid acts through the mass of blood, and favours the view of those who believe, that the im- pression is made immediately on the nerves of the part with which it is placed in contact, or on the nerves that are distributed to the lining membrane of the bloodvessels, as suggested by Messrs. Addison and Morgan.:}: It seems to us, however, that * Pharmacopoeia of the United States, p. 59. Philadelphia, 1842. t Christison's Treatise on Poisons, 3d edit. Edinb. 1836. X An Essay on the Operation of Poisonous Agents upon the Living Body. Lond. 1829. ACIDTJM HYDROCYANICUM. 21 the same objection applies to the explanation of these gentlemen as to that which ascribes the effects to the poison being taken into the blood — that the fatal result is often too sudden for us to presume, that it has entered the bloodvessels ; unless we esteem it an agent possessed of powerfully penetrating properties. In very large doses, the sensibility of the whole nervous system becomes annihilated almost with the rapidity of lightning. A female, who was deceived by the odour of a solution of hydrocyanic acid in alcohol, drank a small vialful and died in two minutes, as if struck with apoplexy. A strong healthy man, thirty -six years of age, being detected in thieving, swallowed a small vialful of the acid, staggered a few steps, and fell dead, Four or five minutes afterwards, the physician who was called found him lifeless, without the slightest trace of pulse or respira- tion. In a few minutes, convulsive expirations were observed, but no indications of returning life : the face was sunken and livid ; the hands and feet deadly cold ; the forehead and face cold and dry ; and the eyes half open and glassy.* Dr. Damasont relates the case of a druggist, who had some hydrocyanic acid in a vial with a ground stopper, and, as it had been prepared almost three months, thinking that it was decom- posed, he opened the vial, and applied it to his nose to ascertain whether the acid retained any smell ; he instantly fell down, and remained for half an hour without giving the slightest signs of life ; but finally recovered after an illness of several days. Many experiments have been made on animals with this acid.. A drop, introduced into the bill or anus of a sparrow, induced death in from one to two minutes, preceded by convulsions. Even holding the bill over a vial filled with the acid proved fatal. A duck was destroyed by fourteen drops. Twenty drops intro- duced into the stomach of a rabbit killed it in three minutes. When a few drops were injected into the jugular vein, death supervened still sooner, A small dog, to which two drops had been given, experienced shortnessof breath, staggered, fell, passed its urine repeatedly, vomited twice, and afterwards seemed quite well. The same animal took, five hours later, eight drops, and fell into a tetanic, comatose condition, but recovered in half an hour. More severe but not fatal effects resulted from sixteen drops. Thirty to forty drops administered to dogs and cats, produced violent convulsions and death, in from six to fifteen minutes. The experiments of Emmert and Coullon seem to have shown that the action of hydrocyanic acid is more violent when it is * Hufeland, Journal der practisch. Heilkund. Band. xl. St. 1, S. 85 — 92, and Osann, in Art. Blausaure, in Enr.yc. Wbrterb. der Medicinischen Wis- senschal't. Band. v. S. 528. Herlin, 1830. f Journal deCliimie Medicale. Juin, 1831. 22 ACIDUM HYDROCYANICUM. injected into the jugular vein, or inhaled in a concentrated form ; less so when injected into the rectum. In the case of a horse, into whose jugular it was injected, death occurred in twenty-one minutes. When placed in contact with the dura mater, or with nerves, no striking phenomena were perceptible. [?] This fact was confirmed by Viborg.* On the other hand, when received into a wound in its concentrated state, it acts most violently. Scharring, who broke a glass containing the acid, and received some of it into the wound produced thereby, died in an hour after the accident. It is not easy to deduce comparative results from the statements of different experimenters, inasmuch as we are ignorant of the precise strength of the acid employed. A French physician made some experiments on the uncertainty of the strength of the medicinal acid ; and found, that he could swallow a whole ounce of one sample, and a drachm of a stronger sample, with- out sustaining any injury ; but on trying some, which had been recently prepared by Vauquelin, he was immediately taken ill, and narrowly escaped with his life.t Dr. PereiraJ once caused the instantaneous death of a rabbit by applying its nose to a receiver filled with the vapour of the pure acid : the animal died without a struggle. A drop of the pure acid of Gay-Lussac, placed in the throat of the most vigorous dog, caused it to fall dead after two or three hurried respirations.§ We have already alluded to the effect of the acid when dropped upon the conjunctiva — a mucous surface, and therefore possessed of highly absorbing powers: but it cannot be placed with im- punity in contact with surfaces, which, owing to their being covered with cuticle, do not readily absorb. Orfila|| states, that a professor of Vienna, having prepared a pure and concentrated acid, spread a certain quantity of it on his naked arm, and died a short time afterwards. Dr. Christison,H however, says this was probably a mistake. On repeating some of the experiments, he** found, that a single drop, weighing scarcely a third of a grain, dropped into the mouth of a rabbit, killed it in eighty- three seconds, and began to act in sixty-three seconds ; that three drops, weighing four-fifths of a grain, in like manner killed a strong cat in thirty seconds, and began to act in ten ; that * Osann, loc. cit. S. 580. ■j- Revue Medicate, xvii. 265, and Christison on Poisons, 3d Edit. p. 690, Edinb. 1836. X Elements of Mat. Med. &c, 2d edit. i. 437, Lond. 1842. § Magendie, in Annales de Chimie et de Physique, vi. 347, and Formu- lary. || Toxicologic. T Op. cit. p. 707. ** Op. cit. p. 694. See also, Dr. Geoghegan, in Dublin Medical Journal, for 1835, and Pereira,Op. cit. p. 242. ACIDUM HYDROCYANICUM. 23 another was affected by the same dose in five, and died in forty seconds ; that four drops, weighing a grain and a fifth, did not affect a rabbit for twenty seconds, but killed it in ten seconds more ; and that twenty-five grains, corresponding with an ounce and a half of medicinal acid, began to act on a rabbit, as soon as it was poured into its mouth, and killed it outright in ten seconds at farthest. Three drops, projected into the eye, acted on a cat in twenty seconds, and killed it in twenty more ; and the same quantity, dropped on a fresh wound in the loins, acted in forty- five, and proved fatal in one hundred and five, seconds. When given in rather too strong a dose, or — if in proper doses — at too short intervals, it produces headach, and vertigo, which go off, however, in a few minutes : when inhaled, even if diluted with atmospheric air, it causes vomiting, prostration, pains in the back part of the head, and great diminution of the arterial pulsa- tions. In a more concentrated state, the effects are more rapidly fatal than in any other form of administration. M. Robert found that when a bird, a rabbit, a cat, and two dogs, were made to breathe air saturated with its vapour, the first and second died in one second; the cat in two seconds; one dog in five, and the other in ten seconds.* With regard to the parts of the economy that are primarily acted upon by the hydrocyanic acid, there can be but little doubt in designating the nervous system.t In no other way can we readily explain the extreme rapidity of its action in fatal cases. When once mixed with the blood, however, out of the body, it altogether changes the character of that fluid, and opposes its coagulation.^ Some of the German writers§ have endeavoured to indicate three grades of its action on the economy. First. In moderate doses, long continued, it occasions a marked diminution in the action of the nervous and vascular systems ; vertigo ; dis- position to syncope ; epistaxis as a consequence of thinness of the blood, and a disposition to putrid diseases.|| Secondly. In larger doses, the sedative effect of the acid on the spinal marrow, and theabdominal ganglia, is indicated by feelings of weakness, numb- ness, tremors, and other involuntary motions of the extremities, involuntary discharge of the urine and faeces, augmentation of the cutaneous and urinary depurations ; palpitations, anxiety at the pracordia, weak pulse, and, according to some, headach, espe- • Annales de Chimie, xcii. 59. t Dr. Lonsdale, Edin. Med. and Surg. Journ., Jan. 1839, and Lond. Lan. June 15, 1839, p. 440. X Magendie, Lectures on the Blood. Lect. xvii. in Lancet, for Jan. 26, 1839, p. 636. On its Action when injected into the Vessels ; see Mr. Blake, in Edin. Med. and Surg. Journ. April, 1839, p. 339. $ Richter, Specielle Therapie, Band. x. S. 280. Berlin, 1828 ; and Osann, loc. cit. S. 527. || Encyc. Worterb. B. ii. S. 313. 24 ACIDUM HTDROCYANICUM. cially in the back part of the head ; excoriation of the tongue and inner parts of the cheeks,* and salivation. This last symptom is given by Dr. Christisonf on the authority of Drs. Macleod and Granville. J It has been suspected, however, that salivation, in these cases, was brought about by the use of an impure acid, con- taining probably a small quantity of the corrosive chloride of mer- cury, particularly if the acid had been prepared — according to the process of the Dublin College — with bicyanuret of mercury, muriatic acid and water. Mercury is, indeed, asserted to have been actually discovered in the acid by Sylvester's test. Thirdly. In still larger doses, it induces violent affections of the spinal marrow, convulsions, trismus, opisthotonos, emprosthotonos, fainting, &c. From the results of all his observations, Osann§ infers, that hydrocyanic acid acts dynamically on the nervous system, by diminishing, depressing, and annihilating itslife ; and, through the nervous system, affecting the organs of vegetation or nutrition, and of hasmatosis ; — that it incontestably has a specific relation to the spinal marrow, the ganglions of the abdomen, and the dependent organs ; and hence it is, that, in comparison with other narcotic agents, it is less stupifying, whilst it influences more deeply the phenomena of vegetative or organic life. He properly remarks, however, that the inferences of Jorg,|| from his experiments, are apparently opposed to this view. Jorg considered its effects upon the brain to be excitant, and that it occasioned turgescence of that or°;an. EFFECTS ON TIIE ECONOMY IN DISEASE. From the effects produced by the hydrocyanic acid on the healthy body, we may infer the cases of disease in which it may be indicated. It is decidedly sedative, allaying nervous irritability and vascular action, and therefore adapted for all cases in which these are inordinately excited. Yet its power, as a medicinal agent, is not as great as was at one time presumed, and as is still presumed, by many. In some countries, too, it has found more favour than in others. In Italy, France and England, it has been more extensively used than in Germany ; yet in many of the Phar- macopoeias of the last country it has been admitted into the list of officinal agents. The great objections that have been urged against it are — its danger, even in a small dose, if not carefully adminis- tered ; the difficulty of having it always of the same strength ; the * Born, in Rust's Magazin, B. xiii. S. 282. | Op. citat. p. 701. f Lond. Med. and Phys. Journ. xlvi. 359 and 363. \ Loc. citat. S. 526. || Materialien zu einer kiinftigen Heilmittellehre. B. i. S. 53, 117. ACIDUM HYDROCYANICUM. 25 impossibility of administering it undiluted, and the danger of giv- ing too strong a dose in consequence of its rising to the surface of water. More than once the difference in the strength of the acid, prepared by different methods, would seem to have occasioned unfortunate results. Orfila,* mentions the case of a sick person, who had used for a length of time the hydrocyanic acid, in in- creasing doses, with advantage ; when, being compelled to send her prescription to another apothecary,the acid he employed was so strong as to produce death, with all the symptoms of poisoning by hydrocyanic acid. For these and other reasons, Riecke, L. W. Sachs, and Osann greatly prefer the Aqua laurocerasi and the Aqua amygdalarum amararum (q. v.), which, although in other respects not less objectionable, are far less dangerous.! Possessed of the powerful sedative agency, which has been described, it is not to be wondered at, that hydrocyanic acid should have been prescribed in a multitude of cases ; and, as con- stantly happens, that unsuccessful trials, suggested by the merest empiricism, should have been made with it. It is rarely employed in fevers, — intermittent, remittent, or continued. By many it has been esteemed beneficial in hectic ; but here its agency must be doubtful.J In inflammations, especially when accompanied with marked erethism of the nervous system, it has been greatly extolled, and, next to bloodletting, has been regarded by many as one of our most valuable antiphlogistics. The followers of the contra-stimu- lant school esteem it as one of their most efficacious contra-sti- mulants. In the acule inflammations of internal organs it has been highly recommended by the Italian physicians, Borda and Brera ; in thoracic inflammation, after bloodletting, in conjunction with tartarised antimony and similar sedative agents ; and by others in enteritis, metritis, and nephritis, and in active hemorrhages. In chronic inflammations it has been advised by Granville, Magendie, Heller, Elwert, Behr, Roch, &c, especially in chronic catarrh, bronchitis, and hooping cough. In the last affection it is conceived by Dr. A. T. Thomson§ to be " the sheet anchor of the practitioner;" and by Dr. Roe|| to possess a "specific" (?) power. In warm weather he thinks it will cure almost any case of simple hooping cough in a short time ; in all seasons it will * Toxicologic | Die neuern Arzneimittel,u. s. w. von V. A. Riecke, S. 5. Stuttgart, 1837; Osann, loc. citat. and Encyclopiid. Worterb. ii. 315. X See the author's General Therapeutics and Materia Medica, ii. 180, Philad. 1843. § Elements of Mat. Med. and Therapeutics, i. 435. Lond. 1832. || A Treatise on the Nature and Treatment of Hooping Cough, &c, p. 10. London, 1838. 3 26 ACIDTJM HYDROCYANICUM. abridge its duration, and in almost every instance, where it does not cure, it will, at least, materially relieve the severity of the cough. In pulmonary consumption it has been recommended by Granville, Magendie, S. G. Morton,* Fantonetti,t and others, particularly where there is any inflammatory or spasmodic com- plication ; but others, as Neumann, Weitsch, Sir James Clark, Andral,J Forget,§ and, we may add, ourselves, have given it in these very cases without any success. By some, indeed, it has been affirmed, that its administration in phthisis is to be adopted with caution, as in many cases instead of allaying, it appears to have increased, the cough and fever,diminished the expectoration, and occasioned a sense of suffocation :|| it has been, moreover, asserted, that its depressing and destructive agency has acted in- juriously on the organism of the consumptive. IT In chronic nervous diseases, especially when of a spasmodic character — as in spasmodic affections of the heart — even when organic, hydrocyanic acid has been advised as a soothing agent, as well as in spasmodic asthma ; in the sense of suffocation that accompanies hydrothorax and other affections ; and in spas- modic dysphagia. Its efficacy, too, has been marked, according to Elliotson,** in various neuropathic disorders of the stomach, especially in those in which pain at the epigastrium was the leading symptom, — in every form, indeed, of gastrodynia ; and in painful affections of the boivels, of a similar character — enteralgia — it has been found useful by Dr. Pereira.tt In enlargement of the heart it was found by Heller to diminish the force and frequency of the pulsations, and in this way to afford essential relief. In an old person, labouring under ana- sarca accompanied by great pain in the breast, Rees observed, after the administration of Vauquelin's acid, great diuresis, with the removal of the dropsy and its concomitant symptoms.JJ In the asthma pulverulentum of the Germans, (Staubasthma,) * Illustrations of Pulmonary Consumption, p. 131, Philad. 1834. f Gazette des Hopitaux, Fev. 19, 1839. X Bulletin General de Therapeutique, Mars, 1840. § L' Experience, Nov. 14, 1839; and Amer. Med. Intel., Sept. 1., 1840, p. 170. | Schneider, Med. Prakt. Adversarienam Krankenbette, Erste Liefer, S. 62, referred to by Osann. If Siebergundi, in Hufeland's Journal der pract. Heilkund. B. liii., St. 6. S. 15. ** On the Efficacy of Hydrocyanic orPrussic Acid in Affections of the Sto- mach, &c. Lond. 1820. ft Op. citat., p. 443. %X Osann, Op. cit., and Harless Rhein-Westphal. Jahrbuch. Bd.x, St. 1, S. 82. ACIDUM HYDROCYANICTTM. 27 that is, in the variety to which millers, bakers, grinders and others are liable, Creutswicher is said to have found it highly serviceable.* Its efficacy has not been so marked in epilepsy, chorea, and kindred affections ; yet it has been strongly recommended in tetanus. Trevezant ordered it in a case of traumatic tetanus, after opium had been given in vain, in the dose of from two to twelve drops with favourable results.! On the other hand, Klein gave it in a similar case, with no other apparent effect than that of rendering death more easy.J It has likewise been advised in spasmodic pains of the uterus. Yet, although it would seem to be soothing and antispasmodic in many cases of erethism, Grindel and Osann§ consider it by no means adapted for the radical cure of spasmodic diseases. In violent neuralgia, especially in an impressible condition of the vascular system, in nervous cephalalgia, hemicrania, tic- dou- loureux, and in gouty and rheumatic sciatica it has been extolled. Dr. E. S. Bonnet, || of Charleston, treated successfully some cases of facial neuralgia, of great severity, by applying it externally in the form of the distilled water of primus laurocerasus. It is proper, however, to remark, that in two of the three cases de- scribed, belladonna was employed in combination. The mode of applying it was by lotion, composed of oiv. of the laurel iva- ter, one ounce of sulphuric ether, alone, or with half a dram or a dram of extract of belladonna. With this lotion the affected parts, previously covered with carded cotton or cotton wadding, were kept constantly wet. It has likewise been recommended by ElliotsonH in the cure of vomiting, not dependent upon inflammation. These are the chief cases in which its internal use has been prescribed. It has been employed externally in the following cases. As a soothing agent in severe pain ; — for example, in toothach from caries ; one to two drops, according to Elwert, being put into the hollow tooth. Krimer applied it in a dilute state to painful luounds ; and it has been injected with advantage into fistulas. In neuralgia, the application of a cataplasm of belladonna and hydrocyanic acid has been advised by some. In cutaneous affections, of an itching, painful or inflammatory nature, it has been used with much success. In five cases of * Rust's Magazin, Bd. xxii. S. 335. f Froriep's Notizen, Bd. xiv. No. 15. S. 324. % Heidelberger Klinische Annalen, Bd. ii. S. 112. § Loc.citat., S. 535. fl North American Archives of Medical and Surgical Science, April, 1835. ^ Lond. Med. Gazette, 1831. and Amer. Journ. of Med. Sciences, May, 1831, p. 242. 28 ACIDUM HYDROCYAIS'ICTJM. obstinate herpes, Schneider used a solution of the acid in alcohol : in similar cases Dr. A. T. Thomson, besides the use of a purga- tive of calomel and colocynth, applied compresses to the parts wetted with the dilute acid. In two cases of impetigo, the local application completely allayed the distressing and intolerable itching and tingling, after other external applications, and. the internal use of anodynes, had been of no avail. The discharge was diminished and rendered milder : alterative doses of mer- cury, combined with sarsaparilla, formed the internal treatment.* Dr. Thomson found the lotion useful, in combination with small doses of corrosive chloride of mercury, in acne rosacea, and. in several other cutaneous affections. In herpes, Magendie advises a lotion of hydrocyanic acid and lettuce water in the proportions mentioned hereafter. The acid has likewise been used, in the form of glyster,in scir- rhus of the pylorus, in the strength of six drops of Vauquelin's acid to eight ounces of water ;t and in uterine pain from scirrhus, in- jections of the acid, combined with infusion of belladonna, have been employed with advantage. In ophthalmia, especially of the scrophulouskind, with engorge- ment of the conjunctiva, it has been advised by ElwertJ — two drops of the acid being mixed with a dram of water, and a little dropped frequently into the eye ; and it has been given in the ac- tive inflammatory stage of blennorrhcea.§ Lastly, when a portion of taenia has protruded from the rec- tum, — with the view of destroying it, it has been advised by Cagnola, Gelnecke, and others, that hydrocyanic acid should be applied to it.|| Such are the principal affections in which the hydrocyanic acid has been used. The author has often employed it internally in many of the cases recommended, especially in painful affections accompanied by great nervous impressibility, and in consump- tion, but he has not had sufficient reason to place it high in rank amongst medicinal agents.TI He has certainly had no evidence, that it can cure consumption when not beyond its first stage, as remarked by Magendie.** If the practitioner will bear in mind * London Medical and Physical Journal, Feb. 1822; and the author's edit, of Magendie's Formulary, p. 112. Lond. 1824. Philad. 1825. f Bernd, in Rust's JVIagazin. Bd. xiii., S. 273. X Ibid. B. xiii., S. 182. § Ibid. B. xxii., S. 228. | Osann, Op. cit., and Gerson and Julius, Magaz. d. Auslandischen Litte- ratur der gesammt. Heilkund. B. ii., 177. Also, Hufeland und Osann's Jour- nal der prakt. Heilkund. Bd. lviii., St. 6, S. 122. See also Richter, Op. cit., S. 313. If See, also, Becquerel, Gazette Medicate de Paris, Jan. 13, 1840. ** The author's edit, of the Formulary, p. 108. ACIDUM HFDROCYANICUM. 29 the effects, which the acid is capable of inducing upon healthy- man, when the dose is carried to the requisite extent, he will have no difficulty in deciding upon the cases in which its agency may be appropriate. If not a true sedative, it is the nearest approach to one, in the catalogue of the Materia Medica, and therefore its employment is clearly indicated in all diseases in which there is much erethism, — administered alone or along with other appropriate agents. MODE OP ADMINISTRATION. After the remarks that have been made on the varying strength of the hydrocyanic acid, according to the particular form by which it may have been prepared, it is hardly necessary to say, that the physician must be acquainted with the character of the acid he prescribes. The ordinary dose of the acid of the Pharmacopoeia of the United States is a drop, given three times a day in a little sugared water : it must be borne in mind, however, that the specific gravity of the acid is less than that of water, and hence the necessity of dropping the quantity of acid at the time of using it, rather than forming a mixture with a larger quantity of the acid, which will certainly rise to the surface, if the mixture be put to one side : and unless the vial is shaken, a much larger dose may be administered than was intended. It must also be recollected, that the acid loses its strength by keeping. Magendie remarks,* that when left to itself in a close vessel, it sometimes becomes decomposed in less than an hour, and that it rarely pre- serves its integrity for more than a fortnight. The substances, that are incompatible with it in the same pre- scription, are most metallic oxides, particularly those of mercury and antimony, nitrate of silver, salts of iron, sulphurets, mineral acids and chlorine. The proper plan is to begin with a small dose and to augment it carefully until some effect is induced, but if any of the signs — mentioned above as indicating the supervention of the seda- tive effects of the acid — should supervene, it ought to be discon- tinued. There is no distinct evidence of its being a cumulative poison. t Magendie, it has been seen, uses the hydrocyanic acid of Gay- Lussac, diluted with 8.5 times its weight of water ; and this mix- ture he denominates medicinal prussic acid. The following are forms in which the acid may be administered. * Op. citat. p. 104. f Christison, Dispensatory, p. 28. Edinb. 1842. 3* 30 ACIDUM HYDROCYANICUM. Mistura acidi hydrocyaniei. Mixture of hydrocyanic acid. Melange pectoral. R. Acidi hydrocyaniei medicinalis, 3j. Aquae deslillatse, f£,j. Sacchari albi, §iss. M. A dessert spoonful of this is directed to be taken every morn- ing and evening at bed time — the dose being gradually increased to six or eight spoonfuls in the 24 hours. Magendie. R. Acidi hydrocyaniei (Scheele's) TT^xij. Vin. antimon., f.3J. Tinet. opii camphorats, f.Jiiss. Misturse camphorae, f.3vijss. Fiat mistura. Dose — In hooping cough; a table spoonful every four hours for a delicate boy four years old, to be given in some warm drink. The child to remain in a warm room, and to live upon light pudding and broth. Roe. R. Acidi hydrocyaniei (Scheele's), m^xx. Vin. antimon., f.^iss. Vini ipecacuanhas, f.Jiss. Aquse, f.^xiij. Fiat mistura. Dose — A small spoonful every two hours for a healthy look- ing female child, five years of age. Roe. Syrupus acidi hydrocyaniei. Syrup of hydrocyanic acid. R. Syrupi purificat. ftjj. Acidi hydrocyaniei medicinalis, 3> M. This syrup may be added to common pectoral mixtures, and used as other syrups are. Magendie. ACIDTTM HYDROCYANICUM. 31 Lotio acidi hydrocyanici. Lotion of hydrocyanic acid. &. Acidi hydrocyanici, f.Jiv. Spiritus vini rectif. f.^j. Aquse destillat. f.^xss. M. This was the lotion employed by Professor Thomson in the cases of impetigo. The following was used by Schneider, in herpes. R, Acidi hydrocyanici, f.Jiss. Spirit, vini. rectif. f.^vi. M. And in the same cases, Magendie employed the subjoined formula. R. Acidi hydrocyanici, 5u- Aquse lactucee, J^ij. M. The distilled water of the garden lettuce probably contains no- thing to recommend it over common distilled water. Dr. Joy* advises the following lotion, in acne and impetigo, to correct itching ; and in ulcerated cancer to diminish pain. R. Acid, hydrocyan. dil., f.^i — %iv. Decoct, malvse, Oj. M. The bottle should be shaken before each appplication. All these formulas are objectionable for the reasons before as- signed ; and it is consequently better to drop the acid at the time of using it, taking care that it has not lost its properties. * Tweedie's Libr. of Med., v. 288, Lond. 1840. 32 ACIDUM LACTIS. III. ACIDUM LACTIS. Synonymes. Acidum Lacteum, Lactic Acid, Acid of Milk. French. Acide Lactique. German. Milchsaure. This acid is recommended as a therapeutical agent by Ma- gendie.* METHOD OF PREPARING. Lactic acid may be obtained either from milk or from the juice of the red beet. In the latter case, the juice is put in a situation the temperature of which is between 77° and 86° Fah. After the lapse of a few days, a commotion is observed in the mass, which is known under the name " viscous fermentation," {fermentation visqueuse,) and hydrogen and carburetted hydrogen are evolved in considerable quantity. When the mass has become fluid again, and the fermentation has ended, which generally requires about two months, it is evaporated to the consistence of syrup ; the whole then becomes traversed by a multitude of mannitic crystals, which — when washed with a small quantity of water, and dried — are entirely pure. The mass, moreover, contains a saccharine matter, which affords all the signs of the sugar of the grape. The product of the evaporation is next treated with alcohol ; this dissolves the lactic acid, and precipitates several substances, that have not yet been examined. The alcoholic extract is then dissolved in water, which occasions a fresh pre- cipitation. The liquid is now saturated with carbonate of zinc, and by this means a fresh precipitation is effected, more copious than the preceding. By concentration, the lactate of zinc shoots into crystals, which are collected and heated in water, to which animal charcoal, previously washed in muriatic acid, has been added : the fluid is then filtered, and the lactate of zinc is deposited in perfectly white crystals : these are washed in boiling alcohol, in which they are insoluble ; afterwards they are treated with baryta, and then with sulphuric acid, which separates the lactic acid, which is finally concentrated in vacuoA * Forrnulaire pour la preparation et l'emploi de plusieurs nouveaux medi- camens, &c. Edit. 9eme. Paris, 1836. f Gay-Lussac and Pelouze, Annales de Chimie et de Physique, Avril, 1833. (Tom. Hi. 410.) ACIDTJM LACTIS. 33 Mitscherlich* gives the following process for preparing it pure. Lactate of lead, formed in the usual way, is decomposed by sul- phate of zinc; the sulphate of lead is separated, and the lactate of zinc crystallised by evaporation ; this is at first yellow, but by re- peated crystallisations, it is obtained of a pure white. The solu- tion of this lactate is decomposed by pure baryta ; the oxide of zinc separated, and the lactate of baryta, which is in solution, is decomposed by sulphuric acid, and the fluid evaporated ; this yields a clear, colourless, syrupy, not volatile acid, which is decomposed, and leaves a residue of charcoal, when heated at a sufficiently high temperature. Milk, which has been suffered to ferment for a long while, and is treated in the same way, affords lactic acid. Corriol has like- wise detected it in an aqueous infusion of the mix vomica. When concentrated in vacuo until it parts with no more water, lactic acid is a colourless liquid, of syrupy consistence ; its specific gravity being about 1.215. It is inodorous, but of a very sour taste, similar to that of the strongest vegetable acids. When exposed to the air, it attracts moisture. Water and alcohol dis- solve it in all proportions. One of its most striking properties, which is of especial interest to the physician, is, that it quickly dissolves phosphate of lime, especially that which is contained in bones. EFFECTS ON THE ECONOMY. As lactic acid was conceived to play a part amongst the juices, which effect the solution of the food in the stomach, Magendie thought it may be given with advantage in cases of dyspepsia, produced by simple debility of the digestive apparatus ; and his experiments afforded him very encouraging results. According to Liebig,t however, no lactic acid is formed in the stomach in a stale of health ; but in certain diseases, there are produced from the starch, sugar, &c, of the food, lactic acid and mucilage. In consequence of the facility with which lactic acid dissolves phosphate of lime, it has been suggested, whether it might not be administered with advantage in cases of white gravel, or, in other words, of phosphatic depositions from the urine. Ma- gendie has not yet been able to institute experiments on this matter. At the time when the edition of his Formulary, to which we have referred, was published, he had commenced some clinical experiments with lactate of potassa, and lactate of soda, but without any results worthy of being communicated to * Report to British Association, 2d meeting', and Philad. Journ. of Phar- macy, vi. 83. Philad. 1834-5. t Animal Chemistry, edited by Gregory and Webster, p. 107, Cambridge, 1842. 34 ACIDUM TANNICUM. the profession. He recommends these salts, however, to the attention of physicians. MODE OF ADMINISTRATION. Magendie gives lactic acid either in the form of lemonade or of lozenges. Potus acidi lactis. Lemonade of lactic acid. R. Acid. lact. liquid. 3J- ad ^iv. Aquae, ftij. Syrupi, sij. M. Pastilli acidi lactis. Lozenges of lactic acid. R. Acid. lact. pur. 5U- Sacch. pulv. 5j. Gum. tragac. q. s. 01. aether, vanigl. gtt. iv. M. Make into Lozenges weighing half a dram each. Let the Lozenges be kept in a well closed vessel. Of these, from two to six may be taken in the 24 hours without any evil conse- quences. IV. ACIDUM TAN'NICUM. Synonymes. Acidum Quercitannicum, Tanninum Purum, Tannicum, Prin- cipium Adstringens, P. Scytodephicum, Tannin, Tannic acid. French. Acide Tannique. German. Tannin, Gerbestoff, Gerbs-iure. This article, in its pure state, has been subjected to experi- ment of late years only. METHOD OF PREPARING. According to Buchner,* tannic acid should be prepared for medical use in the following manner. * Repertorium, B.xxxiv. H. 3 ; also, A. W. Buchner, Neueste Entdeckung. uber die Gerbsaure,u. s. w. Frankf. 1833, and Dierbach, in Heidelberger Kli- nische Annalen, B. x. H. 3, S. 339, Heidelb. 1834. For the process of M. Duval, see Annal. de Chimie et de Physique, and Amer. Journ. of Pharm. July, 1841, p. 171. ACIDUM TANNICUM. 35 From eight to twelve parts of hot water must be poured on one part of powdered galls, and the mixture be allowed to digest for an hour, frequently agitating it. The infusion must then be filtered, and the residue be again treated in the same manner with a little hot water. The different infusions, which generally pass through the filter turbid, must be mixed together, and a little dilute sulphuric acid be added by drops, constantly shaking the mixture so long as any precipitate of tannic acid follows. The acid is deposited very soon in this way, in a collected yel- lowish-white, gelatiniform mass, which by the influence of air gradually assumes a brown colour. After the fluid is poured off, the residue is washed twice with cold water acidulated with sulphuric acid ; carbonate of baryta, or carbonate of potassa, is then added to it in small portions, carefully shaking the mixture, until there is no farther efferves- cence, and until a portion of the mass dissolved in water and tested by chloride of barium affords no more evidence of the presence of sulphuric acid. The yet moist mass is then put into a retort with alcohol of about ninety per cent., which is added repeatedly in small portions ; the alcohol is made to boil, to dis- solve the tannic acid and separate it from the sulphate of baryta or sulphate of lime ; the alcoholic solution is then poured off clear, and by a gentle heat evaporated to dryness. The following form for its preparation is given in the last edi- tion of the Pharmacopoeia of the United States (184.2). Take of Galls, in powder, Sulphuric ether, each a sufficient quantity. Put into a glass adapter, loosely closed at its lower end with carded cotton, sufficient powdered galls to fill about one half of it ; and press the powder slightly. Then fit the adapter accu- rately to the mouth of a receiving vessel, fill it with the sulphuric ether, and close the upper orifice so as to prevent the escape of the ether by evaporation. The liquid which passes separates into two unequal portions, of which the lower is much smaller in quantity and much denser than the upper. When the ether ceases to pass, pour fresh portions upon the galls, until the lower stratum of liquid in the receiver no longer increases. Then separate this from the upper, put it into a cap- sule, and evaporate with a moderate heat to dryness. Lastly, rub what remains into powder. The upper portion of liquid will yield by distillation a quantity of ether, which, when washed with water, may be employed in a subsequent operation. Tannic acid, thus prepared, is of a yellowish-white colour ; of a strongly astringent taste ; very soluble in water, and less so in alcohol and in ether. It reddens litmus paper.* * Pharm. of the United States, p. 63, Philad. 1842. 36 ACIDUM TANNICUM. EFFECTS ON THE ECONOMY. Tannic acid is a strong astringent,* which has hitherto been mainly used in uterine hemorrhage, and especially by the Italian physicians. Portal was, perhaps, the first who tried it. He found it very efficacious in cases of uterine hemorrhage not de- pendent upon any organic mischief in the uterus. It exhibits its powers, according to him, even in small doses — as of two grains, and is well borne by the stomach. Ferrarioi likewise administered it with advantage in the same affection, but he does not consider it adapted for cases in which either partial or general plethora, or local excitement of the uterus, or any organic disease, exists : it is indicated only where pure atony is present. He gives it in the form of powder or pill, in two grain doses, six times a day. The effect, according to him, is generally good : the hemorrhage diminishes and soon ceases, and, at the same time, the strength augments, and recovery succeeds, with- out any disturbance of the functions. Giadorow§ details two cases of diabetes cured by it, when given in combination with opium, as in the prescription at the end of this article. The first patient was cured in ten ; the second in twelve days. According to Ricci,|| tannic acid has frequently been employed in Italy both in internal and external hemorrhages. On the other hand, G. A. Richter,*!! affirms, that he has given it in habi- tual metrorrhagia without any advantage whatever. Within the last few years, M. Cavarra** has instituted many experiments on animals, as well as on himself, from which he concludes, that when tannic acid is placed in contact with certain parts of the living economy, it exerts upon them the same chemico-vital action which it does on an inert organic tissue, or, in other words, it tans them as it tans leather. " These parts," he says, " are the mucous membranes of the urethra, vagina, intestines, and lungs. The action of tannic acid appears to be, to cause such a condensation or contraction in them, that the glands with which they are studded no longer afford passage for the mucus which they secrete." * See, on the action of this agent, Mitscherlich, Medicinische Zeitung, No. 43, 1838, and Bullet. General de Therap. Mars 30, 1837. f Delpech, Memorial des Hopitaux du Midi, &c. Feviier, 1829, p. 51. \ Annali universali di Medicina, Gennajo, 1829. § Annali universali di Medicina, and Gazette Medicale, Sep. 15, 1332. || Bulletin des Sciences Medicales, Sept. 1828. % Arzneimittellehre, Supplement, p. 60 ; also, Cavalier, in Archiv. Gene- rales, xix. 589. ** Bulletin de l'Academie Royale de Medecine, Janvier, 1837 ; also, Dun- glison's Medical Intelligencer, Oct. 16, 1837, p. 258, and Bulletin General de Therapeutique, Mars 30, 1837. ACIDUM TANNICUM. 37 M. Cavarra asserts, that he has proved these positions by nu- merous experiments and demonstrations. When tannic acid is taken internally, its immediate effect is constipation, by arresting the secretion from the mucous membrane. When it has reached the stomach, it is absorbed, and carried into the current of the circulation. There exists between this organ and the vagina, the urethra, and the lungs, no communication except through the circulatory system, and, consequently, the tannic acid — it is fair to presume — must be absorbed to cure leucorrhoea, gonor- rhoea, and the most obstinate chronic catarrhs. M. Cavarra concludes, that of all the effects of tannic acid, two of the most surprising are, the cures operated by it in cases of obstinate nervous coughs, and the excellent action it exerts in phthisis. Farther experiments are, however, demanded before this last point can be admitted. From our knowledge of the properties of tannic acid, it is not easy to see how it — or any other astrin- gent — can be of much service in the latter malady. M. Amedee Latour* has highly extolled tannic acid for its efficacy in haemoptysis. In one case, it completely succeeded when other remedies had failed ; and in three cases of hemor- rhage to a slighter degree, it was wholly successful. M. Char- vett has also recommended it in the sweats of phthisis. He gives it in the dose of from half a grain to a grain and a half, alone, or associated with opium, and generally at bed-time. Hitter affirms, that tannic acid, prepared from dried galls, in the form of ointment or diluted with distilled water, is very serviceable in most cases of Egyptian ophthalmia. In the hy- peremesis, induced by ipecacuanha or emetia, it may be admi- nistered as an antidote. According to the experiments of Magendie,^ it is one of the substances that oppose the coagulation of the blood. METHOD OF ADMINISTERING . It may be given in the form of pill, or draught, or as a lave- ment, and in the dose of from a quarter of a grain to two grains, without producing any unpleasant constipation, but its effects must be observed with care.§ * Journal de Mcdecine etde Chirurg. Pratiq. Nov. 1839. f Bulletin General de Therapeutique, Mai, 1840, and Encyclographie des Sciences Medicales, Juin, 1840. \ Lond. Lancet, Jan. 26, 1839, p. 636. \ Cavarra, in Bulletin General de Therapeutique, Mars 30, 1837. 38 ACIDUM TANNICUM. Vinum aromaticum cum acido tannico. Aromatic ivine xuith tannic acid. R. Vini aromat. f.'viij. Acid, tannic. 9ij. M. R. Vini aromat. f.fviij. Acid, tannic, J^ij. Ext. opii. purif. 3ss. M. Used as a local dressing to chancres. Ricord. The vinum aromaticum of the French Codex, used by Ricord, is composed of four ounces of aromatic herbs, (rosemary, rue, sage, hyssop, lavender, absinthium, origanum, thyme, laurel leaves, red rose leaves, chamomile, melilotum, and elder,) digested in two pints of red wine for eight days. Injectio acidi tannici. Injection of tannic acid. R. Vin. rubr. f.gvj. Acid, tannic, gr. xviij. M. Used in chronic blennorrhcea or what is called an old gleet.'* Ricord. In the case of the female, the quantity of tannin may be doubled or still farther increased. Pilulffi acidi tannici. Pills of tannic acid. R. Acid, tannic, in pulv. gr. vj. Gum acac. in pulv. gr. xij. Sacchar. pulv. gr. lxxij. Syrup, q. s. ut fiat massa in pilulas pond. gr. iv. sing. Dose. — One to four, morning and evening, where an astrin- gent is needed. Cavarra. * La Lancette Francaise, No. 33, Paris, 1838, and Parker, Modern Treat- ment of Syphilitic Diseases, Dunglison's American Med. Library edit., p. 44. Philad. 1840. ACIDTJM TANNICUM. 39 Pulveres acidi tannici et opii. Powders of tannic acid and opium. R. Acid, tannic. 9ij. Pulv. opii. gr. £. Misce et divide in pulveres tres. Dose. — One, morning, noon, and night ; gradually increasing the quantity of tannin to four scruples daily. Giadorow. Pomatum acidi tannici. Pomatum of tannic acid. (LiparoU de tannin.) R. Adipis suill. 5 x 'j- Acid, tannic. Jij. Aquae pur. f-3U- Dissolve the tannin in the water, by triturating them in a glass mortar ; add the fat and mix.* fflml. Lotio acidi tannici. Lotion of tannic acid. (Hydrolotif de tannin, pour Vurethre.) R. Aquae destillat. f.^viij. Acid, tannic, gr. xxxij. Solve. Employed in obstinate blennorrhcea. Beral. * Bulletin General de Th6rapeutique, Janvier, 1838. 40 V. ACONITIA. Synonymes. Aconitina, Aconita, Aconitium, Aconitine. German. Akonitin. This active principle, which was discovered by Peschier,* and by Brandes, has been recommended by Turnbull.t whose eulo- gies on the medical virtues of the natural order Ranunculacea? are evidently overstrained. MODE OF PREPARING. Turnbull gives two processes ; the former being the more easy of manipulation ; the latter yielding a purer result, and on the whole being preferable. A quantity of the fresh root of Aconitum napellus, being very carefully and cautiously dried, and reduced to powder, — one part of it by weight, and two parts by measure, of strong alcohol, are to be digested together at a gentle heat for seven days, and the tincture, whilst warm, is to be filtered. It must then be reduced to the consistence of an extract, by careful evaporation, at a low and well regulated temperature ; the object of this being to prevent the destruction or expulsion of the active principle, which would very probably ensue, if the temperature employed were higher than barely sufficient to carry off the alcohol. To the extract, thus prepared, liquid ammonia is to be added, drop by drop, and mixed well with it, to precipitate the alkaloid ; in this part of the process care must be taken that too much be not added, as in some instances the product appears to have been decomposed by inattention to this circumstance. It is not easy to give a precise rule as to the quantity; but enough will have been added, if the extract exhales the odour of ammonia when stirred. The mass now consists of impure aconitia, mixed with a quantity of extractive, and other matters soluble in water, and it may be taken up either by boiling alco- hol, or by sulphuric ether ; or the soluble matter may be removed by repeated washings with small quantities of cold water, which will leave the aconitia. This latter process, Turnbull says, is * Trommsdorffs Journal der Pharmacie, v. 84. | On the medical properties of the natural order Ranunculaceae, and more particularly on the uses of sabadilla seeds, delphinium staphysagria and. aconitum napellus, and their alcaloids, veratria, sabadilline, delphinia and aconitine, chap. iii. Lond. 1835. ACONITIA. 41 the one he has generally employed, and it is performed by pouring a little water on the extract, arid mixing them carefully together ; then allowing the undissolved part to subside, pouring off the fluid, and repeating the operation as long as any soluble matter is taken up : a quantity of light brown or gray powder is left, which may be purified by subsequent solution in alcohol. This powder contains the active properties of the aconite, in a high degree of concentration. The second process consists in dissolving the alcoholic extract, prepared as above, without the addition of the ammonia, in as much cold ivater as will take it up, and carefully decanting the solution from the insoluble part, and filtering it. To the filtered solution liquid ammonia is to be added, drop by drop, as long as any precipitation is occasioned. When the precipitate has subsided, the supernatant fluid must be carefully poured off, or drawn off by means of a syphon ; and after the precipitate has been deprived of as much of the fluid as possible, it should be purified by a suffi- cient number of washings with small quantities of cold water, or, what is better, it may be dissolved in as much alcohol as will take it up, and the solution be thrown into cold ivater ; the precipitate thus formed is to be carefully dried. The product obtained by this process is white. The London College, in their Pharmacopoeia, of 1836, give the following form : — Take of aconite root, dried and bruised, two pounds ; rectified spirit, three gallons ; dilute sulphuric acid, solution of ammonia, and purified animal charcoal, of each a sufficient quantity. Boil the aconite with a gallon of the spirit for an hour, in a retort with a receiver fitted to it. Pour off the liquor, and again boil the residue with an- other gallon of the spirit, and with the spirit recently distilled, and pour off the liquor also. Let the same be done a third time. Then press the aconite, and having mixed all the liquors and filtered them, distil the spirit. Evaporate the remainder to the proper consistence of an extract. Dissolve this in water and filter. Evaporate the solution with a gentle heat, so that it may thicken like syrup. To this add dilute sulphuric acid, mixed with distilled water sufficient to dissolve the aconitia. Next drop in solution of ammonia, and dissolve the aconitia which is thrown down in dilute sulphuric acid, mixed as before with water ; then mix in the animal charcoal, occasionally shaking for a quarter of an hour. Lastly, filter ; and having again dropped in solution of ammonia so as to precipitate the aconitia, wash and dry it. Well prepared aconitia, according to Geiger, is a firm, colourless, and translucent mass ; of a shining appearance, friable and inodorous : the taste is disagreeably bitter, leaving behind it an acrid sensation in the throat, but not corrosive or burning. 4* 42 ACONITIA. It does not dissolve readily in water ; at the ordinary tempera- ture requiring one hundred and fifty parts thereof, but only fifty parts of boiling water. It is soluble in alcohol, and in ether. Tinc- ture of iodine occasions in the solution a reddish-brown precipi- tate ; the tincture of galls a white one. It forms, with the acids, for the most part, salts that are not crystallisable, which readily dissolve both in water and alcohol. EFFECTS ON THE ECONOMY. The effects of aconitia appear to be essentially analogous to those of delphinia. A grain of the first of the two preparations described by Turnbull was dissolved in a dram of alcohol ; twenty drops of the solution put into the mouth of a guinea-pig occasioned death in a few minutes. Other experiments, too, have been performed, all of which demonstrate the extreme activity of the substance. If a grain or two of aconitia or veratria or delphinia be mixed with a little lard, or dissolved in a dram of alcohol, and a small quantity be rubbed on the skin, a sensation of heat and tingling is experienced after the friction has been per- severed in for a minute or two. There is a slight difference, how- ever, in the effects produced, and the resemblance is greatest between those of delphinia and aconitia. When a small quantity of aconitia, says Turnbull, either made into an ointment, or dissolved in alcohol, is rubbed for a minute or two upon the skin, a sensation of heat and prickling is experienced ; to this succeeds a feeling of numbness and con- striction in the part, as if a heavy weight were laid upon it, or as if the skin were drawn together by the powerful and involuntary contraction of the muscles beneath. This effect lasts from two or three to twelve or more hours, according to the quantity rub- bed in. So small a portion as the one hundredth part of a grain has produced a sensation that has continued a whole day. A minute portion of it mixed with lard, and applied to the eye oc- casions contraction of the pupil according to Dr. Pereira, whilst Geiger and Hesse affirm that the aconitia which they obtained produced dilatation of the pupil. Dr. Pereira states, that the aconitia prepared by Mr. Morson of London is so powerful, that one-fiftieth of a grain has endangered the life of an individual. It is, he considers, the most virulent poison known, not excepting hydrocyanic acid.* Whilst employing aconite itself in hisclinical practice, Dr. Lom- bard,! of Geneva, tried its effects on animals, and chiefly in refer- * Elements of Mat. Med. &c, 2d edit. ii. 1811. Lond. 1842. f Gazette Medicale de Paris, Oct. 10, 1835. ACONITIA. 43 ence to its action on the heart. The experiments were made on frogs, whose hearts beat with great regularity, and for a consi- derable time after the animal has been mutilated. The medicine was introduced into the stomach or applied locally to the heart, which was laid bare after the animal had been stupified by blows on the head. He found, that aconite employed internally ren- dered the pulsations less frequent, without irregularity, and con- sequently that it exerted a decidedly sedative effect on the heart ; whence he infers, that it is a proper remedy in active diseases of the heart, and indeed in inflammatory affections in general, in which he exhibited it with success. In cases of poisoning by it, the contractions of the heart have been found diminished and almost suspended.* The homceopathists regard it to be an energetic antiphlogistic. The diseases, in which Turnbull chiefly employed aconitia externally, were of the neuralgic kind ; but he used it as well in gouty and rheumatic cases, and its success, he remarks, fully answered his anticipations. He employs it either in the form of solution in alcohol, in the proportion of one or more grains to the dram, — or of ointment, made according to the following formula : $. Aconitiae, gr. ij. Alcohol, gtt. vj. Tere optime et adde Adipis, 3j. ut fiat unguentum. The alcohol is added to prevent the aconitia from forming a thick compound with part of the lard, so as to render it difficult to make a proper ointment. In one case of tic douloureux, of extreme severity, as much as eight grains was prescribed in the ointment with the most marked benefit. The best mode of applying it is simply to rub a small portion of it over the whole seat of the affection, until the pain is either for the time removed, or until the full effect', described above, is induced on the cutaneous nerves ; and the friction should be repeated three or four times, or more frequently, during the day, according to the effect on the disease ; the proportion of the aconitia being increased at every second or third rubbing. Turnbull found, in the case of the aconitia — as well as in that of veratria, and delphinia — that unless the friction occa- sioned a full development of the peculiar impressions caused by the aconitia when rubbed on the skin, no benefit whatever was to be looked for from its employment ; and he observes, that if there be the slightest abrasion of the skin, an application of such • Orfila, Toxicologie, ii. 221. 44 ACONITIA. activity should not be resorted to ; and that it should be care- fully kept from coming in contact with any of the mucous mem- branes. Mr. F. C. Skey* details two cases which were cured by it. It was rubbed down into an ointment with lard, in the proportion of one grain of the former to one dram of the latter, and applied in a small quantity by the forefinger over the track of the painful nerve, and was gently rubbed or rather smeared over the surface for half a minute or longer, once or twice a day, according to the degree of pain. Turnbull likewise advises the external application of an ammoniated extract of aconite, which is made by evapo- rating very carefully, and at a low temperature, the tincture of the dried root of the plant, prepared as directed in the process for obtaining aconitia, to the consistence of an extract. To every dram of this, eight or ten drops of liquor ammonise should be added, and after the mixture has stood a short time in a very gentle heat, to drive off the excess of ammonia, it may be used in the form of an ointment, according to the following prescription : Ungucntum extracti aconiti ammoniati. Ointment of ammoniated extract of aconite. R Ext. aconit. ammon. 2j. Adipis. 3iij- Misce ut fiat unguentum. When this ointment is rubbed upon the skin, it occasions sen- sations in the parts similar to those produced by the aconitia oint- ment : they are, however, rather more pungent. In less severe cases, Turnbull advises the simple saturated tincture of the dried roots, with or without the addition of a little ammonia. The external use of the tincture of aconite has been recommended in neuralgia and chronic rheumatism, by Dr. Pe- reirat and Mr. Jos. Curtis. J The alcoholic extract of aconite — Extractum aconiti alco- holicum — which is officinal in the last edition of the Pharma- copoeia of the United States, 1842 — has likewise been advised by * London Med. Gaz. Nov. 5, 1836. t Elements of Materia Medica, 2d edit. ii. 1808. Lond. 1842. X -Lond. Lancet, June 26,1841. ACUPUNCTURA. 45 Dr. Lombard, of Geneva,* in articular rheumatism. He gives it in doses of half a grain every two hours, and gradually aug- ments the dose to six or nine grains in the same period. A case of poisoning by five grains of this extract — from which, however, the patient recovered — has been published by M. E. L. Pereyra, of Bordeaux.! VI. ACUPUNCTU'RA. Synonymes. Acupuncture ; Acupuncturation. German. Die Akupunktur; der Nadelslich. Although acupuncturation is really an ancient therapeutical agent, attention to it has been so much revived of late years, and its use has been so largely extended, that it may be looked upon as constituting one of the novelties of therapeutics. It consists in the introduction of needles into different parts of the body with a view of removing or mitigating disease ; and appears to have been entirely unknown to the Grecian, Roman, and Arabian physicians. J From the most ancient times, however, it has been in use with the Chinese and Japanese, by whom it was regarded as one of the most important of remedial agencies. By these people it was systematically taught onappropriate phan- toms or mannekins, called Tsoe-Bosi, and the practice of the operation was permitted to those only who were able to pass a rigid examination thereon. In Europe, it was first known about 160 years ago, from the writings of a Dutch surgeon, Ten- Rhyne, who wrote in 1683 ;§ and attention was subsequently drawn to it by Kampfer ;|| but after this it was almost forgotten, until Berlioz, in 1816, drew attention to its employment. His example was soon followed by Beclard,H Bretonneau,** Haime,tt Demours,JJ Sarlandiere,§§ Pelletan, Segalas, Dantu, Velpeau, Meyranx,|||| Dance, in France; by Churchill, Scott, * Gazette Medicale, Juin 28, 1834. See, also, Dr. Sigmond, in Lancet for August 5, 1837. f La Laneette Franchise, No. 37, Mars 26, 1839. X V. A. Kiecke, Die neuern Arzneimittel u. s. w. S. 12, Stuttgart, 1837. § Mantissa schematica de Acupuncture ad dissert, de Arthritide. London, 1683. || Amoenitat. exotic, politico-physico-medic. p. 583. Lemgov. 1712; and his History of Japan, vol. ii., Appendix, sect. 4, p. 34. If Mern. de la Societe" Medic. d'Emulation, viii. 575. ** Journal Universel des Sciences M6d. xiii. 35. Paris, 1817. ■ft Journal G£ner. de Mcdec. torn, xiii., and Journal TJnivers. des Sciences Medic, torn. xiii. 1819. §§ Mern. sur l'Electropuncture. Paris, 1825. Ul| Archives Generates de Med. torn. vii. Paris, 1825. 46 ACUPUNCTURA. Elliotson,* and others in England ; by Friedrich,t Bernstein,:}: L. W. Sachs, Heyfelder, Michaelis,§ Grafe, || and others, in Ger- many ; by Carraro,1T Bergamaschi,** Bellini, andothers,in Italy; and by Ewing,tt E. J. Coxe,JJ Bache,§§ and others, in this country. M. Jules Cloquet had much to do in reviving its employment in his own country and elsewhere, by his treatise on the subject published at Paris, in 1S26, where it was for a long period a fashionable article in the hospitals ; so much so, it is affirmed, that attempts were even made to heal a fractured bone by it without the application of any appropriate apparatus ! and at one time, it is said, the patients in one of the hospitals actually re- volted against the piqueurs m6decins!\\\\ MODE OF ADMINISTRATION. In the operation of acupuncture, needles are employed, which are very fine, well polished and sharp pointed. They are usually from two to four inches long, the length being adapted to the depth it may be desired to make them penetrate. If steel needles are selected, they are heated to redness, and allowed to cool slowly, in order that they may be less brittle. At the blunt ex- tremity of the needle, a head of lead, or sealing wax is attached to prevent it from being forced entirely into the body. This is the simplest method of acupuncturation, and it is as effectual as any other. By various acupuncturists, needle-holders or handles of ivory have been devised, to some of which the needle is per- manently attached. Perhaps the jjorte-aiguille, or 'needle-holder' recommended by Prof. F. Bache,Hir is as good as any that has been invented. The needle, with its porte-aiguille, consists of a handle with a steel socket to receive the end of the needle, which may be fixed securely, after having been inserted, by the pressure * Med. Chir. Trans, xiii. 467. Lon. 1827; and art. Acupuncture, in Cyclop. Pract. Med. Lond. 1832. | Translation of Churchill's work in German, p. 40. \ Hufeland's Journal, lxvii. Berlin, 1828. § Grafe und Wallher's Journal, B. v. St. 3. S. 552. || E. Grafe, in art. Acupunctur. in Encyc. Worterb. der medicinisch. Wis- senschaft. B. i. S. 312. Berlin, 1828. If Annali Universali d'Omodei, 1825. ** Ibid. 1826. ft North Amer. Med. and Surg. Journal, ii. 77. Philad. 1826. XX Ibid. ii. 276. Philad. 1826. \\ Ibid. i. 311. Philad. 1826; and art. Acupuncture, in Cyclop, of Pract. Med. i. 200. Philad. 1833. IHI Riecke, Op. cit. S. 13. fl Cyclop, p. 202. ACUPUNCTURA. 47 of a small lateral screw. By this construction, the operator can at pleasure fix in the handle a needle of the length he may de- sire, and after inserting it he is enabled to detach the handle by relaxing the screw. After all, however, needles prepared in the simple manner mentioned above are adequate to every useful purpose. Besides common steel needles, those of gold, silver, and pla- tinum have been used, but it does not appear that one metal is preferable to another. To introduce the needle, the skin is stretched, and the needle inserted by a movement of rotation performed in opposite direc- tions, aided by gentle pressure. As a rule, the seat of pain will indicate the place where the needle should be introduced ; but where the feelings of the patient do not point out the spot, it must be suggested by our knowledge of anatomy and physiology. From the experiments of Beclard, Bretonneau, Segalas, Dantu, Velpeau, and others, it would appear, that perforation of arteries, nerves, and even of important viscera with very fine needles has not been followed by any injurious results; yet, at times, acci- dents have been produced thereby ; and, therefore, it may be laid down as a rule, that the greater nerves, and arteries of a certain size, should be avoided. Prudence would likewise sug- gest, that important viscera, as the heart, stomach, intestines, &c, should not be penetrated. The number of needles to be used varies according to the ex- tent of the affected parts. In the opinion of many experienced physicians, we ought not to be afraid of the number, but rather insert too many than too few, and not at too great a distance from each other. The length of time, during which the needles should be suf- fered to remain in the part, differs ; no fixed rule can be laid down. Some suffer them to remain for an hour and a half, or two hours ; at times, a period of five minutes is sufficient. In other cases, they have been kept in for two or three days. It appears to be by no means settled what medicinal influence is exerted by their longer or shorter continuance in the parts. EFFECTS ON THE ECONOMY. Allusion has already been made to the impunity with which, in the generality of cases, acupuncturation may be practised even on important organs. As respects the nerves, Cloquet has seldom or never seen the puncture of them give rise to so much pain as to render it neces- sary to withdraw the needles ; the pain was generally trifling and speedily passed away. He inserted needles into the brain and 48 ACUPTTNCTTTRA. spinal marrow, and into the crural nerve of a cat, without any evidence of severe suffering or of change of function. Similar experiments were made by E. Griife with the same results.* Nor was inconvenience found by Delaunay, Beclard and Cloquet to be sustained on puncturing the arteries and veins. A few drops of blood perhaps issued, but the flow was readily stopped by pressure with the finger. The slight ecchymosis, which, at times, supervened, disappeared rapidly of itself. In Grafe's ex- periments, he never found much bleeding ensue, although he properly esteemed it advisable to keep clear of the nerves and blood-vessels, in order to avoid any unnecessary pain or mis- chief. As regards the fasciae and periosteum, Grafe found, that the in- sertion of needles into them was always very painful, and he re- commends, therefore, that the operation should be performed with care on those parts. Should, however, the needles be in- troduced, and much pain be experienced, it rapidly ceases when they are withdrawn. Lastly — MM. Haime, Bretonneau, Velpeau, and Meyranx, instituted several experiments on dogs by passing needles into the brain, heart, lungs, stomach, &c, and little or no inconveni- ence, as remarked above, was experienced, provided the needles were extremely fine. Cloquet passed his needles so deeply into the chest of an animal as to leave no doubt, that they had penetrated the lungs, and he subsequently pierced the liver, sto- mach, and testicles without the supervention of any unpleasant results. The pain occasioned by acupuncturation is generally easily tolerated ; but at times it is so violent, that the patients cry out ; the violence however, usually passes away either when the needle is drawn out or forced in deeper. It would seem, that the opera- tion is, as a general rule, most successful when it occasions the least pain. Cloquet asserts, that a kind of electric shock is some- times experienced in the surrounding parts at the moment of the introduction of the needle ; in other cases, a tremulous motion is observable in the fibresof the muscles penetrated. Almost always, some time after the entrance of the needles, a more or less regular aureola or halo of a red colour, and without tumefaction, is per- ceptible around the needles, which soon disappears after they are withdrawn ; but when they are suffered to remain long in the part it may persist for hours. When the operation is productive of benefit, relief is speedily experienced. The extraction of the steel needles is ordinarily accompanied by more pain than their insertion, especially if they have penetrated * Art. Acupunctur. in Encyc. Worterb. u. s. w. S. 317. Berlin, 1828. ACUPUNCTURAL 49 deeply, and been retained in the flesh for a long time. The diffi- culty is owing to their having become oxidized, and consequently rough on the surface. In withdrawing them, it is advisable to give them a movement of rotation, and at the same time to press upon the skin surrounding them with the thumb and index finger. In the hospitals of St. Louis, La Pitie, and Hotel Dieu, of Paris, acupuncturation was practised some thousands of times, and in every case, according to Guersent, without the occurrence of any thing unpleasant. Pelletan, however, affirms, that he saw it on four occasions followed by slight faintness at the hospital St. Louis, but none of the cases assumed the characters of full syn- cope. Gaultier de Claubry has frequently seen faintness, febrile movements, spasm, and insupportable pain produced by it, and Heyfelder saw it followed by convulsions and fainting. Beclard has related a case where the needle penetrated to the bone, and occasioned intense pain. The patient remained a long time faint, and afterwards violent delirium ensued, which gradually ceased in the course of the day, and was followed by great de- bility. Subsequently, an abscess formed in the part on which the operation was practised. As to the modus operandi of acupuncturation, we cannot con- ceive its effects to be any thing more than a new nervous im- pression, produced by the needle in the parts which it penetrates. The needles having been found oxidized, especially at the point, it has been supposed by some, that the oxidation is connected with the remedial agency, and it has been even affirmed, that in some diseases they oxidize more readily than in others.* It is a suffi- cient reply to this view, that beneficial results are obtained from the use of needles made of metals that do not become oxidized, and that the steel needles oxidize in the sound, as well as in the diseased body, and even in parts that have been removed from the body, and placed in warm water ; for in the cold dead body, it is affirmed, the phenomenon is not observed. Cloquet and Pelle- tan think, from their experiments, that the effects of acupunctura- tion are a consequence of the development of the nervous fluid — which they liken to the galvanic — around the needles ; a view Avhich is denied by Pouillet and Beclard, but adopted in a modi- fied form by Dr. Bache,fwho throws out the conjecture, " that in many cases of local pain this accumulation of the nervous (elec- trical) fluid depends upon the altered state of the various fasciee or condensed sheets of tissue, giving them the power, to a certain extent, of insulating the parts which they serve to embrace." The explanation is ingenious, but we do not think it necessary, if ade- * Grafe, loc. cit. S. 319. f Op. citat. 305. 5 .50 ACUPUNCTURA. quate, to explain the phenomena. We have.no doubt, that the effects are owing to a concentration of the nervous power towards the part transfixed by the needle, so that a derivation of the nervous influx is induced towards the seat of pain, or towards the nerves particularly concerned in the production of the pain ; but farther than this we know not. There is one phenomenon, by the way, which is dependent on the oxidation of the needle. When the free extremity of an in- serted needle is connected with the ground by means of a con- ducting substance, or is put in connexion with a soft part of the patient's body, it becomes the seat of a galvanic current, which is exhibited by the multiplier of Schweiger. That this pheno- menon is dependent upon the oxidation of the metal is proved by the circumstance, that it does not take place when an un- oxidizable metal is employed.* Acupuncturation has been used by Berliozf in gouty and rheumatic cases ; by Haime in rheumatic, spasmodic, and con- vulsive affections, and by Demours in amaurosis, and ophthal- mia, the needles being inserted in the temples ; Finch advised it in anasarca practised on the feet ; he also discharged, in this way, the fluid of ascites.% Pipelet§ employed it advantage- ously in a violent convulsive affection. The needles did not remove or markedly diminish the symptoms, but they postponed their recurrence. Michaelis|| cured a case of rheumatism by it, but he did not find it so serviceable in oedema of the feet, as the fluid would not flow readily through the minute apertures. Friederich proposed, that in cases of asphyxia, when every other remedy had been employed unsuccessfully, the cavities of the heart should be penetrated by a needle to excite its contraction, and this plan was subsequently advised by Carraro,1T who found, from his experiments on cats, that they could in this way be re- suscitated after drowning, when every manifestation of vitality had ceased. His experiments, however, when repeated by Dr. E. J. Coxe,** of Philadelphia, were not found to succeed. J. Cloquet obtained the happiest results from acupuncturation in neuralgia, rheumatism, muscular contractions, spasms, pleu- rodyne, cephalalgia, ophthalmia, toothach, epilepsy, gout, gas- trodynia, contusions, lumbago, periodical cmiaurosis, diplopia, paralysis, &c. A case of neuralgia, after amputation, has been *Riecke, S. 16. fOp. citat. Paris, 1816. X Lond. Med. Repos. Mar. 1823. § Journal Complem. du Diet, des Sciences Medic, t. xvi. 1823. || Grafe und Walther's Journal, B. v. St. 3. TT Annal. univ. di Medicin, 1825. See, also, Provincial Med. and Surg. Journ., May 15, 1841. ** North. Araer. Med. and Surg. Journal, ii. 292* ACUrUNCTURA. 51 reported as cured by it.* The patient was attacked by ago- nizing pains, not only in the stump, but also in the opposite thigh, accompanied by convulsions and fainting. In this state, two needles were planted in the course of the sciatic nerve. These produced no effect, but as soon as the third was introduced, the patient exclaimed, " the doctor has struck the toe of my foot." The needle was then pressed still deeper, so as to pass through the nerve, when the pain immediately ceased. After the needles had remained in half an hour, they were removed, and the patient enjoyed a sound sleep and awoke free from pain. About twenty days afterwards, the pain recurred; the needles were again applied, and relief as instantaneously followed. Several cases of neuralgia removed by it have been published by Prof. Riberi, of Turin.f It is in rheumatic affections that its success has been most marked. Dr. ElliotsonJ cured 30 out of 42 cases by it in St. Thomas's hospital. In sciatica its efficacy has been evident.§ By Velpeau it has been proposed to cure aneurism by acu- puncturation. In performing some experiments on animals he found, that arteries punctured by the needle became the seat of a coagulum, and were ultimately obliterated. In 1830, he read a paper before the Acadhnie des Sciences, of Paris, proposing the operation in the cases in question. || He found in his experi- ments, that whenever the needle remained three days in the flesh, the transfixed artery was completely obliterated. M. Bonnet, Chirurgien-en-chef to the Hotel Dieu at Lyons,1F has affirmed, that he treated eleven cases of varicose veins by in- troducing pins through their cavities, and allowing them to re- main there some time. Nine of these cases were cured. The same treatment was applied to herniary sacs. He passed three or four pins through the herniary envelopes close to the inguinal ring, and in order that they might exert a certain degree of com- pression, as well as of irritation, on the sac, he twisted the points and heads upwards so as to give them a circular direction. The inflammation and pain usually commenced on the third or fourth day after the operation, and the pins were removed a few days afterwards. M. Bonnet had treated four cases of inguinal hernia by acupuncturation. In two, the hernia was small, and three weeks sufficed for the cure : the third was more troublesome. * Bulletino delle Scienze Medich. Ottobre, 1838, and Brit, and For. Med. Review, Jan. 1840, p. 252. f Medico-Chirurg. Rev. April, 1841, p. 501. I Art. Acupuncture, Cyclop. Pract. Med.; Lond. 1832. § Renton, in Edinb. Med. and Surg. Journ. for 1830, xxxiv. 100; and Dr. Graves, in Lond. Med. Gaz. July, 1831, and Lond. Med. and Surg. Journal, April, 1833. (| Lond. Med. Gaz., and Amer. Journal of Med. Scienc, Aug. 1831, p. 510. "IJ Bulletin General de Therapeuticjue, and Dunglison's American Medical Intelligencer, for Dec. 1, 1837, p. 317. OK ACTJPUNCTURA. Caution is of course requisite not to injure the spermatic cord. In a subsequent communication, M. Bonnet inculcates the ne- cessity of causing the obliteration of the veins in several places separated from each other by short spaces.* Of late, acupunctu ration has been revived! in the treatment of hydrocele by Mr. Lewis, Mr. King,J and others. It consists in carrying a common sewing needle — of the size used for sewing a button to a shirt — through the skin, the dartos and cremaster, into the bag containing the fluid, so that a drop of the fluid follows the instrument as it is withdrawn. It is executed in nearly the same manner as the ordinary method of tapping with a trocar, except that the needle, which should be oiled, cannot be plunged in so easily as that instrument. Mr. King suggests, that the needle should be fixed in a handle, by which means it can be made to enter with comparative facility. After the opera- tion, a compress, moistened with a discutient lotion, may be kept on the scrotum, and the patient may walk about or remain at rest, as may best suit him. The phenomena which present themselves in a few hours are as follows : — the swelling begins to be less circumscribed, and to lose its tenseness, and the cellu- lar tissue of the scrotum becomes gradually more and more infiltrated with the fluid, which before distended the tunica vaginalis, and which, in the space of from twenty-four to forty- eight hours, will, according to Mr. King, have entirely changed place. In five or six days, the infiltration disappears, and the patient is cured. Mr. Lewis first introduced the method as a palliative cure, but he has seen cases where a radical cure was effected by it.§ He considers the principle of puncturing with a fine pointed needle not only applicable to promote the absorption of the fluid in hydrocele, but in every case of encysted dropsy. || Reference has already been made to the use of acupuncturation in anasarca. The author has used it advantageously to drain off the fluid from the cellular membrane : in such cases larger needles are needed ; some prefer them to be of the size of an ordinary glover's needle, and of a triangular shape ; a puncture of this kind being less likely to close.1T * Archives Generates de Medecine, Mai, 1839. See, also, Mr. Dodd, in Medical Gazette, Dec. 20, 1839. f Mr. Travers, in Lond. Med. Gazette, Feb. 1 837, p. 737. Mr. Lewis, Ibid. Feb. 1837, p. 788. Mr. Robert Keate, Ibid. p. 789. % British Annals of Medicine, No. 1, p. 13. § Dr. Davidson, in Edinb. Med. and Surg. Journ. for Jan. 1838. || Lancet, May 7, 183G, and Jan. 14, 1837. See a case of Ovarian Dropsy, in which it was employed by Dr. Robert D. Thomson, in Lancet, May 25, 1839, p. 344; and one of Ascites by Mr. Campbell, Lond. Med. Gaz., Nor. 1838. H" Dr. Graves, Lond. Med. Gazette, Oct. 1838. See, also, Mr. King, Ibid. Oct. 7, 1837, and Nov. 25, 1837. 2ETHER HYDROCYANICUS. 53 In the mass of cases, it need scarcely be said, this course can act merely in a palliative manner, — the cause of the dropsical accumulation persisting. Still, as Dr. Graves has remarked, under favourable circumstances, and in a good constitution, the simple operation of evacuating the fluid, by punctures made through the skin, has been, of itself, sufficient to effect a cure. In a lady, under his care, general anasarca came on after fever, and resisted every form of treatment he could devise. When he had made many fruitless attempts to produce absorption by means of internal remedies, another practitioner was called in, who practised acupuncturation of the lower extremities, and succeeded completely. Lastly, Mr. Vowell* has published a case in which acupunc- turation was successfully employed for the removal of a ganglion. A young lady under his care had been affected with a ganglion of a considerable size on the extensor tendons of the foot, which produced not only disfiguration, but some uneasiness. Mr. Vowell applied blisters, and afterwards iodine ointment and pressure, for above a month, without benefit. He then inserted the tambour porte-aiguille of his patient. Pressure was applied, and within a week the tumour had completely disappeared. When acupuncturation is conjoined with electricity or galva- nism, it constitutes eZectro-puncture,&ndgalvano-puncture. (q. v.) VII. AETHER HYDROCYAN'ICUS. Synonymes. iEther Prussicus, Hydrocyanic, or Prussio Ether. German. Cyanather. This preparation was discovered some years ago by Pelouze,t and, according to Magendie, % it resembles in its effects hydro- cyanic acid, without being so violent a poison, and, consequently, he esteems it worthy of regard as an addition to the materia medica. MODE OF PREPARING. Equal parts of sulpho-vinate of baryta and cyanuret of potas- sium are mixed intimately together, put into a glass retort, to * Lancet, Aug. 25, 1838, p. 770. f Journal de Pharmaoie, xx. 399. Paris, 1833. X Formulaire — d emigre Edition. 5* 54 JETHER HYDROCYANICUS. which a tubulated receiver is adapted, and exposed to a moderate temperature. By distillation, a colourless, or slightly yellowish fluid is obtained, which separates into two distinct strata. The lighter consists chiefly of hydrocyanic ether, which is not pure however, but mixed with water, alcohol, sulphuric ether, and hydrocyanic acid. In order to purify it, it must be strongly shaken, and, with four or five times its bulk of water, must be exposed for some time to a temperature of 60° or 70° centigrade ; it must be again agitated with a little water, decanted, suffered to remain in contact with chlorinated lime for twenty-four hours, and then distilled. The ether thus obtained is pure. It is a colourless fluid, of a penetrating, disagreeable garlicky odour. Specific gravity 0.7S. It boils at 82° centigrade ; is very slightly soluble in water, but soluble in every proportion in alcohol and sulphuric ether. In its pure state, it does not disturb a solution of nitrate of silver. It inflames very readily, and burns with a blue light. Potassa decomposes it with difficulty, and only when highly con- centrated. EFFECTS ON THE ECONOMY. Six drops of this ether placed in the throat of a dog, occasioned, in a short time, deep respiratory efforts : the dog fell on its side, and convulsions succeeded, with considerable motion ofthe paws. This condition continued for four minutes, after which the effects gradually disappeared, and in the course of half an hour passed away. Six drops injected into the jugular vein rapidly caused death, with symptoms similar to those induced by hydrocyanic acid. According to Magendie, these experiments were frequently repeated by him with different modifications, after which he ven- tured upon its administration in disease. He added six drops of the ether to a mucilaginous linctus, and prescribed it to a patient labouring under hooping-cough, who, in the course of a few days, derived signal benefit from it, and without complaining of its pene- trating, disagreeable odour. The same good effects happened to several patients to whom he gave it in the Hotel Dieu. But although the results were favourable in cases in which the hydro- cyanic acid was indicated, he found it often necessary to discon- tinue its use, on account of the invincible nausea which its smell induced. Magendie advises it in those diseases in which mix- tures of hydrocyanic acid have been found of service. ALUMINA SALES. 55 VIII. ALU'MINiE SALES. Synonyme. Salts of Alumina. In making experiments on the agency of various substances as antiseptics, M. Gannal* found, that the aluminous salts are alone possessed of the property of preserving animal mat- ters, — "their bases combining with geline to form a special compound, the acid being set free." He found the alumi- nous deliquescent salts to be, of all saline substances, those that afford the most satisfactory results. The acetate of alu- mina and chloride of aluminum succeeded perfectly. A mix- ture of equal parts of chloride of aluminum at 20° Beaume (s. g. 1.161), and of the acetate of alumina at 10° (s. g. 1.075), proved as good an injection as we possess for the preservation of dead bodies. The preservation of animal substances appears to depend upon the combination of geline with alumina ; but the acid sulphate does not possess enough of the preservative element ; and hence M. Gannal was driven to the employment of the salts of alu- mina, that are richer in alumina, and more soluble in water. Of all these, the sulphate of alumina was found to merit the preference, owing to its being of simple preparation and mode- rate price.t It may be made by the direct combination of alu- mina and sulphuric acid ; and contains 30 per cent, of the former to 70 per cent, of the latter. A kilogramme — about two pounds, eight ounces, and a dram and a half troy — dis- solved in two quarts of water, and costing twenty cents, M. Gannal found to be sufficient, in winter, to preserve a body fresh by injection for three months. To preserve it for a month or six weeks, it was not even necessary to inject the blood-ves- sels, — an enema of one quart, and the same quantity injected into the oesophagus being sufficient for the purpose. In hot weather, the solution must be stronger, or in greater quantity, and it should be injected into the carotids. The acetate of alumina, of which M. Gannal made use, was prepared by the addition of acetate of lead to sulphate of alu- mina and potassa. The acetate of alumina, thus prepared, at 18° of Beaume's areometer, and in the quantity of five or six quarts, was sufficient to preserve a body for five or six months. This salt of alumina is, however, too costly ; and, therefore, can- * History of Embalming, &o., by J. N. Gannal, Paris, 1838, translated by R. Harlan, M.D., p. 203. Philad. 1840. t Ibid. p. 233. 56 ALUMINJE SALES. not be employed in amphitheatres, where large quantities are required. In the report on M. Gannal's memoir presented to the Insti- tute of France, the commission adduce, in favour of his plan, the experience of MM. Serres, Dubreuil, Bourgery, Azous, Velpeau, and Amussat. " In the month of June, 1836," says M. Serres, " in the am- phitheatre of the hospital, the body of a man, 22 years of age, was injected. Left to the open air, in a room exposed to the south, and upon a wooden table, it was preserved until the month of September, and was ultimately mummified. In the month of July, eight bodies were injected for dissection, and kept fifteen days. During the months of August and Septem- ber, sixty subjects were injected. They were kept for twenty days." From these experiments, M. Serres concludes, that the liquid furnished by M. Gannal, permits the dissection of bodies during summer, which had not been practicable in the anatomi- cal schools of the hospitals of Paris ; and that it gave to the in- struction in operative medicine a development, which it had not previously enjoyed ; for, during the months of August and Sep- tember,they were enabled to have thirty bodies at a time on the tables, as in the middle of winter, so as to enable them to repeat before the students all the operations required in a regular course of operative surgery. For his discovery the Institute of France awarded M. Gannal the grand Monthyon prize of 1600 dollars, established for the discovery of any means calculated to remedy the unwholesome- ness of any art or profession. A useful application of M. Gannal's process is said to have been made by the police of Paris, in preserving bodies for many weeks in the Morgue or dead-house, where suspicions of murder required an unusual retention of the body above ground.* The specimens of pathological anatomy, preserved in the liquid of the injection, were not exempt, according to Dr. Harlan, from the usual inconvenience attached to similar preparations in a solution of chloride of sodium and other salts, being equally liable to incrustations, so as to require a change or renewal of the solution. The salts of alumina have been used in this city with the view of temporarily preserving the dead ; and a case has been pub- lished recently, in which the acetate was employed ; but the cor- rosive chloride of mercury was used along with it, which was altogether unnecessary. In the afternoon of the day on which the individual died, the abdominal aorta was injected upwards and downwards with a saturated solution of corrosive chloride * Harlan, Appendix to Gannal, op. cit., p. 254. ANTHRAKOKALI. 57 in alcohol ; and on the following day, a saturated solution of acetate of alumina was thrown in, " which," says Dr. Sharpless,* " had the immediate effect of giving the whole body a manifest rose colour, making it resemble life in a remarkable degree." The salts of alumina have been chiefly employed to prevent putrefaction in the dead body ; but they might, doubtless, be used with eminent advantage as external applications in cases that require the topical use of antiseptics. IX. ANTHRAKO'KALI.t This article was first proposed by Dr. Polya, of Pesth, in the year 1837. MODE OF PREPARING. Two forms are employed, the simple and the sulphuretted. The former is prepared by dissolving carbonate of potassa in 10 or 12 parts of boiling water, and adding as much slaked lime as will separate the potassa. The solution thus obtained con- tains only caustic potassa. The filtered liquor is placed on the fire in an iron vessel, and suffered to evaporate until neither froth nor effervescence occurs, and the liquid presents a smooth surface like oil. To this is added the levigated coal in the pro- portion of 160 parts to 192 parts of potassa. The mixture is stirred and removed from the fire, and the stirring is continued until a black homogeneous powder results. This powder is kept in a dry place. To obtain the sulphuretted antiirakokali, 16 parts of sul- phur must be mixed accurately with the coal, and the mixture be dissolved in the potassa as directed above. EFFECTS ON TIIE ECONOMY IN DISEASE. M. Polya affirms, that Anthrakokali exerts its influence on the skin generally, and especially on chronic cutaneous affections. It has also been given beneficially in scrofula and chronic rheu- matism. * Medical Examiner, Au M. D ose . — a table-spoonful night and morning. Magendie. 10* 114 CAINCiE RADIX. XXXVIII. CAIN'C^E RADIX. Synonymes. Rad. Chiococca, R. Cainanae, R. Caninana?, R. Cahincffi, R. Kahincaj, R. Serpentarise Braziliensis ; Cainca Root. Portuguese. Raiz Crusadinha, R. Preta. German. Caincawurzel. The plant, which furnishes the root introduced into Europe of late years, and which has since become known as a remedial agent, is Chiococca anguifuga, of the Family Rubiaceas, Sexual System, Pentandria JMonogynia.* The shrub grows wild in the forest of Brazil, especially in the province of Minas Geraes, and the root is used there against the bites of serpents. This root is of the thickness of the finger, round, and knotty ; the surface smooth or irregularly wrinkled ; the wood tough and of a whitish colour ; the smell disagreeable, especially that of the fresh root ; and the taste at first like that of coffee, but after- wards nauseous and pungent. The bark of the root alone pos- sesses efficacy, the woody portion having no action. The bark separates readily from the wood ; it is thicker on the root itself than on its branches ; and, on the outside, is of an amber, or brownish yellow green colour ; yellower and brighter on the youngest parts ; the epidermis is not easily separated. Accord- ing to the chemical investigations of Pelletier and Caventou,f the following are found to be the constituents of the bark : — 1. A bitter principle, crystallisable in small, white, silky, shining needles; inodorous, and very soluble in hot alcohol, which com- municates to the whole plant a degree of astringent bitterness, and at the same time has an acid reaction on litmus paper. In order to separate this acid, which has been termed by those che- mists Acidum cahincicum, in a pure state, the alcoholic extract of the root must be dissolved in water, filtered, and precipitated by lime, until the fluid loses all bitterness ; the precipitate is then decomposed by oxalic acid, and boiling alcohol ; or the acetic, or muriatic acid may be dropped into an aqueous decoction of the bark of the root, and, in the course of a few days, the acidum cahincicum will separate in the form of small crystals. With cahincic acid, prepared in this way, however, some colouring matter is still united. 2. A fatty, green, nauseous smelling sub- stance, which communicates to the plant its smell. 3. Yellow colouring matter; and 4. A viscid colouring matter. J * Art. Chiococca, in Encyclopad. Worterb. vii. 521. Berl. 1831, and Von Martius, Spec. Mat. Med. Brasil, i. 18. { Journal General de Medecine, Mai, 1830, and Phil. Journ. of Pharmacy, iii. 165. Philad. 1831. % Journal de Pharmacie, xvi. 465. CAINCffl RADIX. H5 EFFECTS ON THE ECONOMY. The effect of cainca root seems to be especially exerted on the digestive and urinary organs. It occasions watery evacuations, and diuresis. From the experiments, however, of Albers,* made on a great number of dropsical patients, in the Charite at Berlin, he was induced to deny its diuretic powers, and to place it amongst the drastic purgatives, by the side of helleborus niger. Wolff was of the same opinion. According to Von Langsdorff,! it is a highly efficacious emmenagogue, possessing also — to use his own language — considerable resolvent virtues, and hence employed in dropsies, that are connected with obstructions in the abdomen. Riecke,i asserts, that he had occasion to employ it in two cases of ascites complicated with induration of the liver. He had no expectation of effecting a radical cure, but it afforded no palliation ; diuresis was not excited, whilst nausea, colic, and diarrhoea supervened, so that he discontinued it : he gave it in decoction. Others have observed the same inconve- nience from its use, or have found it wholly ineffectual ; for ex- ample, B. Heyfelder, Reinhardt, Bartels,§ and others. Riecke suggests the possibility, in these cases, of adulteration of the drug. On the other hand, cainca has been highly extolled by Frangois, Ribes, Wagner, Solieer, Lowenstein,|| &c, but particu- larly by Von Langsdorff. The main diseases in which cainca is recommended, are, 1. Dropsies, in which many favourable trials have been made by Von Langsdorff, Spitta,1T Guddoy, Engler, Frangois, Wagner, Solieer, Robredo,** &c. 2. Intestinal worms, against which it appears to act like other drastics. 3. Obstructed menstruation : on this subject, however, farther trials are needed. When it operates as an emmenagogue it is probably altogether like cathartics that act more especially on the lower part of the bowels, that is, by contiguous sympathy. 4. M. Francois has recommended it highly in catarrhus vesicae, but the experience of others has not confirmed this.tt It may be mentioned, that in its native country it is used for rheumatic pains ; in a peculiar * Medicin. Zeitung. No. iv. Sept. 1832. f Hecker's Litter. Annal. B. iv. S. 395, and Rust's Repertorium, B. xiv. S. 458. \ Die neuern Arzneimittel, u. s. w. S. 84. Stuttgart, 1837. § Grafe und Walther's Journal der Chirurgie, u. s. w. xxiv. S. 470. Ber- lin, 1836. || De radice Cainca ejusque in morbis hydropicis virtute. Berol. 1828. •[[ Hecker's Litterar. Annal. iv. 396. ♦♦Journal de la Academia do Medicina de Megico. Oct. 1836, and Brit, and For. Med. Review, p. 562, Apl. 1838. ft Bulletin General de Therapeutique, No. 13, Juillet, 1837. 116 CAINCA RADIX. kind of pica experienced by the negroes of South America ; and, as already remarked, against the bites of serpents. MODE OF ADMINISTERING. Cainca is given in various forms — powder, infusion, and decoction ; and, besides these, a tincture and an extract have been made of it. A syrup and a wine have also been re- commended. To form the latter, one ounce of the powdered root is infused in a pint of ivine ; the tincture is made with one part of the root and eight parts of alcohol at 20°. The alco- holic extract is considered to be the most uniform in strength, and has, therefore, been preferred by many. The syrup is formed by dissolving 5iiss. of the extract in a little alcohol, mixing this with a pint of hot simple syrup, and allowing it to boil for some time, in order that the alcohol may evaporate. The dose of the powder is from di. to 3SS. in the twenty-four hours. It appears, however, to be the most objectionable form, and to give rise to unfavourable symptoms more frequently than the others. Opinions vary as to whether the infusion or the decoction should be preferred. According to Caventou and Pelletier, boiling extracts very well the efficacious parts of the root, and there are cases in which the decoction has rendered essential service after the infusion had been administered without success. Of the decoction, from f.3j. to f.3uj. are given in the day. Of the extract, the dose, in the twenty-four hours, is from twenty to thirty grains; of the tincture f.3j. to f^ij.* The decoction, used by Spitta and others, was made as fol- lows : Decoctum radicis caincae. Decoction of cainca root. R. Rad. caincee, Jij- Coque cum aquae Oiss. ad dimidiam partem, et cola. Dose. — A table-spoonful three times a day. Von Langsdorff.\ By others, the following form has been employed: R. Rad. cainc. 5J. Aquae, Oij. Coque ad dimidiam partem et cola. Dose. — Two table-spoonfuls three or four times a day. Engler. * Journal de Chimie Medicale, Mai, 239-242. Paris, 1827. t Hufeland und Osann's Journ. B. lxii. St. 2. CALENDULA OFFICINALIS. 117 Dr. John H. Griscom,* of New York, considers there is a re- markable analogy between cainca and apocynum cannabinum. The Acidum cahincicum, described above, is said to possess tonic, cathartic and diuretic powers, and has been used success- fully in some cases by Frangois, in the dose of six grains gradu- ally increased to fifteen. XXXIX. CALEN'DULA OFFICINALIS. Synonymes. Calendula Sativa, Caltha Sativa, Verrucaria, Chrysanthemum, Sponsa Solis, Single Mangold, Garden Marigold. French. Souci, S. Ordinaire. German. Ringelblume. This plant belongs to Family Synanthereas, Sexual System, Syngenesia Necessaria. It is much cultivated in the gardens of southern Europe more especially, and grows wild there. The whole plant has a feeble aromatic smell, which is not, however, unpleasant. The taste is bitter and somewhat pungent. It was examined chemically by Geiger and Stoltze,t who found in it a peculiar glutinous matter, readily soluble in alcohol, insoluble in ether, and in ethereal or volatile oils, and but little soluble in water : to this they gave the name calendulin. EFFECTS ON THE ECONOMY. The term officinalis indicates, that the calendula was formerly received into the lists of the Materia Medica as an " officinal ;" but it had become entirely obsolete when Westring,J a Swedish physician, in 1817, recalled attention to it. He recommended it particularly in cases of cancer of the breast and uterus, having noticed its good effects by accident. Visiting an aged female, who had suffered, for a long time, under an extremely painful * Amer. Journal of the Medical Sciences, for May, 1833, p. 55. f Berlin. .Tahrb. d. Pharmac. li. xxi. S. 282. % Erfahrung iiber die Heilung der Krebsgeschwiire, u. s. w. Translated from the Swedish into German by K. Sprengel. Hal. 1817. IIS CALENDULA OFFICINALIS. induration of one mamma, he found she was able to allay the burning pain by the application of the fresh plant. This induced him to try it in several cases of cancer, and from the results he was led to infer, that it is perhaps the best agent that can be employed in that frightful malady. He never, however, em- ployed it alone, but associated with it other active remedies, so that but little attention was paid to his recommendation; — a great portion of the efficacy of the agents employed, being — it was thought probable — ascribable to the associated articles. Some time after Westring's publication, the remedy was used by others, when his observations were confirmed. Rudolph* employed it with advantage internally, in a case of induration of the mammse in a young female ; but the acetate of iron was at the same time applied externally in solution. Fehrt found it highly useful not only in incipient, but in advanced scirrhus. Stein praises it in cancer of the integuments (hautkrebs). He forms the expressed juice of the young plant and flowers into an ointment with fresh butter, and applies it once or twice a day by means of lint, having previously washed the ulcers with a decoction of the plant. Internally, the calendula is prescribed in the form of decoction, made with milk or water, or of a mel- lago prepared from the fresh juice, dissolved in an aromatic water ; or made into pills. When the salve is applied, a sense of burning arises, which speedily becomes absolute pain. This soon, however, abates ; and almost wholly disappears ; and if it be too violent, more butter may be added ; the ichorous discharge becomes improved ; the offensive odour corrected, and in from fourteen to twenty-one days, the ulcer is converted into one of a benign and readily cicatrisable character. Rust, also, frequently administered the extractum calendulas in cancerous ulcers and as a discutient in chronic indurations, in combination, however, with other efficacious agents. Schnei- der affirms, that he prescribed the extract with the best effects in induration of the stomach, and in tumefaction and decided induration of the glands and uterus. A decoction of the flow- ers and plant, he employed in cancer of the uterus, and found it an excellent soothing, and discutient agent. Muhrbeckf used the extract with eminent success in chronic vomiting ; Carter§ * Hufeland und Osann's Jour, der prakt. Heilk. B. Iviii. St. 1. S. 119. f Verhandlungen der verein. arztlich. Gesellschaft. der Schweiz. Jahrg. 1831, and Dierbach, in Heidelberger Annalen, B. x. H. 4. S. 501. Heidel- berg, 1834. X Hufeland's Journal der prakt. Heilk. B. lxii. St. 5. S. 128. Rust's Ma- gazin. der gesammt. Heilk. B. xi. S. 350. § London Med. Rep. April, 1826, p. 347. See, also, Link and Osann, in art. Calendula in Encyc. Wbrterb. u. s. w. B. vi. S. 520. Berl. 1831. CALENDULA OFFICINALIS. 119 in extremely obstinate vomiting ; and De Camp in a case of cardialgia, where the excitability of the stomach was so great, that every remedial agent was rejected before it had opportunity to act. Fehr also extols it as an emmenagogue, for which pro- perty it was celebrated with the older physicians ; but as Riecke* has remarked, the amount of experience with calendula is yet small — too small for us to pronounce whether it merit a fixed place in the lists of the materia medica. MODE OF ADMINISTERING. The extractum calendulas is contained in the Hanoverian and Saxon Pharmacopoeias ; in the latter it is directed to be pre- pared in the following manner : — R. Calendul. officinal, part j. Aquas, part. viij. Macerate for twenty -four hours ; then boil for a quarter of an hour, and strain forcibly ; boil the remainder with four parts of water ; mix the two liquors, and, after twenty-four hours' rest, evaporate to the proper consistence.-}- The dose of the extract is different according to different ob- servers. Muhrbeck gave four grains, five times a day. Fehr allows, jij. to sjvj. Phobus directs the dose of the extract, pre- pared according to the Prussian Pharmacopoeia, to be from eight to sixteen grains, gradually increasing it to gss. and more, from two to four times a day. It may be given either in the form of pill or mixture. Externally, the extract is used in solution, to moisten the dressings of ulcers, and to form ointments. The dose of the decoction of the fresh plant is f.gj. to f.gij. The Sardinian Pharmacopoeia has a Conserv a florum calen- y adding ten parts of water, to one part of the chlorinated lime divided in a mortar; suffering the solution to settle, and then filtering. 132 CALX CHLORINATA. Collyrium calcis chlorinate. Colly rium of chlorinated lime. R. Calcis chlorin. gr. iv. ad vj. Vin. opii, rr\,x. Mucilag. acac. f.Jiss. Aq. rosse, f.gij. M. et filtra. To be dropped in the eye in cases of catarrhal and scrophu- lous ophthalmia. Farvagnie. Injectio calcis chlorinate composita. Compound injection of chlorinated lime. R. Calcis chlorinat. Jij. Decoct, kramer. f.3xiij. M. Half an ounce of this to be injected into the nose three or four times a day in cases of ozsena. Detmold (of Hanover). Cataplasma calcis chlorinate. Cataplasm of chlorinated lime. R. Calcis chlorin. Sodii chlorid. aa. sss. Aquae destill. Oss. Farinse sem. lin. q. s. ut fiat cataplasma. Used in cases of scrophulous swelling of the joints. Grdfe. Unguentum calcis chlorinate. Ointment of chlorinated lime. R. Calcis chlorin. 3j. Adipis, 5j. M. fiat unguentum. To be rubbed in, in cases of scrophulous swellings. Cima. R. Calcis chlorin. 3ss. Adipis, §j. M. f. unguent. Used in goitre. Werneck. CANNABIS INDICA. 133 R. Adipis, §j. Sodse borat. Calcis chlorin. aa. 3j. M. exactissime. In cases of chilblains. Trusen. R. Sulphuris, ^iss. Calcis chlorin. bene, tritur. §ij. Adipis, gx. M. In itch, morning and evening. Hospital. linimentum calcis chlorinate. Liniment of chlorinated lime. R. Calcis chlorin. ^ss. Tere in mortario vitreo et sensim affunde Aq. rosse, (sea fontanae,) f.^j. Et post, limpid, clarificat. admisce 01. amygd. f.^j. To be applied by means of a pencil in cases of tinea capitis. Trusen. XLI. CAN'NABIS IN'DICA. Synonymes. Indian Hemp, Gunjah. Dr. Pereira* states, that the Cannabis, which grows in India aid has been described by some botanists under the name Can- nabis Indica, does not appear to him to possess any specific dif- ferences from the common hemp, Cannabis sativa ; and ac- cordingly, by many botanists, they have been regarded as d ntical. The narcotic effects have been long known to the people of Southern Africa, South America, Turkey, Egypt, Asia Minor, India, and the adjacent countries of the Malays, Burmese, and Siamese, by whom it is used in various forms to induce intoxi- cation. It is, likewise, extensively employed in popular prac- tice in various diseases. In Western Europe its use is unknown, and it is questionable, whether the hemp of that region or of * Elements of Materia Medica, 2d edit. p. 1096. Lond. 1842. 134 CANNABIS INDICA. this country be possessed of the same properties. Dr. O'Shaugh- nessy states, that me extraordinary symptoms produced by the oriental plant depend upon a resinous secretion with which it abounds, and which seems to be wholly absent in the European plant. The absence of the resinous secretion, and consequent want of narcotic power, he ascribes to difference of climate. Within the last few years, Dr. O'Shaughnessy, of Calcutta,* has detailed many interesting facts in regard to the therapeutic agency of this plant, which, " we doubt not" — says a recent writer! — " will cause a great sensation among the members of the profession throughout the world." In certain seasons, and in warm countries, a resinous juice exudes, and concretes on the leaves, slender stems and flowers of the Cannabis. This constitutes the churrus of Nipal and Hindusthan, and in it reside the powers of all the preparations of hemp. This resin — cannabin — is very soluble in alcohol and ether; partially soluble in alkaline, but insoluble in acid, solutions. When pure, it is of a blackish-grey colour ; it is hard at 90° of Fahrenheit, but softens at higher temperatures, and fuses readily. It is soluble in the fixed, and in several volatile oils. Its odour is fragrant and narcotic ; taste slightly warm, bitterish and acrid. The dried hemp plant, which has flowered, and from which the resin has not been removed, is called Gunjah. It yields to alco- hol twenty per cent, of resinous extract, composed of the resin — chw*rus — and green colouring matter. The Gunjah is used for smoking. The larger leaves and capsules, without the stalks, constitute Sidhee, Subjee, or Bang, which is used to form with water an intoxicating drink. When the plant is distilled with a large quantity of water, traces of volatile oil pass over, and the distilled liquor has the powerful narcotic odour of the plant. EFFECTS ON THE ECONOMY IN HEALTH. The effects of this remedy would appear to have been well known to the Arabian and Persian physicians of both modern and ancient periods ; but the first person, who seems to have well tested its properties is Dr. O'Shaughnessy. In his various experiments, he did not observe the least indication of pain, or any degree of convulsive movement. They all, he affirms, " led to one remarkable result, — that while carnivorous animals and fish, dogs, cats, swine, vultures, crows, and adjutants invariably and speedily exhibited the intoxicating influence of the drug, the * On the Preparations of Indian Hemp, or Gunjah {Cannabis Indica), &c, Cal- cutta, 1839 ; and Brit, and For. Med. Rev. July, 1840, p. 224. | Brit, and For. Med. Rev. loc. cit. CANNABIS INDICA. 135 graminivorous, — such as the horse, deer, monkey, goat, sheep, and cow, — experienced but trivial effects from any dose that was ad- ministered." Encouraged by these results, Dr. O'Shaughnessy felt no hesitation as to the perfect safety of giving the resin of hemp an extensive trial in cases in which its apparent powers promised the greatest degree of utility. The general effects observed on man were alleviation of pain in most cases, remarkable augmentation of the appetite, aphro- disia, and great mental cheerfulness. The more violent effects were a peculiar form of delirium, and a cataleptic state. Dr. Pereira* experimented on some specimens of Gunjah and Nipalese churrus, which were sent to him by Dr. O'Shaughnessy. He tried them both on animals and man, and gave specimens of them to medical friends ; but their effects were found to be comparatively slight. " Whether," — says Dr. Pereira, — " this be owing to the preparations having undergone some deteriora- tion in their passage, or to the comparative phlegmatic tempera- ment of the English, I know not. My experiments on animals were made in the Lecture-room of the London Hospital before the students of the Materia Medica class ; and the trials on the human subject were made in the wards of the hospital." EFFECTS ON THE ECONOMY IN DISEASE. Indian hemp was prescribed by Dr. O'Shaughnessy in various diseases. In rheumatism, acute and chronic, the results were not very satisfactory. In one case, the most marked catalepsy supervened along with the usual intoxicating effects. In a case of hydrophobia, the soothing influence of the remedy was very great ; but the disease terminated fatally. In cholera, he con- sidered its agency to be " promising, and to deserve the attention of the practitioner." The testimony is strongest in regard to its influence in traumatic tetanus ; of which Dr. O'Shaughnessy refers to fourteen cases : of these, nine appear to have recovered. From the results of these cases, he concludes, that the resin of hemp, given boldly and in large doses, is capable of arresting effectually the progress of that formidable disease, "and in a large proportion of cases, of effecting a perfect cure ;" — and further ; "that in hemp the profession has gained an anticonvulsive remedy of the greatest value." With such strong evidence in its favour, it is certainly im- portant, that Indian hemp should be subjected to a full and fair trial ; and even admitting that it may fall short of the character given of it by Dr. O'Shaughnessy, it can scarcely fail to be an important addition to our Materia Medica. * Elements of Mat. Med. 2d edit. ii. 1098. Lond. 1842. CARBO ANIMALIS. MODE OF ADMINISTERING. The preparations used by Dr. O'Shaughnessy are the fol- lowing: — Extractum cannabis Indicse alcoholicnm. Resinous or alcoholic extract of Indian hemp. This is prepared by boiling the rich adhesive tops of the dried Gunjah in alcohol (.835) until all the resin is dissolved. The tincture, thus obtained, is evaporated to dryness in a vessel placed over a pot of boiling water. In hydrophobia, the resin in soft pill, to the amount of ten to twenty grains, is directed to be chewed by the patient, and to be repeated according to the effect. Tinctnra cannabis Indies. Tincture of Indian hemp. R. Extract, cannab. indie, alcohol, gr. xxiv. Alcohol, dilut. f.5j. Of this a dram is given in tetanus every half hour, until the paroxysms cease, or catalepsy is induced. In cholera, ten drops given every half hour were often found to check the vomiting and purging, and bring back warmth to the surface. Dr. O'Shaughnessy's experience leads him to prefer small doses of the remedy in order to excite rather than narcotize the patient. XLIL CARBO ANIMA'LIS. Synonymes. Carbo Carnis, Animal Charcoal. French. Charbon animal. German. Thierische Kohle ; Fleischkohle, Thierkohle. Animal charcoal is an ancient remedy, which has been revived amongst us. The older physicians used several kinds, and re- commended them in various diseases, but without having any fixed principle ; the circumstances, indeed, that suggested their CARBO ANIMALIS. 137 exhibition in many cases, are entirely unintelligible to us of the present day. In the old Wirtemberg Pharmacopoeia, we find the Erinaceus combustus, or "burnt hedgehog," as an antihydro- pic; the Sericum tostum, or "burnt silk," and the Hirundines combustse, or "burnt swallows," as antiepileptics ; the Lepus combustus, or " burnt hare," as an antilithic ; the Reguli usti, or " burnt wrens," advised in nephritis and in calculous affections ; and the Talpgs combustse, or " burnt moles," at one time much extolled in erratic gout, lepra, scroplmla, ulcers and fistulas ! All have properly fallen, however, into oblivion with the profession, although there may yet be some, who cling with pertinacity to these relics of ancient ignorance and superstition. The " cancer remedy" of Cosme, into the composition of which burnt shoe- soles entered, appears to have kept up the employment of ani- mal charcoal ; as well as the " burnt sponge," Spongia usta, in which, however, the charcoal is of but little efficacy compared with the iodine it contains. These were perhaps the only forms in which animal charcoal was used at the time when Weise, a German physician, revived its employment ; and many physi- cians soon came forward to attest favourably in regard to it. METHOD OF PREPARING. Weise gives the following method of preparing it : — Cut ribs of veal, with the flesh attached, into small pieces, and put them into a drum for roasting coffee, — turning the drum constantly whilst it is placed over the fire. When inflammable air begins to pass off, which is distinguished by the flame playing around the drum, the combustion must still be kept up a quarter of an hour longer. If it be continued so long as any inflammable air is disengaged, the preparation is inefficacious. The substance, most commonly met with under the name of "animal charcoal," is obtained by burning bones. The residue, when reduced to powder, is the well known substance bone black, ox ivory black. This generally contains more or less phosphate of lime accord- ing to the kind of bone from which it has been procured. It is directed in the London Pharmacopoeia and in the last edition of the Pharmacopoeia of the United States (1842), to be purified by digestion in dilute muriatic acid, as follows : Take of animal charcoal, a pound ; muriatic acid and water, each twelve fluid ounces. Mix the muriatic acid with the water, and gradually pour it upon the charcoal ; then digest for two days in a gentle heat, occasionally agitating. Set aside, and pour off the super- natant liquor, then wash the charcoal with repeated portions of water, till no traces of acid are perceptible ; lastly, dry it. Charcoal, prepared in this way, should be a combination of car-* 12* 138 CARBO ANIMALIS. bon, carbonate and phosphate of lime, hydrogen, and azote. From an analysis, which Meurer made of animal charcoal, pre- pared according to Weise's formula, it contains, also, chloride of sodium and a little carbonate of soda, as well as a portion of iron. EFFECTS ON THE ECONOMY. In the case of a young man of scrophulous diathesis, Weise saw a tumour, of the size of a hazelnut, and very painful, situate under the nipple, disappear under the use of animal charcoal. According to him, its efficacy is strongly exerted on the uterus and mamma;. Rothamel and Hohnbauin extol it in dyspepsia and gastricism, as well as in cases of diarrhoea. In obstinate chronic glandular indurations, especially of the mammary glands, Weise affirms it to be a certain remedy : he, at the same time, however, considers a regulated diet to be indispensable. Scirrhus of the lips, he says, also disappears under its use, and even scirrhous goitre when the charcoal is associated with burnt sponge. On cartilaginous polypi, it is said to have exerted a beneficial agency, and to have diminished the tendency of mu- cous polypi to return after operation. Even open cancer, it is asserted, has been healed by it.* On these recommendations of Weise, animal charcoal has been used by several German phy- sicians, especially by Wagner, Kopp, Pitschaft, Radius, Rotha- mel, Hesselbach, Gumpert, Hohnbaum, Fricke, Michaelsen, and Siebenhaar ; and, as a general result of their observations, it would seem not to be devoid of therapeutical agency ; although many of the experimenters failed in noticing any sanative effect from it. Fricke, for example, did not observe the least benefit in the very cases mentioned by Weise. He gave it, also, in the way of experiment, in several other cases, but without detecting the slightest influence on the organism. Other physicians saw advantages from its use in open cancer, but these were only transient. On the other hand, the experience of Wagner, Kopp, Michaelsen, and Rothamel would seem to show, that it was effectual in removing incipient scirrhus of the mammae. Kopp employed it successfully in scirrhous goitre, and Pitschaft in a case of what he terms struma varicosa. Radius dispersed under its use a considerable swelling of the submaxillary glands. In scrophulous affections, especially in scrophulous indurations of the glands, it is said to have proved useful in the hands of Kopp, Rothamel, Speranza, Kuhn, and others, but Baudelocque did not find it to possess any therapeutical property .t Pitschaft, in a * Riecke, Die neuern Arzneimittel, u. s. w. S. 104. f Dubois (d' Amiens), Traite de Pathologie Generate, 2erae edit. p. 206. Bruxelles, 1835. C.ARBO ANIMALIS. 139 delicate, strumous woman, who was suffering constantly under ozsena, found it of eminent service after other remedies had failed. Radius thought it aided the absorption of a disintegrated cataract, and Siebenhaar saw good effects from it in induration of the jjancreas. Riecke* suggests, that farther trials may show, that it might be used in the place of iodine, which it appears to resemble in its action on the economy, whilst it affects the organism less in- juriously. It is extremely doubtful, however, whether the pro- perties of the two substances can be regarded as at all analo- gous, and whether animal charcoal be possessed of any other properties than those usually ascribed to prepared charcoal. MODE OF ADMINISTERING. Carbo animalis is given in doses of from half a grain to three grains twice a day, — commonly in the form of powder with sugar, or with powdered liquorice root. Weise advises it to be sprinkled on the hard edges of cancerous ulcers, and Speranza extols an ointment made of charcoal, and oil, or simple cerate as a discu- tient in scrophulous swellings. Pulvis carbonis animalis. Powder of animal charcoal. R. Carbon, animal, gr. ij. Glycyrr. pulv. gr. v. F. pulvis. A powder to be given morning and evening. R. Carbon, animal, gr. vi. Spong. ust. gr. xij. Glycyrrhiz. pulv. Jss. M. f. pulv. in partes vi. tequales dividendus. A powder to be taken night and morning in scirrhous goitre. Riecke. R. Carbonis animal, gr. iv. CI ycyrrh. pulv. 9iv. M. et divide in part. viij. One of these to be taken dry, morning and evening, a little ♦ Op. cit. 140 CARBONIS SESQTJI-IODIDTJM. water being drunk afterwards, in cases of scirrhous indurations of the mammx. After the eight powders have been taken, the dose may be increased gradually by half a grain, until it ulti- mately attains four grains. At the same time, unirritating and spare diet should be inculcated. Boli carboiiis animalis. Boluses of animal charcoal. R. Carbon, animal, gr. iij. Ammon. muriat. pulv. ^j. Ext. conii, gr. ij. glycyrrhiz. q. s. ut fiat bolus. One of these to be given three times a day ; — in cases of swelling and scirrhus of the prostate, and of the mucous mem- brane of the urethra. Magendie. XLIII. CARBO'NIS SESQUI-IO'DIDUM. Synonymes. Carbonis Sesqui-ioduretum, Sesqui-iodide or Sesqui-ioduret of Carbon. This preparation is made by mixing concentrated alcoho- lic solutions of iodine and potassa until the former loses its colour. A solution is obtained, from which the addition of water throws down a yellow precipitate — the sesqui-iodide of carbon. This substance is soluble in alcohol and ether, but insoluble in water. The ethereal solution yields large yellow crystals by slow evaporation. It has a sweet taste, and a strong saffron- like odour. Mitscherlich* considers the taste very disagreeable. Fifty grains given by Dr. Cogs\vell,f to a strongly made terrier dog, proved fatal ; and, on dissection, the large vessels were found congested ; the inner membrane was closely corrugated, and the apices of the rugae were of a rose-red colour. * Traite de Chimie, traduit par Valerius. | Essay on Iodine, p. 122. Edinb. 1S37. CETRARINA. 141 EFFECTS ON THE ECONOMY IN DISEASE. Dr. Litchfield* used it with advantage in five cases of enlarged glands ; in two of lepra, and three of porrigo, in the form of ointment composed of 3ss. of the powder to 3yj. of simple cerate. XLIV. CETRARFNA. Synonymes. Cetrarin, Cetrarine. French. Cetrarin. This substance has been extracted, of late, from Cetraria Islan- dica, by M. Herberger, a pharmacien at Kaiserslautern.t METHOD OF PREPARING. The coarse powder of cetraria is boiled for half an hour in four times its weight of alcohol at .8S3 ; it is then left at rest until vapours cease to be given off, to avoid the loss of the alcohol ; when it is strained and pressed. Three drams of muriatic acid, previously diluted with water, are now added to each pound of the moss ; this is mixed with from four times and a quarter to four times and a half its bulk of water, and the mixture is left at rest for a night in a closed flask. The next day, the deep yellow fluid, which swims above the copious deposite obtained, is poured off: this deposite is the impure cetrarin, the colour of which is more or less greenish. It is now collected on a filter (chausse), left to drain as little as possible and subjected to pressure. To purify it, it must be divided into small fragments, and washed whilst still moist with alcohol or ether, which deprives it of colour ; it is then treated with two hundred times its weight of boiling alcohol, in which the inorganic matter, that has hitherto accompanied it, is scarcely soluble. The greater part of the cetrarin is gradually precipitated on the cooling of the alcoholic solution. The portion, which still remains in solution, may be separated by the evaporation of the alcohol. Pure cetrarin is, at times, in the state of a white powder, re- * Lond. Med. Gaz., Aug. 183G. f Buchner's Kcpertorium, B. viii. H. 1. 1837. 142 CETRARINA. sembling magnesia ; at others, in small globules united in the form of arborisations, which do not present — even under the microscope — any crystalline texture. When gently compressed, it has a slight silky splendour. It is neuter, light, unalterable in the air, inodorous, and has a very intense bitter taste, especially in the alcoholic solution. Its best solvent is absolute alcohol, one hundred parts dissolving 1.70 of it at the boiling tempera- ture, but only 0.28 at 14° centig. (5S° Fahr.). Alcohol, at 0.830 dissolves 0.44 when boiling, 0.28 at 25° cent. (77° Fahr.), and only 0.04 at 14° cent. (5S° Fahr.). It is still less soluble in boil- ing and in cold water, the essential oils, creasote, &c. It is some- what more soluble in ether, but insoluble in the fixed oils.* EFFECTS ON THE ECONOMY IN DISEASE. Muller, a physician of Kaiserslautern,t details two cases in which he has administered cetrarin. One of these was a quar- tan, the other a tertian intermittent. The effects appeared to be exerted more slowly than those of quinia, but it seemed to him not to affect the stomach so much.[?] Its price must be considerably less, as M. Herberger succeeded in obtaining from a pound of lichen 135 grains of very pure cetrarin. It has not been given, so far as we know, in this country. METHOD OF ADMINISTERING. Muller gave it in the form of powder, according to the follow- ing prescription : — R. Cetrarin. Acaciae, aa. gr. ij. Sacchar. ^ss. M. et fiat pulvis. Dose. — One of these every two hours, during the apyrexia. Bruck,J suggests, that if dissolved in alcohol, its action may be incomparably more potent, and that it may more speedily arrest the paroxysms of an intermittent than when given in powder. * Journal de Pharmacie, xxiii. 505. Paris, 1837, and Bulletin General de Therapeutique, No. 18, Sep. 30, 1837. f H. Bruck, in Bulletin General de Therapeutique, No. 17, Sep. 15, 1837. ± Op. cit. CHIMAPHILA. 143 XLV. CHIMAPH'ILA (FO'LIA). Stnonymes. Chimaphila vel Chimophilse Umbellatae Folia ; Pyrola, Py- roke Umbellatae Folia, Winter Green, Umbellated Winter Green, Pipsis- sewa. French. Herbe a pisser, Pyrole en Ombelle. German. Die Blatter des holdenbllihtigen Wintergriins. This plant is not new to us ; but numerous trials have been made with it recently in Europe. It is admitted into the Pharma- copoeia of the United States, is a beautiful evergreen, and is in- digenous in the northern parts of Europe, Asia, and America. It belongs to the Natural Family of heaths, Ericea?, Pyrolacese (Lindley) ; and Sexual System, Decandria Monogynia. A good description of it is given by Barton.* The leaves have a bitter sweetish taste, with some degree of astringency. The taste of the stems and roots is, in addition, considerably pungent. Boiling water and alcohol extract the virtues of the plant. The constituents, so far as ascertained, are bitter extractive, tannic acid, resin, gum, lignin, and saline matters. The active principle has not been determined. It probably resides in the bitter extractive; — the resin and tannic acid, how- ever, contributing to its eifects.f EFFECTS ON THE ECONOMY IN DISEASE. The leaves of Chimaphila were long used by the Indians of this continent, and from them the American physician was in- duced to employ them. The first regular treatise respecting the plant is said to have been a thesis of Dr. Mitchell, published in the year 1S034 In Canada, it is said to have been long used in diseases of the urinary passages, especially in calculus, dropsy, and in chronic gout and rheumatism ; its effects appearing to resemble — but not to exceed — those marvellously ascribed to uva ursi.§ Somerville|| and Barton extol it as an excellent diuretic in different forms of dysuria, and in dropsies, especially such as succeed to acute diseases ; in nephralgia as a palliative, * Medical Botany, i. 17 ; see, also, Art. Chimaphila, in Wood and Bache's Dispensatory, ltd edit. p. 197. Pliila. 1839. f Pereira's Elements of Materia Medica, &c, ii. 1333. Lond. 1842; or Amer. edit, by Dr. Carson, Philad. 1843. X Barton's Collection, ii. 2. \ See the author's General Therap. and Mat. Med. i. 275. Philad. 1843. II Medico-chirurgical Transactions, v. 340. 144 CHIMAPHILA. especially when the paroxysms are occasioned by gravel which has accumulated in the kidney ; and even in vesical calculus. During its use, the appetite improved, and the digestive powers augmented ; the patients often experiencing — immediately after it was taken — an agreeable sensation in the stomach, and in the region of the kidneys. Radius* found it especially serviceable in dropsy, gout, and rheumatism ; and in inordinate activity of the secretory func- tion of the mucous membranes — chronic catarrh, phthisis pituitosa, &.C According to him, it is contraindicated where there is much fever, disposition to diarrhoea, gastricism, and great debility of the stomach. Heyfelder affirms, that it appears to be advantageous in the debility of the digestive organs at- tendant upon dropsy, but its diuretic effect is not considerable, or enduring, so that it requires to be associated with other more powerful agents. Experiments, which have been made recently in the Burger- hospital at Pesth, and which have been collected by St. Rochus and published by Windisch, the director of the hospital, are ex- tremely favourable to the chimaphila. Within two years, nearly two hundred dropsical cases are said to have been radically cured by it. Windisch recommends it most strongly to the at- tention of his colleagues ; he asserts it to be one of the best diuretics we possess ; that it does not impair digestion ; moder- ately accelerates the circulation ; gently encourages the action of the bowels, and powerfully augments the urinary secretion ; that the patients willingly take it, and that it induces no nausea. It was administered with advantage in dropsies unaccompanied by fever, and not dependent upon organic mischief, upon " corrup- tion of the humours or paralysis of the lymphatic textures." In febrile conditions and inflammatory diatheses, it is said to have been always injurious, as well as when it was administered prior to the resolution of obstructions remaining after long protracted intermittents ; but when these are removed, and no excitement exists, — more, according to Windisch, is to be expected from it than from any other agent, and he strongly advises, that careful trials should be made with it in the proper cases. He advises, also, that its use should be persevered in, in order that good effects may be derived from it. The author has frequently administered chimaphila in public and private practice, and has found it serviceable, where a tonico- diuretic was indicated. It is probably owing to its tonic pro- perties, that it has been found occasionally serviceable in scro- phula. * Auserlesene Heilformeln zum Gebrauche fur praktische Aerzteund Wun- darzte, u. s. vv. Leipz. 1836. CHIMAPHILA. 145 MODE OF ADMINISTERING. Chimaphila is given either in infusion, or, what is preferable, in decoction ; the dose in the day being from half an ounce to an ounce. Where it does not act sufficiently on the bowels, Radius advises, that a few senna leaves should be added. In af- fections of the chest, he found the addition of the spirit of nitric ether advantageous. Generally, however, he gave it alone. Windisch found a combination of it with tartrate of antimony and potassa, sulphuret of potassium, muriate of ammonia, squill, and, in very great weakness, cinchona and preparations of iron, serviceable. Radius often administered also the aqueous or spirituous extract. Decoctnm chimaphilae. Decoction of chimaphila. R. Chimaphil. ,§j. Aquaj, Oij. (Oiss. Ph. U. S. and Lond.) Coque ad colatur. Oj. To be used daily in dropsy. Somerville. Dr. Joy* adds to this two drams of Liquor Potassse Carbo- natis, and directs four table-spoonfuls of the mixture to be taken three times a day. He recommends it " in dropsy and chronic affections of the urinary organs" as if all these affections were identical or even analogous pathological conditions ! i£. Chimaphil. gss. ad gj. Coque cum aquce f.^xij. ad reman, f.^vj. Coctione finita adde Spiritus frumenti. (gin, malt spirit or whisky) f .3 i j . Digere frigide per horas vj. et cola. Dose. — Two spoonfuls to be taken four times a day in dropsy and gout. Radius. * Tweedie's Library of Medicine, v. 312. London, 1840 ; and 2d American edit. vol. iii., p. 692. Philad. 1842. 13 146 CHLORI>"UM. 1£. Chimaphil. 5 v j- Coque cum aq. f-5xij. ad reman, f.svj. Sub finem coctionis adde Fol. sennse 5'j- et cola. Dose. — A spoonful to be taken every two hours. Radius. XLVI. CHLO'RINUM. Synonymes. Chlorinium, Chlorineum, Chlorum, Chlorine, Murigene, Acidum Muriaticum Oxygenatum, Acidum Marinum Dephlogisticatum, Spiritus Salis Marini Dephlogisticatus, Dephlogisticated Muriatic Acid, Oxygenated Muriatic Acid. French. Chlore. German. Chlor, Chlorgas. Uncombined chlorine is employed medicinally not only in the gaseous but in the liquid state. Of each of these we shall treat in succession. The forms for evolving it in the gaseous state, as well as the gaseous chlorine itself, have had various names assigned them expressive of their chemical or medical properties. They have been termed, respectively, Acidum muriaticum oxygenation ad contagia ; Fumigatio muriatico-oxygenata ; Pulvis adfumi- gationes muriaticus ; Species pro vaporibus superoxydi muria- tici ; Suffilus oxymuriaticus ; S. chlorini ; Jllexiterium Clilo- ricum, Fumigation de Chlor, F. de Guyton, F. Guytonienne, F. Bygienique, &c. MODE OF PREPARING. Chlorine is obtained from chlorohydric or muriatic acid. For this purpose, one part of well pulverised peroxide of manganese with five or six parts of concentrated muriatic acid is put into a retort, to which heat is applied and the gas received over water. Or, it may be obtained from a mixture of one part of peroxide of manganese, four parts of kitchen salt, two parts of concentrated sulphuric acid, and four parts of water. Chlorine is a greenish-yellow gas ; of a peculiar, strong, dis- agreeable, stifling odour. The flame of a lighted taper intro- duced into it becomes at first pale, afterwards red, and is ulti- mately extinguished. It remains unchanged in the highest tem- peratures. It has a great affinity for hydrogen, so that it abstracts CHL0RINTJM. 147 this gas from every substance that contains it, and forms with it chlorohydric acid. Hence it decomposes all the gases that con- tain hydrogen, and all organic colouring matters, as well as — it is conceived by many — miasmata and contagious matters. EFFECTS ON THE ECONOMY. Chlorine, when diluted, and received into the lungs, occasions coughing, and symptoms of suffocation, to which a protracted catarrh often succeeds : not unfrequently, too, we observe in those, who are compelled to be exposed to the gas, bronchitis, and pneumonia. Animals soon die when they are immersed in it.* In Mr. Broughton's experiments, mice exposed to it fell dead in less than thirty seconds. On opening them, the heart was found palpitating ; the peristaltic motion of the intestinal canal continued, and could be kept up by irritating it with a probe. The vessels of the brain were collapsed. The lungs were tinged with the yellow colour of the gas, and the peculiar odour of chlo- rine was perceptible throughout their structure. Coagulation of the blood took place as under ordinary circumstances. A rabbit, two or three weeks old, was immersed in chlorine, and died in less than half a minute. On opening the thorax, the heart was found acting freely, and on puncturing the aorta, the blood jetted out forcibly to a considerable distance. The peri- staltic motion of the bowels was also going on. The vessels of the brain were in a collapsed state. The lungs were very much distended, tinged yellow, and, when removed from the chest to a distance, emitted the odour of chlorine. The right ventricle of the heart was distended with dark blood. The eyes were much glazed in each experiment. " It has been generally thought," adds Mr. Bronghton, "that chlorine is incapable of passing the epiglottis" [the glottis], " but from the above obser- vations it is evident that this gas enters the bronchial tubes in the act of inspiration. A portion of it probably circulates through the brain, suspending the cerebral functions without directly de- stroying the action of the involuntary organs, — contractility remaining long after the destruction of animal life, as is evinced by the activity of the heart and of the intestinal canal. "t These very facts, however, seem to show, that but little of the gas enters the lungs; probably no more than what passes immediately preceding the closure of the glottis by the forcible contraction of the arytenoidei muscles. When inhaled in a dilute state, it is absorbed ; and, according to Mr. Wallace, the urine * See Christison on Poisons, 3d edit. p. 73G. Edinb. 183G. f Journal of the Royal Institution, from Jan. to June, 1830. 14S CHLORINUM. acquires bleaching properties. It would appear, also, that, in manufactories, the chief consequences from exposure to an atmo- sphere of chlorine are acidity, and other stomach complaints, which the men generally remove by taking chalk :* this fact is confirmatory of the view, that acidity of the stomach is usually, if not always, dependent upon excess in the secretion of the gastric acids, the most important of which is the chlorohydric. When chlorine is inhaled, it is reasonable to suppose that more of this acid may be secreted in the stomach. METHOD OF EMPLOYING. 1. By Inhalation. — In the way of inhalation, chlorine gas is never administered in a state of purity, but always diluted with atmospheric air ; often, too, it is united with watery vapour. Gannal affirms, that the workmen in a bleaching establishment, who suffered under diseases of the chest, were visibly improved, and ascribed the amelioration to the inhalation of air containing chlorine. He, therefore, instituted various experiments on con- sumptive individuals, from which good results, he conceived, followed. Sir James Murray! also mentions, that a friend of his had observed similar effects among his workmen who were exposed to the inhalation of watery vapour strongly impregnated with chlorine. The experiments, however, which were insti- tuted at La Charite, in Paris, on this mode of treating phthisis, Avere by no means encouraging ; and the same may be said of those at the Hotel Dieu of that city, instituted by Rullier.t In many cases, indeed, the disease appeared to be aggravated. Bayle, likewise, thought the inhalation of chlorine generally unfavourable, although he asserts that he cured a case of tuber- cular phthisis with it. Recently, it has been recommended by Cottereau. Professor Albers,§ of Bonn, who administered it repeatedly, and carefully watched its effects, conceives, that it acts as a stimu- lant when applied to the membrane, but that, when it gets into the blood, its effects are antiphlogistic ; and he is of opinion, that, when there is no haemoptysis, or violent local irritation present, chlorine inhalations may be used in diseases of the lungs and air- passages. Its stimulant effect gradually diminishes, and, after a * Pereira, Elements of Materia Medica, &c. 2d edit. i. 228, Lond. 1842 ; or Araer. edit, by Dr. Carson, Philad. 1843. f A Dissertation on the Influence of Heat, &c. Lond. 1829; cited in the Dublin Journal of Medical Science, for March, 1839, p. 96. \ See, also, Pereira, Op. cit. p. 229 ; and E. J. Coxe, Practical Treatise on Medical Inhalation, p. 83. Philad. 1841. § Hannoversche Annalen, 1836, and Brit, and For. Med. Rev. for July, 1837, p. 215. CHLORINUM. 149 time, the mucous surfaces of the lung become less sensible to its exciting influence. In tubercles of the lung, in chronic catarrh, in chronic inflammation and ulceration of the bronchial mucous membrane, and in dilatation of the bronchi, he found it of no ser- vice, and, in most cases, it could not be borne, in consequence of the irritation it induced ; but its operation was very salutary in ■pure ulceration of the lungs or vomica. It had always, however, to be administered cautiously and experimentally. Dr. Stokes always found chlorine inhalations prejudicial in phthisis, producing, in every case, increase of bronchial irritation, dyspepsia, and arrest of the pulmonary secretion. In his trials of the remedy in gangrene of the lungs* he found it decidedly bene- ficial, correcting the fcetor of the breath and expectoration, and, therefore, calculated to obviate not only the local but the consti- tutional symptoms. Sir James Clarkt is of opinion, that the inhalation of chlorine has only produced relief in persons whose lungs have been dis- eased to a very limited extent. Dr. A. T. ThomsonJ considers it " the best topical expectorant, and the most salutary excitant to the mucous membrane of the lungs that has yet been inhaled ;" and Dr. Christison§ affirms, that he has tried the practice repeat- edly; and although, like Dr. Elliotson, he has witnessed "such amelioration as he never saw before under the use of narcotics or any other means," he has not met with any instance where the amelioration was permanent. Such, likewise, has been the experience of the author. Dr. Pancoast informed the author, that a case of aphonia, occurring in a young lady, in which there was but little volun- tary power over the diaphragm, was cured by the inhalation of chlorine, after the galvanic plates and the electro-magnetic appa- ratus had been used in vain. Chlorine may be inhaled from a common dish or inhaling apparatus, by dropping any of the acids on a mixture of chlori- nated lime, so that the chlorine may be disengaged slowly ; but the best method of inhaling it, as well as iodine, is that recom- mended by Dr. Corrigan.|| He properly remarks, that, in order for inhalation to have a fair trial, it is requisite, first, That the apparatus should be simple in its construction, and easily kept in order. Secondly, That it should be capable of keeping up a supply of vapour for any length of time, and that the evolution of the vapour should be steady and easily regulated. Thirdly, * Dublin Hospital Reports, vol. v. f Treatise on Tubercular Phthisis, p. 84, Lond. 1834 ; also, Amer. edition, Philacl. 1835. X Elena, of Mat. Med. and Therap. 2d. edit. Lond. 1835. § Dispensatory, p. 312. Edinb. 1842. || Dublin Journal of Medical Science, March, 1839, p. 94. 13* 150 CHLORINUM. That it should also furnish a sufficient supply of aqueous vapour to prevent any irritation of the larynx, or lining membrane of the air-tubes ; and, fourthly, and most important of all, that its em- ployment should entail neither trouble nor fatigue on the invalid. To fulfil these objects, Dr. Corrigan advises the apparatus re- presented in the figure beneath. It consists of a light open iron- wire frame, about eighteen inches high, at the bottom of which is a spirit lamp, A : at the proper height above it is an evapo- rating porcelain dish, about six inches in diameter, B : above this is a glass globe, C, with its neck downwards. In the neck of the globe is a cork, D, bored, and through the opening is drawn, moderately tight, a short plug of cotton wick, such as is used in a spirit lamp : in the glass globe at E, opposite the neck, is drilled a pin-hole, to allow air to pass in, according as the fluid within drops out through the neck. To use it, the porce- lain dish is filled with hot water, the spirit lamp is lighted, and as soon as the water in the dish has begun to boil, the glass globe containing chlorinated lime, (if this be the substance used,) is placed as in the illustration below. The rate, at which the fluid in the globe shall percolate the cotton wick and drop into the hot water beneath, is easily regulated. If it should not drop with sufficient rapidity, one or two of the threads of cotton may be removed. Should it drop too rapidly, this is corrected by pressing in the cork more tightly, or introducing one or two ad- ditional threads of wick. CHLORINUM. 151 Eight ounces of a saturated solution of chlorinated lime may be poured into the glass globe ; and into the water of the porce- lain dish, two ounces of the dilute sulphuric acid of the phar- macopoeia. As the solution drops, the acid seizes on the lime, and the chlorine is evolved in connexion with aqueous vapour.* Chlorine is but little used in this form, and can only be adapted for cases in which the pathological condition of the bronchial mucous membrane, or neighbouring parts, requires the exhibi- tion of an excitant.t In this way, it may be occasionally ser- viceable in chronic bronchitis ; but its administration requires great caution. J In cases of poisoning by hydrocyanic acid, as well as by sulphuretted hydrogen, chlorine is a most efficacious agent. Chlorinated of lime may be used for this purpose. 2. By Fumigation. — Fumigations of chlorine have been parti- cularly recommended by Dr. Wallace, of Dublin. § They appear to resemble, in their action, the nitrous and nitro-muriatic acid baths,|| and have been especially employed in liver diseases, un- accompanied by inflammation, but in which there is a disturb- ance of the biliary secretion. According to Wallace, fumigations of chlorine are more certain than ablutions and baths of nitro- muriatic acid, and they have the advantage, that their applica- tion subjects the patient to less inconvenience. The good effects of chlorine, in such cases, have likewise been tested by Zeise,1F in his bathing establishment at Altona. When chlorine is brought into contact with the skin, in this way, it soon occasions a prick- ing sensation ; increase of transpiration ; great afflux of fluids to the surface of the body, and sometimes a pustular eruption ; increased secretion of saliva, urine, and bile ; slight inflamma- tion of the mouth and fauces, and impeded respiration and cir- culation. Dr. Mettauer is disposed to refer the action of the compound, in every, case, to the presence of chlorine, and to believe with Dr. Scott, of India, who first introduced the nitro-muriatic acid to notice, about twenty-six years ago (1817), that a solution * Lond. Med. Gaz., April 6, 1839, p. 49. t Toulmouche, in Revue Medicale, Avril, 1834. See, on the various modes of inhalation, Sir C. Scudamore, in Lond. Med. Gaz. Feb. 7, 1840, and Dunglison's Amer. Med. Intel. April 15, 1840, p. 25; and E. J. Coxe, Practical Treatise on Inhalation. Philad. 1841. % Archives Generates, Avril, 1834 ; and a communication on the excel- lent effects of chlorine vapour in catarrh, in Gazette Medicale de Paris. June, 1838. \ Researches respecting the Medical Powers of Chlorine, &c. Lond. 1822. || See, on the Nitro-Muriatic Mixture, as a remedial agent, Dr. J. P. Met- tauer, Amer. Journ. Med. Sciences, Feb. 1840, p. 291. If Nye Hygea udgived af C. Otto, 1825, and Hufeland und Osann's Journ. der prakt. Heilkund. B. Ixiii. St. 1. 152 CHLORINUM. of chlorine in water will answer, in all cases, as well as the acid. In the last edition of the Pharmacopoeia of the United States, the following formula has been introduced for the preparation of the Acidum Nitro-muriaticum. Take of Nitric acid, f.^iv., Muriatic acid, f.^viij. Mix them in a glass vessel, and, when effervescence has ceased, keep the product in a well stopped glass bottle, in a cool and dark place. Dr. Wallace found chlorine fumigations serviceable not only in hepatic diseases ivith disordered secretion of the liver, but in several other morbid conditions, as hypochondriasis, cachexia, and in all affections in which a prolonged excitation of the skin, and a restoration of its suppressed or impaired functions are esteemed serviceable, — hence, in old cases of syphilis, scrojihula, chronic catarrh, and rheumatism. Generally, cathartics were combined with the fumigations, and the evacuations were con- stantly observed to present a highly bilious character. In chronic cutaneous affections, as in lepra, psoriasis, and scabies, these fumigations have been found useful ; but, gene- rally, fumigations of sulphurous acid are employed by preference, in consequence of the greater facility with which they can be prepared.* Injections of chlorine gas have been employed for the radical cure of hydrocele by M. Deblois, of Tournay, and M. Deconde.t The chlorine gas is contained in a bladder, to which is attached a pipe and stopcock adapted to the canula of the trocar, into which it is fixed after the fluid is evacuated : the stopcock is then turned, and the bladder pressed so as to force the gas into the tunica vaginalis. When this is distended, the pipe and bladder are removed, and the thumb is placed over the mouth of the trocar, so as to prevent the issue of the gas for the space of two minutes ; it is then allowed to pass, and two or three repetitions of the injection are made, which are sufficient for the cure. It would appear, that risk must be incurred from the injection of such an acrid substance, but M. Deconde says not. Fumigations of chlorine, with the view of destroying the mat- ter of contagion, and of preventing the spread of contagious diseases, have long been used. J As long ago as the year 1773, they were proposed for these purposes ; and were subsequently extensively used by Guyton de Morveau ; hence they have been called the " Guytonian, or the " Guyton Morveau fumiga- tions." They are the best agents that we possess. * Green on Diseases of the Skin. Dunglison's American Library edit. Philad. 1838. f Bulletin Medical Beige, Janvier, 1836. X Link, Art. Chlor, in Encyclopad. Worterb. der medicin. Wissenschaft. B. vii. S. 575. Berlin, 1831. CHLORINI AQUA. 153 In fumigating the extensive general penitentiary at Milbank, Westminster, Dr. Faraday adopted the following method. One part of common salt was intimately mixed with one part of black oxide of manganese ; the mixture was placed in a shallow earthen pan, and two parts of oil of vitriol, previously diluted with two parts by measure of ivater, were poured upon it, — the whole being stirred with a stick. Chlorine was liberated for four days. The quantities of the ingredients employed were 700 pounds of common salt, the same quantity of the oxide of manganese, and 1400 pounds of sulphuric acid.* When chlorine is evolved in the manner described, it is liable, like all the acid gases, to the objection, that it is extremely irri- tating when respired. It cannot, therefore, be used in the sleep- ing apartments of the sick, although it may be employed bene- ficially after they have been withdrawn, and the object is to disinfect the chamber. It ruins all polished surfaces, but this can be effectually obviated by painting them over with a com- post of starch. The chlorides are not liable to the same amount of objection, as they exhale the chlorine slowly.t XLVII. CHLO'RINI AQUA. Synonymes. Aqua Chlorinii, A. Chlorinei, Solutio Chlorinii, Liquor Chlori, Aqua Chlori, Aqua Oxymuriatica, Liquor Acidi Muriatici Oxygenati, Aqua Oxygenata Muriatica, Aqua Oxygeno-Muriatica, Liquor Alexiterius Oxy- genatus, Solutio Alexiteria Oxygenata, Solution of Chlorine, Liquid Oxy- muriatic Acid. French, Chlore Liquide, Eau de Chlore. German. Chlorwasser. This preparation is contained in many of the pharmacopoeias. It is in those of Austria and Anvers ; and in the Batavian, Bava- rian, Belgian, Danish, Dublin, Edinburgh, Parisian, Finnish, Hanoverian, Polish, Prussian, and Swedish.J It has been more extensively administered on the continent of Europe than in this country, or in Great Britain. * Pereira, Op. cit. p. 228. t See the author's General Therapeutics, p. 509. Philad. 1836 ; and his General Therapeutics and Mat. Med. ii. 376. Philad. 1843. % Pharmacopcc Universelle, i. 405. Paris, 1828. 154 CHL0RIXI AQUA. METHOD OF PREPARING. The Prussian Pharmacopoeia directs chlorine gas, made after the manner before described, to be passed into the bottles of a Woulfe's apparatus filled with distilled ivater, until two-thirds of the water are displaced : the bottles are corked under water, and the water is agitated until it takes up the gas. The liquid is then drawn off into small bottles, which are well filled, and kept in a dark place. In this way, liquid chlorine may be kept for a long time undecomposed. In its preparation, some little chloro- hydric acid is formed, so that it has at times to be purified by treating it with a solution of nitrate of silver. The process of the Dublin Pharmacopoeia is similar to this. That of the Edinburgh Pharmacopoeia differs ; and is as fol- lows : — Take of Chloride of sodium, sixty grains ; Sulphuric acid (commercial), two fluid drains ; Red oxide of lead, three hundred and fifty grains : Watertight fluid ounces. Triturate the chlo- ride of sodium and oxide together ; put them into the water con- tained in a bottle with a glass stopper; add the acid, and agitate occasionally till the red oxide becomes almost white. Allow the insoluble matter to subside before using the liquid. EFFECTS ON THE ECONOMY IN HEALTH. From experiments made by Orfila* on dogs, it appears, that considerable doses of a moderately concentrated solution of chlo- rine prove fatal, by exciting sooner or later inflammation of the stomach, accompanied with great languor ; and when death takes place very rapidly, signs of organic alteration are met with in the stomach. In its action on the economy, chlorine is closely allied to the acids, and especially to the chlorohydric. Intro- duced into the stomach in moderate doses, solution of chlorine excites an agreeable feeling of warmth, which soon spreads over the whole of the body : in strong doses,according to L. W. Sachs, a kind of intoxicating stupor is induced by it, soon succeeded by prostration. It has been conceived to act equably as a moderate excitant of the nervous system, and thereby to moderate inordi- nate action in any part ; and is, to a certain extent, antiphlogistic, without possessing any of the debilitating qualities of the anti- phlogistics proper. In the opinion of some of the German pa- thologists, it powerfully stimulates the organic actions, especially the lymphatic and glandular systems, moderating inordinate secretion. Its antiseptic properties are likewise considerable. * Toxicologic Generate, i. 141. CHLORINI AQUA. 155 It would appear, however, that the number of observations has not been sufficiently great — although they have been by no means few — to allow of any comprehensive appreciation of its exact modus operandi on the human organism.* EFFECTS ON THE ECONOMY IN DISEASE. Although solution of chlorine is properly no new remedy, it is only of late years that it has been frequently administered. At the present day, in some countries, it is in common use. It is not long since Meurer maintained, that it is impossible to ad- minister chlorine internally, and that in every case in which it was believed to have been given, the article really taken was the chlorohydric or muriatic acid ; for, owing to the affinity of chlorine for hydrogen, whenever any union takes place between it and organic matters, the chlorine, he affirmed, disappears, and chlorohydric acid alone exists, as he had proved by repeated experiments. In this assertion, however, he was opposed by many observers. Herzog and Barmann came forward with ex* periments to show, that Meurer had gone too far in his deduc- tions ; and from all the experiments, it would appear, that in prescribing aqua chlorini many mistakes had been, and — we may add — still are, committed, From Barwald's experiments, it would appear, that if water which has rested on aromatic or other vegetable substances be chosen for the dilution of the solu- tion of chlorine instead of distilled water, a difference is produced in the rapidity of the decomposition. In a mixture of aqua chlorini, distilled water, and simple syrup, the decomposition takes place tardily ; but if, in place of syrup, a mucilaginous juice be substituted — for example, the syrupus althsese, — acids are speedily formed ; as well as when a decoction of althasa is substituted for distilled water ; whereas a mixture of the decoc- tion of salep, (gr. v. to water §j.) syrup, and aqua chlorini, in well stopped bottles, remained undecomposed above twenty-four hours. In these experiments, however, the persistence of the smell and taste of the chlorine exhibited, that the whole of the chlorine had not been converted into chlorohydric acid. In the same manner as in the case of the decoction of marshmallows, the addition of Infusum sennae and Infusum valerianic, as well as of the solutions of extracts, and especially of liquorice, de- stroyed the smell of the aqua chlorini instantaneously, even when the taste of chlorine could still be detected. When the solution was combined with remedial agents, that contained much colouring matter, the decomposition took place with great * Riecke, Die neuern Arzneimittel, u s. w. S. 30. Stuttgart, 1837. 156 CHLORINI AQUA. rapidity. From the results of these experiments, Barwald ad- vises aqua chlorini to be given in admixture with distilled water and simple syrup, as in this way only can we be sure, that the patient has taken the chlorine undecomposed. Herzog Jays it down as a rule, that the solution of chlorine should only be mixed with colourless transparent substances — water, simple syrup, gum arabic or decoction of salep. In respect to its administration in disease, it may be well to speak first of its internal use, which, in several morbid conditions, seems to have rendered good, and in some cases eminent, ser- vice. The following are the diseases in which it has been chiefly recommended. 1. Irritative fever, as in the violent irritative fever that occurs during the period of dentition ; in which it has been administered with great success by Kopp, Mehlhausen, Goden, Trusen, and Riecke.* Dangerous determinations to the head have been, in this way, obviated, along with the unpleasant complications which are apt to be occasioned thereby. Toelt exhibited it in convulsions, during dentition, which were accompanied by too great activity of vessels; and he affirms, that he has prescribed no remedy, which, in all respects, answered so well. 2. Nervous fever, especially when tending to the putrid cha- racter. In the plague, according to Wagner, it is of no avail ; but in put rid fever, according to Kopp, it is highly useful. Span- genberg observed good effects from it in an epidemic typhus with hepatic derangement. It is likewise extolled in typhus by Wolf, Braun, Hufeland, and others ; and by Sacco in the fever called petechial, — itself a typhus. Of late, it has been much used in Germany in typhus abdomiualis, which corresponds to our typhoid fever, to oppose the origin and development of the intes- tinal ulcerations ; but when the disease is farther advanced it has been found useless. It is especially recommended in this disease by Clemens, but he commonly premised the use of an emetic. Trusen considers the emetic unnecessary. He first ap- plies leeches to the epigastrium, and then prescribes immediately aqua chlorini in considerable doses ; — in lighter cases, a dram every two hours ; and if the disorder of the head be already great, the tongue chapped (rissig), and the peculiar expression of countenance present, he gives two drams every two hours. Bartels is less satisfied with the action of chlorine in abdominal typhus. It raises, he says, the sinking powers very speedily, but often excites the sanguiferous system, but not unfrequently increases the abdominal symptoms so palpably, that the physi- cian is compelled to have recourse to other agents. RieckeJ * Op. eit. S. 30. f Archiv. d. med. Erfahrung, Marz und April, 1825, i Op. cit. S. 33. CHL0R1NI AQUA. 157 thinks, however, that it may be of essential service in this disease, which so frequently mocks the best directed efforts of the prac- titioner ; and he suggests, that farther experiments are highly desirable, especially as those instituted by Trusen and others are not free from objections, by reason of their having associated with chlorine substances that quickly decompose it. 3. Carbunculus malignus {Milzbrandkarbunkel). — - In the variety of malignant anthrax caused by handling the skins of cattle, the internal and external use of chlorine has been found of essential service by Ettmuller, Herbst, Stumpf, and Hoffmann. 4. Scarlatina. — Pfeufer, Wendt, Kopp, and Trusen extol it highly in this disease, for which, on theoretical grounds, it would seem to be appropriate, by reason of the great turmoil in the san- guiferous system, as indicated by rapidity of pulse and inordinate secretion of heat, bearing but little direct ratio to the degree of vital energy. Braithwaite, who, it is asserted, was one of the earliest, if not the earliest, that advised chlorine in scarlatina, supposed that it acted as specifically as the bark in intermittent, or mercury in syphilis ; and Trusen asserts, that it may be ad- vantageously used in cases where other remedies have been found ineffectual. It is especially recommended by Braun and Spiritus in malignant scarlatina. 5. In other febrile affections, — small-pox, measles, rubeolas, &c, it has been prescribed with advantage. In putrid dysentery, (faulige Ruhr,) it is extolled by Nysten and Kopp ; and in inter- mittent, by Kopp and Kretschmar. Trusen recommends it in the irregular, and especially in the anticipating forms, where danger exists of their becoming continued. Under its use, he found the paroxysms became regular, with perfect apyrexia, so that the ordinary febrifuges could be given advantageously. In gastric fever, Trusen trusted to it solely for the removal of the disease : he found that it corrected the morbid secretions from the mucous membrane of the digestive tube. Other physicians have also derived equally favourable results from its administration in that disease. 6. In gastromalacia, it has been prescribed by Rhades, Blasius, and Winter, but as Riecke,* from whom this detail of the expe- rience of the German practitioners has been chiefly taken, pro- perly observes, farther observation is necessary before we can decide as to its efficacy in such cases. 7. In erysipelas, especially of children, it has been recom- mended by Kopp. 8. In inflammation of the liver, favourable results were ob- tained from it in the Children's Hospital of St. Petersburg ; and * Op. cit. S. 34. 14 158 CHLORINI AQTJA. it exhibited, in these cases, the analogy to calomel in its action, which has been pointed out by many observers. 9. In hydrophobia, it has been used both internally and exter- nally as a preventive, especially by the Italian physicians Brera, Previtali,* Ghisaldoni, Agliati, Arrigoni, Narcisi, and Anelli, whose experience is in its favour. Wendelstadt and Ruppius have likewise published favourably regarding it. It is obvious, however, that much fallacy may arise as to the precise agency of reputed preventives. Every one, for example, who maybe bitten by a mad dog is not attacked with hydrophobia ; and, un- less great caution be used, any article may be regarded as a preventive. This is the main reason, why we have so many preventives of hydrophobia and other diseases. 10. Again: — the solution of chlorine has been advised by Ruppius and Mertzdorf in dropsy, especially such as supervenes on the acute exanthemata. 11. In the diathesis phthisica, it has been recommended by Goden,and has been affirmed to moderate the hectic in phthisis, and to make the remissions more marked. In these cases, it re- quires to be given in large doses, and to be exhibited for a con- siderable time. 12. In many cases of chronic cutaneous affections, with dimi- nished plastic energy, it has been used with success by Kopp. 13. In noma or cancrum oris, and in fcetor of the mouth, it has been recommended internally as well as topically ; and, according to the experiments of Persoz, Nonat, and others, it renders eminent service in cases of poisoning by hydrocyanic acid. Externally, it is used either pure, diluted with water, or in combination with oil. Godier affirms, that he cured strumous swellings of the glands by a cerate of chlorine. Eisenmann, Cullerier, and Blache recommend it at times pure, at others diluted, in the way of injection, in gonorrhoea and leucorrhcea. It is employed, also, in flabby, putrid, and offensive ulcers, in carbunculus malignus, in chronic cutaneous affections, as tinea capitis, itch (Deimann), herpes (Alibert), cancrum oris, asthenic aphthse, &c. Lastly : ablution with a solution of chlorine, or of the chlorides, has been advised as a preventive of venereal infection. In can- cerous ulcers, it corrects the unpleasant odour, and excites anew action in the part ; causing the secretion of better pus : farther than this, we cannot expect much from it. Baths of chlorine are recommended by Wagner as an excellent means for pre- venting the plague. Schonlein advises that, in scarlatina, the whole surface of the body should be washed with a mixture of * Pratiche Osservazioni Ball' Idrofobia, &c. Milan, 1820. CHLORINI AQUA. 159 aqua chlorini and water, which he prefers to ablution with cold water. Finally : — aqua chlorini is occasionally sprinkled in the sick chamber, to purify the atmosphere during the prevalence of con- tagious or other diseases. MODE OF ADMINISTERING. As already remarked, whenever aqua chlorini is prescribed, its facility of decomposition must be borne in mind. It is, for this reason, best to prescribe it with water only,* or at most with the addition of simple syrup, for internal administration. For exter- nal use, water alone should be associated with it. As to the precise mode in which chlorine is affected by fatty substances, we have as yet no accurate knowledge ; it may be calculated, however, that a part undergoes decomposition. Such combina- tions have, notwithstanding, been found very useful. The solution should never be prescribed in quantity larger than is necessary for twenty-four hours, as by frequently opening the vessel in which it is contained, decomposition readily ensues. The vessel should be put into a dark place, and be surrounded by black paper. The average dose for an adult, in the twenty-four hours, may be fixed at an ounce, although much larger doses may be given without inconvenience. It is scarcely necessary to say that the precise dose must vary with the degree of concentration. Unguent um chlorini. Ointment of chlorine. Unguentum oxygenatum ex tempore parandum. R. Aquae chlorin. p. j. Adipis, p. viij. M. Used in itch. Pharmacopoeia of Austria. Linimentum aqua; chlorini. Liniment of chlorine. R. Aquae chlorin. f # 3J. Olei olivae, f.gj. M. Externally, in obstinate itch, tinea capitis, and herpes. Deimann. * Lepage, Journ. de Chimie Mdd. cited in Encyclog. des Sciences Med. Janv. 1842, p. 22. 160 CHONDRUS. R. Cerae albae, 3ij. Leni calor. liquef. adde 01. amygdal. q. s. Ut fiat liniraentum cui refrig. adde Aq. chlorin. 5iss. M. Used externally in ulcers. Ludivig. Gargarisnia aquae chlorini. Gargle of chlorine. R. Tragac. pulv. gr. xij. Aquae, fjiv. Aquae chlorin. Syrup, aa. f.^ss. M. To be used as a gargle in ulceration and chronic inflamma- tion of the mouth and fauces. Ratier.* XLVIII. CHONDRUS. Stnonymes. Fucus Crispus, Lichen Carrageen, Chondrus Crispus, Sphaero- ooccus Crispus, Ulva Crispa, Chondrus Polymorphus, Irish Moss, Carra- geen or Corigeen Moss. French. Mousse d'Irlande, Mousse Perlee. German. Krauser Tang, Seetang. Although Carrageen or Irish moss has long been used in Ire- land, it was but little employed in other parts of Europe, or in this country, until within the last few years. Of late, it has been used precisely in those cases in which Lichen Islandicus or Iceland moss has been deemed appropriate. In Germany, the first trials were made with it in the year 1833, by Von Grafe of Berlin, and the results were given to the world in his report for that year,t of the Clinical, Surgical and Ophthalmic Institute, at- tached to the Frederick William University. Chondrus, which belongs to the Natural Family Algas, exists in the Atlantic Ocean, on the coasts of England, Ireland, * Forraulaire Pratique des Hopitaux Civils de Paris, 3me edition. Paris, 1827. f Bericht iiber das klinische chir. augenarztliche Institut. der k. Friedr. Wilh. Univers. fur d. J. 1833. Bed. 1834. CH0NDRUS. 161 western France, Spain, and Portugal, and as far as the tropics. It is also said to be a native of the United States. It is met with more abundantly, however, in Ireland, especially in Clare, where it is used by the poor as an article of diet. It is thrown on the shore by the waves, and is gathered at the time of the ebb.* Irish moss, when fresh, is purple-brown or purple-red, and somewhat resembles the Iceland moss ; but when dried, as we meet with it in commerce, it is mostly yellowish or dirty white, but intermixed with purplish-red particles, and resembles lamina? of horn : it is crisped, translucent, and frequently containing small shells, calcareous concretions, and grains of sand. It has not much taste ; the smell seems to betray iodine, which, how- ever, has not been detected in it. When the moss is chewed, it feels like so much cartilage, but, by the moisture and warmth of the mouth, it soon looses its brittleness. It contains a little chloride of sodium.t The jelly obtained from it is transparent and colourless ; its taste is by no means disagreeable : it keeps several days, and is not converted by muriatic acid into mucus, like the jelly which is obtained from land plants. It exists in the proportion of 79.1 per cent., and has been considered to consist of pectin in large proportion, and starch ; but Dr. PereiraJ esteems it a peculiar principle, and gives it the name Carrageenin. It is easy ol digestion, is readily borne by weak and irritable stomachs, and exerts a soothing influence on the air-passages and the intestinal canal. In order to obtain it, the moss is cut small, carefully cleared from impurities, boiled with the selected vehicle, and strained. Von Grafe obtained, from nine ounces of milk boiled with half a dram of the moss, five ounces of jelly ; and as much from a dram and a half of the moss and twelve ounces of water. The formula, commonly used by him, is given below. To this jelly may be added any dietetic or remedial agent, which may be considered indicated in the particular case.§ Chondrus is in the secondary list of the Pharmacopoeia of the United States ; — cetraria in the primary ; but the assignment appears to be arbitrary, as one is perhaps as valuable an agent as the other. || * Pereira, Elements of Materia Medica and Therapeutics, ii. 874. Lond. 1842 ; or Amer. edit, by Dr. Carson, Philad. 1843. f E. Griife in Art. Fuous, Enoyolopad. Wbrterb. der medicinischen Wissen- schaft. xiii. S. 1. Berlin, 1835. X Op. cit. § See L. Feuchtwanger, in Philad. Journ. of Pharm. vi. 204. Philad. 1833-4. (| See the Author's General Therapeutics and Mat. Med. ii. 248. Philad. 1843. 14* 162 CHONDRTTS. EFFECTS ON THE ECONOMY. Chondrus is used in the affections that are considered to be benefited by Iceland moss. As a diet, it is given in consumptive cases, and wherever there is erethism in the respiratory or di- gestive apparatus. It is sometimes prescribed in diarrhoea along with astringent or other remedies. The jelly has been ad- vised as a diet in scrophulous cases. Von Grafe affirms, that he has often found it serviceable in hoarseness, dry spasmodic covgh, consumption, diarrhoea, and dysentery : in the intestinal pain, which remains after inflammation and ulceration of these parts, and after poison has been taken; in diseases accompanied by much emaciation, and in the prostration ensuing on serious diseases and operations. In similar affections it has been ex- tolled by Hufeland.* On the other hand, Heyfelder affirms, that he, and many physicians of his acquaintance have used the moss without either good or evil results 'm phthisis, as well as in ere- thism of the respiratory and digestive organs ; and Riecket remarks, that as it makes a very agreeable jelly, when boiled with milk, and with the addition of a little of the aqua lauro- cerasi, it may do for cases where we must prescribe " ut fecisse aliquid videamur." The truth is, that it can render no more service than other substances, which contain a similar principle ; and, accordingly, but few prescribe it with any other view than as a demulcent and nutritious aliment, in cases where such is needed. MODE OF ADMINISTERING. Decoctum chondri. Decoction of Irish moss. R. Chondri (elect, et concis.) Jss. Lact. recent, f.^ix. Coq. ad remanent, colatur. f-§v. Adde Sacchar. gss. ad 3J. Aq. amygdal. amar. concentr. ^i. To be taken in the course of the day. Von Griife. * Hufeland und Osann's Journ. der Practisch. Heilkund. B. 77, St. 5, p. 135. t Die neuern Arzneimittel. Stuttgart, 1837, S. 235. CIMICIFUGA. 163 R. Chondr. (elect, et concis.) 3iss. Coq. cum aq. font, f.gxij. ad remanent, colat. f.|v. Syrup, rubi. idaei, f.Jjiss. ad f.§ij. Aq. amygd. amar. concentr. 9j. To be used through the day. When employed as diet, Von Grafe allows from ten to eighteen ounces of the jelly in the day. R. Chondr. (elect, et concis.) Jss. Coque cum aq. font. q. s. ad reman, f.^vj. Colatur. adde Sodse phosphat. 2>iss. Syrup opii, f.Jij. ad f.^iij. Dose. — A spoonful every two hours in cases of hsemoptysis, between the attacks. Clarus. R. Lactis, f.^xxiv. Chondr. (elect, et concis.) ^iv. Sacch. |j. Cinnam. cont. 9j. Coque per minut. x. leni igne ; flltr. et exprime. Biral. R. Chondr. (elect, et concis.) Jij. Coque cum lactis Oj. ad consist, gelatin. Tere cum Sacch. gij. Amygdal. amar. No. 2. To be used in the course of the day, and daily. Hvfeland. XLIX. CIMICIF'UGA. Svnonymes. Cimicifuga Racemosa, C. Serpentaria, Actsea Racemosa, Ma- crotrys Racemosa, Black Snake-root, Cohosh, Bugbane, Cohort. French. Act<-e, Ilerbe Saint Christophe. German. Traubenformiges Christophskraut. This plant is a native of the United States, growing in shady and rocky woods from Canada to Florida. Sexual System, Polyandria Di-Pentagynia ; Natural Order, Ranunculacese. The root is the part used in medicine. It yields its virtues to boiling water, and was found by Mr. Tilghman, of Philadelphia, 164 CIMICIFUGA. to contain gum, starch, sugar, resin, wax, fatty matter, tannin, and gallic acid, a black colouring matter, a green colouring matter, lignin, and salts of potassa, lime, magnesia, and iron.* EFFECTS ON THE ECONOMY. Cimicifuga belongs to the class of Acro-narcotics. Until re- cently, it is said to have been employed chiefly in domestic prac- tice, as a remedy in rheumatism, dropsy, hysteria, and in various affections of the lungs, especially such as resemble consumption.! It is noticed here, however, chiefly in consequence of the enco- miums that have been passed upon it, of late, as a remedy in chorea. Several cases of this disease, reported by Dr. Jesse Young to have been cured, were published some years ago ; and at the same time it was stated, that Dr. Physick had known it prove successful in several instances. J Dr. Wood§ also states, that he administered it in a case of chorea, which rapidly recovered under its use, after the failure of purgatives and metallic tonics. He also remarks, that he had derived the happiest effects from it in a case of convulsions, occurring periodically, and connected with uterine disorder. More recently, Dr. T. S. Kirkbride,|| has published some cases of success, obtained in the same disease, from its administration ; after free purging had been employed. In one successful case, in a girl, nine years old, whose mental faculties were much disordered ; and who had lost nearly all power over both her left extremities, — there being, at the same time, irregularity of the bowels, headache, and pain frequently shooting down the left arm, cups were applied to the back of the head and neck once ; stimulating pediluvia were prescribed, with friction with salt over the surface of the body, and she was moderately purged every day for a week before the Cimi- cifuga was begun with. Dr. Kirkbride refers to a very intract- able case, that fell under the care of Dr. Otto, and that yielded ultimately to the Cimicifuga. He always purges before he has recourse to it, and general frictions with salt or the flesh-brush, and pustulation with Croton oil over the spine, he believes to be of much value in chronic cases. Dr. Beadlel of New York treated a case successfully in a girl * Journal of Philadelphia College of Pharmacy, vi. 20; and Dr. Wood, in Dispensatory of the United States, by Drs. Wood and Bache, Art. Cimi- cifuga. f Dr. F. J. Garden, Amer. Med. Recorder, Oct. 1823. % Amer. Journ. of the Med. Sciences, ix. 310. § Op. citat. II American Journal of the Medical Sciences, February, 1840, p. 289. If New York Journal of Medicine and Surgery, July, 1840, p. 191. See, CIMICIFUGA. 165 eighteen years of age. There was considerable gastric derange- ment, with suppression of the catamenia for nearly five months, from pregnancy. She was put upon the use of Cimicifuga,five grains of the powder being given every three hours, and no other remedy except an occasional dose of sulphate of magnesia. There was little improvement in her condition during the day, for nearly a week, after which she improved rapidly and was well in three weeks. The medicine produced no sensible effect. Allusion has been made to the employment of Cimicifuga in popular practice, in cases of rheumatism. Like other narcotico- acrids, when pushed, so as to produce catharsis and even slight narcosis, it may unquestionably be of service in acute forms of the disease.* In some parts of the country, it has become a very popular remedy in coughs ; and Dr. E. G. Wheelert affirms, that he has found it useful in several cases of severe and pro- tracted cough ; and especially in the chronic cough or bronchitis of old people. Dr. Wheeler states farther, that by some eminent physicians, it has been thought to be a good substitute for ergot in partu- rition, being dissimilar, however, in its mode of action, — relax- ing the parts and thereby rendering labour short and easy ; which requires confirmation. Recently, it has been advised by Dr. C. C. HildrethJ " in acute phthisis, uncomplicated with much inflammation in the vesicular structure, or pulmonary mucous or serous membranes;" who states, that he has " often seen the most prompt action of the decoction alone, in throwing off febrile excitement or the hectic paroxysm, allaying cough, reducing the rapidity and force of the pulse, and inducing gentle perspiration." " In those intercurrent congestions and inflammations, so frequent in the second and third stages of phthisis, from atmospheric exposures," he states, that he has " often seen the same happy influence ex- erted ;" but the testimony in regard to its beneficial action in these cases is certainly wanting in precision. § MODE OF ADMINISTERING. The dried root of cimicifuga may be given in powder. Dr. Kirkbride administered it in the dose of a tea-spoonful ; and Dr. also, Dr. C. C. Ilildreth, Amer. Journ. of the Med. Scienc. Jan. 1843, p. 31 ; and Dr. F. J. Garden, Ibid. p. 247. * Drs. E. A. Anderson, and Alexander Vedder, in Dunglison's American Medical Intelligencer, vol. ii . p. 29G. Philadelphia, 1839. Also, Boston Medical and Surgical Journal, Oct. 2, 1839, p. 126. f Boston Med. and Surg. Journal, Sept. 4, 1839, p. 65. X Amer. Journ. of the Med. Sciences, Oct. 1812, p. 288. { See the Author's General Therapeutics and Mat. Med. ii. 195. Philad. 1843. 166 CINCHONIA. Wheeler in the dose of 3j. from three to five times a day. It is most commonly, however, given in the form of the Decoctum cimicifngae. Decoction of black snake-root. R. Cimicifug. contus. 5J. Coque paulisper in Aquae, Oj. Dose. — One or two fluid ounces — two to four table-spoon- fuls — several times a day. Tinctura cimicifugrc. Tincture of black snake-root. R. Cimicifug. contus. §iv. Alcohol (.835), Oj. Dose. — Twenty drops three or four times a day. An idea prevails that the stronger the alcohol the better is the prepara- tion, but this may be questioned. L. CINCHONIA. Synonymes. Cinchonina, Cinchoninum, Cinchonin, Cinchonine. Although Duncan, of Edinburgh, Reuss, of Moscow, and Gomez,* of Lisbon, had endeavoured to separate the active prin- ciple of the cinchonas, and had given the term cinchonine to a resinous extract obtained in their investigations, the honour of discovering both cinchonia and quinia, and of applying them to practical purposes belongs to the French chemists — Pelletier and Caventou.t Cinchonia is commonly obtained from the gray or pale varie- * Richter's Specielle Therapie, B. x. S. 325. Berlin, 1828 ; and Magendie's Formulaire. f Annales de Chimie et de Physique, xv. 289 and 337. CINCHONIA. 167 ties of cinchona ; the yellow furnishing the quinia, and the red both cinchonia and quinia. It is an alkaloid strikingly analo- gous to quinia in its chemical and medical relations, but is not as much used. METHOD OF PREPARING. Cinchonia is obtained by boiling cinchona in alcohol, until it loses all its bitterness ; the alcoholic solution is then evaporated to dryness in a water bath ; the extract, thus obtained, is dissolved in boiling water, strongly acidulated with muriatic acid ; an excess of calcined magnesia is added, which, after a few minutes' boiling, will fix all the red colouring matter, and render the liquid clear. When cold, the liquid is filtered, and the magnesian pre- cipitate washed with cold water ; it is then dried in a stove, and all the bitterness separated by repeated digestions in boiling alcohol ; the alcoholic liquors are mixed, and the cinchonia crystallises as the fluid cools. Cinchonia, thus obtained, still contains a green fatty matter, which may be separated by solu- tion in a very weak acid. If the acid be too strong, it will dis- solve a part of the fatty matter, and the intended object will be thus defeated.* Cinchonia may also be obtained by treating pulverised pale cinchona by weak sulphuric acid, precipitating the solution by means of lime in excess ; collecting the precipitate on a filter, washing, and treating it, after drying, with boiling alcoholA Cinchonia is white, translucent, crystallising in needles ; re- quiring, for its solution, 700 parts of cold water, according to Magendie ; according to others, 2500 parts of boiling water. On account of its very sparing solubility in water it has but a slightly bitter taste. In alcohol, it is readily soluble, and the solution is extremely bitter, as well as the salts formed by its union with acids, which resemble the salts of quinia. It does not dissolve readily in fixed or volatile oils, or in ether. At a certain tem- perature, it volatilises ; a great part, indeed, is destroyed by the operation, yet a sensible portion escapes the decomposing power of the caloric. In medicine, pure cinchonia, as well as the sulphate and ace- tate, is prescribed. The sulphate is soluble in 54 parts of water, and in 6.5 parts of alcohol (s. g. 0.S15) : it is not soluble in ether. It forms crystals and tastes bitter. The acetate, on the other hand, does not crystallise; and is less soluble in water than the sulphate ; but an excess of acid facilitates the solution. * Magendie, Formulaire, &c. t Pbarmacopce Universelle, i. 414. Paris, 1828. .68 CINCHONIA. EFFECTS ON THE ECONOMY. It is not necessary to say much on the application of cinchonia and its preparations to disease, as they have been almost wholly superseded by quinia and its salts. It is a weaker article, and therefore requires to be given in larger doses • Magendie and Gittermann assert, that it. has been found ineffective as an anti- periodic. Bally,* Chomel,t Mariani,J Wutzer,§ and others, however, have exhibited it successfully. || DufresnelT frequently prescribed it, and he assigns it this claim to preference, that it is almost tasteless, or at least that the bitter taste is but tardily developed ; and that it need not be given in combination with acids, as the acid contained in the gastric secretions will render it soluble.** He gave it in intermittents, during the apyrexia, in the quantity of from six to twenty grains, and he found it of marked use in the cases of gastralgia with formation of acid, which are so often met with in young females, and are not un- frequently associated with leucorrhcea, hypochondriasis, melan- choly, &c. MODE OF ADMINISTERING. The following formulas have been recommended, but, as was before remarked, they are rarely used, the preparations of qui- nia being now almost universally prescribed. Syrupus cinchonia;. Syrup of cinchonia. R. Cinchoniae sulphat. gr. xlviii. Syrup. Oj. Used in the same cases as the Syrupus quinix ; a table- spoonful for a dose. Magendie. * Nouv. Biblioth. Medicale, ix. 189. f Nouv. Journ. de Medecine, Mars, 1821. X Osservaz. sulla Pratica del Solfato de Cinconina, &c. § Rust und Casper's Krit. Repert. B. xxi. and Bulletin des Sciences Medic. Sept. 1827. || Art. Cinchonine, in Merat and De Lens, Diet de Mat. Med. ]f Bibliotheque Universelle, Mai, 1831, p. 89. ** See, also, Ganz, in Bulletino delle Scienze Mediche di Bologna, Agosto et Settembre, 1836, p. 121. CINCHONIA. 169 I Yinnm cinchoniae. Wine of cinchonia. R. Cinchoniae sulphat. gr. xviij. Vini Maderens. Oij. Tinctura cinchoniae. R. Cinchoniae sulphat. gr. ix. Alcohol (34° or s. g. .847), f.gj. M. Magendie. Magendie. Magendie recommends, that this tincture should be used for preparing, extemporaneously, the wine of cinchonia, by adding two ounces of the tincture to a pint of Madeira wine. Boli cinchonia;. Boluses of cinchonia. Boli antifebriles. Febrifuge boluses. R. Cinchoniae sulphat. gr. iij. Micee panis, Mellis, Glycyrrhiz. aa. q. s. ut fiat bolus. Dose. — One, every two hours. Brera* Mistnra cinchoniae. Mixture of cinchonia. R. Cinchoniae sulphat. gr. vi. ad xlviij. Potassae acetat. Sacchar. aa. ^ss. Solve in Aqum anthemid. 3VJ. Dose. — A table-spoonful every two hours, in intermittent. Sundelin. * Ricettario Clinico di Brera. Padov. 1825. 15 170 LI. CODEIA. Svnonymes. Codeina, Codeinum, Codeine. German. Kodein. Although opium had been repeatedly examined by the che- mists, and certain of its active constituents separated from it, it was not until within the last few years, that the article, whose name is at the head of this paragraph, had been obtained from it. It was discovered by Robiquet in 1832,* and as it has been exhibited as a therapeutical agent, it requires notice. METHOD OF PREPARING. According to Winkler,t this new alkaloid may be prepared in the following manner. Morphia is first thrown down from a solution of opium, made in the cold, by means of ammonia ; the meconic acid is precipitated by the chloride of calcium ; for the removal of the colouring matter, the fluid is then treated with the extract or subacetate of lead ; and the extract of lead con- tained in the fluid poured off from the precipitates, is afterwards decomposed by sulphuric acid ; the fluid, separated from the sulphate of lead, is now treated with an excess of caustic alkali ; the mixture is exposed to the air until the excess of free alkali has attracted carbonic acid from it : it is then agitated and digested with ether, and left to evaporate spontaneously, after which a yellowish, highly transparent, but not crystalline com- pound remains, which forms with muriatic acid a crystalline salt, and resembles exactly the codeia of Robiquet. MerckJ procures codeia in a very simple manner, He treats morphia, precipitated by soda, with cold alcohol; the spirituous tincture is carefully saturated with sulphuric acid ; the alcohol drawn off, and the residue treated with cold water as long as it is turbid ; it is then filtered, and the filtered liquid evaporated until it has the consistence of syrup : on cooling, ether is poured over it in a large flask ; caustic alkali is added in excess, and the whole strongly agitated. The ethereal mixture is then so saturated, that codeia crystallises from it in a few hours. By * Journal de Pharmacie, xix. 91 and 162. Paris, 1833. f Buchner's Report, xlv. p. 459, cited in Journal de Pharmacie, xxi. 251. Paris, 1835. X Journal de Pharmacie, cited in Amer. Journal of Pharmacy, new series, i. 171. Philad. 1835. CODEIA. 171 evaporating the ether, and treating the residue with alcohol, the codeia is obtained, by degrees, wholly pure, and separated from an oily matter, which is a great obstacle to crystallisation. Codeia, according to Pelletier, consists of 31 parts of carbon; 40 parts of hydrogen ; 5 parts of oxygen, and 2 of azote. It is an alkaloid, soluble in water, alcohol and ether ; but not so in alka- line solutions. It unites readily with acids, and, with the chlo- rohydric especially, forms a salt, which crystallizes with great facility. When the crystals of codeia are heated on a plate of platinum, they burn with a flame without leaving any residue. Heated in a tube, they melt at about 150° centigrade ; and, if allowed to cool immediately, they form a crystalline mass •, if, however, the heat be continued, the oleaginous fluid rises along the sides of the tube, appearing to shun the heat; but it does not volatilise. When dissolved in water, codeia communicates to it decidedly alkaline properties. 1000 parts of water at 60° Fahrenheit, dissolve 12.6 parts of codeia; the same quantity at 100°, 37 parts, and at 212°, 58. 8 parts. If more codeia be added to boiling water than can be taken up, the surplus melts, and forms, like meconin, an oleaginous layer on the bottom of the vessel. This aqueous solution, by careful refrigeration, affords a translucent and uncommonly well defined metal. The tinc- ture of galls forms a copious precipitate with a solution of codeia, in which respect, the latter differs essentially from morphia, as it does in many other of its properties. EFFECTS ON THE ECONOMY. As morphia does not represent the whole of the activity of opium, Robiquet concluded, that other substances might concur thereto, and he conjectured that codeia might be one of those. Under this idea, Kunkel* instituted experiments with it on rab- bits and dogs, from which he obtained the following results. First. Codeia differs from morphia in this, that it does not, like the latter, paralyse the lower extremities. Secondly. Codeia appears to exert a powerfully excitant action. It occasions con- vulsions of the limbs, and of the muscles of the neck, and when it produces death, this seems to be owing to its action on the cerebellum and medulla oblongata ; twice, he noticed symptoms of backward progression under its use, and those parts after death were found turgid witli blood. To judge from the condition of the heart and lungs it affects likewise the circulatory organs. It occasions inflammation of the tissues, with which it comes in immediate contact. Its action is more energetic, when intro- * Journal deChirnie Mcdicalc, ix. 223. 172 CODEIA. duced into the cellular membrane, than into the stomach. It seems, also, to exhibit a special action on the urinary organs, for. animals to which it is given never evacuate their bladder as long as they are under its influence. Thirdly. The action of codeia differs from that of the watery extract of opium, in not paralysing the hinder extremities ; but it approximates it in this, that it acts, as has been said, more powerfully when introduced iuto the cellular membrane than into the stomach, and accele- rates respiration and circulation. Kunkel, however, remarks upon the results of his experiments, that they demand repeated trials for confirmation, as he was only able to experiment with a very small quantity of the substance. Robiquet observes, that Kunkel's experiments have led to the inference, that when codeia is combined with acids, it loses much of its efficacy — the very opposite, by the way, to the inferences of Magendie. Barbier* has taken considerable pains to fix the value of codeia as a remedial agent. He prescribed it in the dose of one or two grains in a syrup, prepared with the aqueous solution of the alkaloid, of such strength, that a table-spoonful or half an ounce contained one grain of codeia. In his opinion, it exerts a pecu- liar agency on the nerves of the ganglionic system, whilst it ap- pears to possess but little influence on the hemispheres of the brain, and to make no impression upon the spinal marrow. In the epi- gastric region, he remarks, the agency of codeia is powerfully manifested ; and here in the centre of the ganglionic system, its effects may be investigated, and their extent and magnitude ap- preciated. If a spoonful, or, at an interval of from one to two hours, two spoonfuls of the syrup of codeia be administered to one affected with the symptoms to be described immediately, it will be found, that it exhibits a considerable"and remarkable effect upon the economy. If the person complain of pain in the epigastric region, beneath the lower extremity of the ster- num, and stretching to the sides and back ; and if, with these symptoms, there is combined a feeling of heat, with indescribable anxiety, marked debility, paleness, decided alteration of the fea- tures ; a sense of painful traction sometimes on one side, at others on the other of the epigastric region, with tendency to syn- cope, frequent sighing, despondency, and more or less sensibility to pressure in the epigastric region, &c, Barbier considers the seat of the disease to be the epigastric nervous plexus ; and in such cases, he says, he has found no remedy superior to syrup of codeia. He has observed it afford decided relief, where the coats of the stomach were manifestly in a state of degeneration. A common effect of codeia is sleep; which is never accompanied by heaviness of the head, or by determination of blood to the * Gazette Medicale, Mars 8, 1834. CODEIA. 173 brain. When the persons awake from the sleep produced by it, the countenance is bright and lively, and there is a ten- dency to laughter. Barbier was led to believe, that it does not affect the nervous cords connected with the vertebral portions of the centre of the nervous system. In his observations at the hospital of Amiens, he often noticed the neuralgic affection of the abdomen above mentioned to be accompanied by pains in the head, loins, and limbs, and whilst codeia relieved the abdo- minal uneasiness, it left the others untouched, — a singular cir- cumstance if true, but requiring fresh observation before we can esteem it to be established. He remarks farther, that almost all the patients that were benefited by codeia had used laudanum unsuccessfully., Codeia, he adds, occasions no manifest change in the circulation and respiration ; it does not disturb the diges- tive function ; seems merely to diminish the feeling of hunger, and occasions no constipation. During its use, itching of the surface is frequently experienced. When applied, to the skin, it induces no striking phenomena. When placed, in the quantity of two grains, on a surface abraded by a blister, it excites a painful sensation of burning, without any other change appear- ing to supervene; — the neuralgic pains, for the removal of which it may have been thus employed, not appearing to be modified by it. Dr. W. Gregory made experiments upon himself and some of his pupils with nitrate of codeia. None of them experienced any effect from a dose of three grains and under ; from four to six grains, however, occasioned striking symptoms — quickness of pulse, sense of heat in the head and face, remarkable excite- ment, like that following the use of intoxicating liquors ; agree- able, and apparently permanent, stimulation, accompanied by considerable itching, which began at the head and extended over the whole body. To this succeeded, in the course of a few hours, a disagreeable sense of relaxation, with nausea, and often vomiting. None of the experimenters felt the slightest inclina- tion to sleep, until after the supervention of the feeling of relaxa- tion. Riecke* thinks that these experiments confirm Kunkel's observations, that codeia loses its efficacy when combined with acids. In the year 1834, M. Martin Solon, at one of the sittings of the Acadcinie Royale de Medecine, when the experiments of Barbier with codeia were the subject of discussion, confirmed his views regarding its soporific property. It appeared to him to allay the cough of the consumptive. He remarked, however, that he had not observed the effects on the ganglionic nervous system, which Barbier had witnessed. * Die neuern Arzneimittel, u. s. w. S. 140. Stuttgart, 1837. 15* 174 CODEIA. Magendie* took a grain of codeia, dissolved it in a little water, and injected it into the jugular vein of a middle-sized dog, which was immediately thrown into profound sleep — readily broken, however, by any strong noise made in the vicinity of the animal ; but the interruption was of brief duration, — sleep soon recur- ring. This condition persisted for several hours without being accompanied by any unpleasant symptoms. The effect was not the same with the muriate of codeia, a single grain of this salt, introduced in the same manner into the organism, suddenly in- duced deep sleep ; but, after the animal had slept five or six hours, it died. Several similar experiments afforded a like result. Magendie administered codeia in the Hotel Dieu to different patients. He found that* r one grain, given once or twice, suc- ceeded, in many cases, in inducing a quiet and soft, sleep, to which no confusion succeeded the next day, as is commonly the case with morphia. As respects intensity of action, he com- pares one grain of codeia to half a grain of morphia. Two grains often excited nausea, and even vomiting. Magendie found the muriate to be decidedly stronger than pure codeia. Two grains commonly induced, besides sleep, vertigo, nausea, and even vomiting ; but this dose succeeded like a charm, in cases of neuralgia faciei and in sciatica, that had resisted the most valued agents.! Dr. Miranda, of the Havana, has published^ the results of his experience with codeia in what he calls powerful nervous irri- tations of the mucous membrane of the stomach, and he affirms, that he cured eleven cases by the syrup of codeia alone. He began with a dram of the syrup night and morning, and gra- dually increased the quantity to an ounce in the twenty-four hours. His success was so striking that he is induced to " re- gard the discovery of codeia to be fortunate for humanity, espe- cially in climates like that of the Havana, in which gastrites are so multiplied." Syrupus eodeiae. Syrup of codeia. This is directed by M. Cap§ to be prepared in the following manner : — R. Codeiae, gr. xxiv. Aquae destillat. f.3iv. Sacchar. 3*viij. Reduce the codeia to an impalpable powder in a glass or por- * Formulaire pour la preparation et l'emploi deplusieura nouveaux medica- ment Edit. 9me. Paris, 1836. f Gully's Translation of the 8th edit, of Magendie's Formulaire. Lond. 1835. X Journal de Pharmacie, xxiv. 145. Paris, 1838. § Ibid, xxiii. 418. Paris, 1837. COLCHICUM. 175 celain mortar. Triturate with one-third of the water, allow it to settle and decant. Treat the residuum with another third of the water, and again with the remainder. Put the whole into a small mattrass, covering the opening with a piece of moistened parchment perforated with a pinhole. Heat in a water bath until the codeia has entirely disappeared. Remove the mattrass from the fire to add the sugar ; cover the opening again ; agitate, and put the vessel again in the bath, until the sugar is completely- dissolved. Each ounce of the syrup contains two grains of codeia. The muriate has been used in this city, but it has not been found to possess any virtues which the salts of morphia do not ; whilst its price has been enormous — as much, we are in- formed, as four dollars the dram. L1I. COL'CHICUM. Synonymes. Colchicum Autumnale, Meadow saffron. French. Colchique, Tue-Chien, Mort aux Chiens, Safran des Pres, Safran Batard, Vieillotte. German. Herbstzeitlose, Zeitlose, Wiesensafran, Herbstblume. Meadow saffron is a well-known plant in the temperate parts of Europe, where it grows wild in moist meadows. It belongs to the Family Colchicacese ; Melanthaceae {Lindley) ; and to Sexual System Hexandria Trigynia. The plant is avoided by cattle ; and its active poisonous properties have been long known ; fatal cases, indeed, still occur every now and then from its employ- ment, not only in animals, but in consequence of its too free use in the treatment of gout. Reynolds, the inventor of the wine of Colchicum, commonly called " Reynold's Specific," is said to have killed himself by an overdose of it. A case is given of a man who took, by mistake, an ounce and a half of the tincture, and died in forty-eight hours, after suffering much from vomit- ing, acute pain in the stomach, colic, purging, and delirium. 1 The cases of two children are also on record, who were poisoned by a handful of the seeds, and who died in the course of the day, death being preceded by violent vomiting and purging. In the bodies of these children, considerable redness of the mucous coat Bdin. Med. and Surg. Journal, xiv. 262. 176 COLCHICUM. of the stomach and small intestines was found ; in other cases, no morbid appearance has been detected.* A fatal case has been published by Dr. Blumhardt, from the papers of Dr. Neubrandt. The patient, a man aged thirty- two, took by mistake a decoction made of a large table- spoonful of the seeds of Colchicum to three pints of water. He was soon afterwards attacked by vomiting, purging, and died two days afterwards under symptoms of narcosis and endo- enteritis. Another fatal case, which was caused by the leaves of the Colchicum,! is referred to, in the same journal 4 Colchicum is not of modern introduction. It is, indeed, the Hermodactyl of the ancients. It had, however, almost wholly fallen into neglect, when its use was revived in Great Britain, in the first quarter of the present century, as an excellent agent in rheumatic and gouty affections. That it is highly esteemed as a therapeutical agent is shown by the number of officinal works into which it has been admitted. Amongst others, it is in the Pharmacopoeias of the United States, Austria, Amsterdam, and Anvers, and in the Batavian, Belgic, Brunswick, Danish, Dublin, Spanish, Edinburgh, Paris, Ferrara, Geneva, Hamburg, Hano- verian, London, Lisbon, Russian, Saxon, Swedish, and Wir- temberg. Several chemists have investigated the composition of the plant. Pelletier and Caventou believed, that they had found veratria in it ; but, from the examination of Geiger and Hesse, it appears that the alkaloid, discovered by those gentlemen, was not vera- tria, but apeculiarprinciple, colchicia or colchicine, which is found in every part of the plant ; crystallises in slender needles, is in- odorous, and of a very bitter, and afterwards biting taste. In- troduced into the nose, it does not occasion sneezing like veratria. It has a feeble alkaline reaction ; but neutralises acids com- pletely, and forms with them crystallisable salts, which have also a bitter pungent taste. It dissolves with tolerable facility in water. For therapeutical purposes, the root or bulb, {cormus,) as well as the flowers and seeds have been administered. The fresh root has a somewhat disagreeable smell, and a bitterish acrid taste. When chewed for any length of time, it excites the secretion of saliva and thirst ; destroys the sense of feeling in the tongue ; causes a sense of burning in the mouth and lips; constriction of the fauces, hiccup, violent pains in the abdomen, * Christison on Poisons, 3d edit. p. 791. Edinb. 1836. I See a case of overdose of Colchicum, by Mr. T. A. Henderson, in Lond. Med. Gaz. Aug. 17, 1839, p. 763. I Medicinisches Correspondenzblatt, 1840, and Encyclographiedes Sciences Mcdicales, Mai, 1840, p. 492. COLCHICUM. 177 vomiting, diarrhoea, and discharge of blood upwards and down- wards. By drying, the bulbs lose somewhat of their efficacy. The seeds have of late come much into use. They are inodorous, but of a very acrid taste. Their agency is like that of the bulb, and — some think — they are more equable in their effects. To ensure this, however, they must be gathered wholly ripe, when they first become entirely black. They have been highly recom- mended by Dr. Williams and others. The flowers are the mildest part of the plant. They have likewise been successfully administered by several English phy- sicians. EFFECTS ON THE ECONOMY IN HEALTH. In its effects, colchicum resembles digitalis in one thing, that it renders the pulse less frequent,* according to Thomson and Willis ; but, in other respects, Osann and Riecket think it agrees more with the squill. J In moderate doses, the different parts of the plant that have been mentioned act as diaphoretics, diuretics, and cathartics. On the digestive organs, they are conceived to produce less debilitating effects than the squill. Sir Everard Home ascribes much of the griping and nausea- ting effect, that sometimes follows the use of the vinous and other tinctures of colchicum, which have not been carefully filtered, to the sediment which forms in them, and which may be removed without injury to the desired effect of the medicine. § Sir C. Scudamore,|| however, found the sediment to be inert. Several experiments were made with colchicum on healthy individuals. In the first case, 160 drops of the vinous tincture of the seeds were taken in 24 hours, by a young man aged 18 ; — the first dose being 50 drops, the last 60. Seven copious evacu- ations were produced, with loss of appetite and debility for 24 hours. In the second case, a youth, 17 years old, took 170 drops in 9 hours, in doses of 70, 30, and 40 drops ; nausea and vomit- ing, and six copious evacuations followed. Third case ; a youth, aged 15, took 130 drops in 10 hours, and in four doses; the first of 40 drops, and the last three of 30 ; vomiting and only one stool were the result. Fourth case ; a youth, aged 12, took 60 * Art. Colchicum, Encyc. Wbrterb. der Med. Wissensch. viii. 136. Berlin, 1832. t Op. cit. S. 142. £ See the Author's General Therapeutics and Materia Medica, i. 289, Philad. 1843. 5 Brande's Dictionary of Materia Medica, p. 189. Lond. 1839. || Treatise on Gout, 3d edit. p. 513. 17S COLCHICUM. drops in two doses, after an interval of eight hours : nine copious watery evacuations were produced. Fifth case ; a youth, aged 17. took 40 drops at bed time, 30 drops next morning, and 30 drops seven hours after — in all, 100 drops in 19 hours : vomit- ing and faintness, and five copious evacuations were the result. The same boy afterwards took 70 drops at one dose, which were followed by vomiting and headach, but not by purging. Sixth case ; a boy, aged 10, took 80 drops in 24^ hours, in four doses, of 20, 15, 25,^ and 20 drops : great sickness and vomiting, and nine evacuations resulted. EFFECTS ON THE ECONOMY IN DISEASE. The diseases in which colchicum is recommended, are as fol- lows : — In gouty and rheumatic cases, it has been supposed to be almost a specific. Numerous practitioners have testified to its valuable agency in such affections ; among these may be named Mr. Want, Dr. Johnson, Dr. Williams, Mr. Battley, Dr. Arm- strong, Sir Everard Home, Sir C. Scudamore, Mr. Haden, Dr. Copland, Dr. Graves, Sir Henry Halford, Dr. Wallis, Dr. Bar- low,* and Mr. Wigan,f in England ; and Locher-Balber, Kah- leis, Gumpert, Plasse, Weber, Klokow, Biermann, &c, in Ger- many.;]; In rheumatic gout, Mr. Wigan gives it in the dose of eight grains every hour, until " active vomiting, profuse purg- ing, or abundant perspiration takes place, or at least until the stomach can bear no more." Thus administered, he pronounces it to be " the most easily managed, the most universally applica- ble, the safest, and the most certain specific [?] in the whole compass of our opulent Pharmacopoeia." Colchicum is presumed to be the active ingredient of the cele- brated gout remedy — Eau medicinale d'Husson — which has been considered to be formed of two ounces of colchicum root, macerated in eight ounces of Sherry wine ; the dose being from twenty to eighty drops. In acute rheumatism, as well as in various inflammatory affections, colchicum was proposed by the author's friend, Mr. Charles T. Haden, § as an excellent sedative to reduce excited organic action, which he conceived it capable of effecting to such an extent, that bloodletting might generally be rendered unneces- * Art. Gout, in Cyclopaedia of Pract. Med. | Lancet, and Med. Gaz., June 30, 1838. \ Riecke, Op. cit., and Richter's Specielle Therapie, x. 180. Berlin, 1828. § Practical Observations on Colchicum Autumnale in Inflammatory Dis- eases. Lond. 1820. COLCHICUM. 179 sary in febrile and inflammatory disorders ;* yet, in the very cases in which it was esteemed so appropriate by Mr. Haden and by Carminati,t it is regarded unadvisable by others. Thus, Riecke,| speaking of its use in acute rheumatism, says, that it was atone time given in that disease under the most opposite cir- cumstances, but that it was soon found necessary to restrict its employment within narrower limits, and to pretermit it when any considerable febrile condition existed. The author has often exhibited the different preparations of colchicum in gout, and frequently with decided advantage ; but very often it has failed altogether. In his own person, it has never appeared to prevent or to modify the paroxysm. In acute — and the same may be said of chronic — rheumatism, its advan- tages have not been by any means clearly marked in his experi- ence ; many physicians, however, testify most strongly in its favour. Like other acro-narcotics,as the cimicifuga, when pushed to the extent of slightly affecting the system, as shown by nausea, with some cerebral confusion, it has at times, affected a revul- sion, which has broken in upon the morbid chain in cases of acute rheumatism. Recently, a severe case of acute rheumatism, under the author's care, yielded rapidly to colchicum, pushed to the extent of inducing painful diarrhoea, accompanied by dis- tressing tenesmus. In this case, twenty-five drops of the tinc- ture of the seed were given three times a day. When the bowels become affected, the remedy must be discontinued altogether, or the quantity be diminished. By attending to these rules, Dr. Christison§ affirms, that he has never had occa- sion to observe any unpleasant effects from the use of colchicum, or any symptoms, which a dose of opium did not readily subdue. He adds, that he has never seen a case of rheumatism essentially benefited, till the patient suffered from colic and diarrhoea on the one hand, or from frontal headach and giddiness on the other. The ill success, which some practitioners have encoun- tered in using colchicum, he thinks may have arisen from inatten- tion to this circumstance. In chronic rheumatism, it has exhi- bited less marked results ; yet there is no agent, perhaps, which is so much employed in rheumatic cases in general. In none of these cases, according to most observers, need any sensible evacu- ation be produced by it, although some, we have seen, have affirmed — and such is the result of our observation — that it is * See, also, Dr. Lewins, in Edinb. Med. and Surg. Journal for April, 1837, and in Brit and For. Med. Review, for Oct. 1837, p. 565. t Memor. dell' Instituto del Regno Lombardo-Venet. 1819. % Op. nit. S. 143. § Dispensatory, p. 355. Edinb. 1812. 180 COLCHICUM. more efficient when it evinces its influence upon the alimentary- canal.* The vinous tincture of the seeds has been extolled in the teta- nus of warm climates, by Dr. W. G. Smith,f of Port-au-Prince. He begins with 3ss. and increases the dose every half hour, repeating it until emesis or catharsis has been produced. The remedy is then discontinued. In dropsy, colchicum was used of old with good results ; and it has been employed in modern times. Carminati gives the details of a case of dropsy supervening on scarlatina, and Plasse, one of hydrothorax, in which it was advantageously prescribed. In such cases, it may be well to push the remedy until it affects the bowels. In chronic bronchitis, it has been given by many physicians, and especially by Drs. Armstrong:}: and Hastings,§ with advan- tage ; and Dr. Pereira|| found it of great service, in humoral asthma, and other chronic bronchial affections, especially when these complaints were accompanied with anasarcous swellings. By Rittonl it has been advised as an extremely efficacious remedy in leucorrhcea, in the dose of five grains of the powder three times a day ; and in several spasmodic diseases it has been extolled by Raven. Mr. Tait** speaks in exalted terms of it in scarlatina — the dose, to children from four to six years of age, being three or four drops of the vinum colchici every three or four hours. Mr. Fosbroke advises it in ischuria; Elliotson saw favourable effects from it in obstinate prurigo; Bullock gave it in erysipelas ; and by Chisholm and Baunibachtt it was exhi- bited successfully against tape-worm. Colchicum is sometimes applied externally as a liniment to rheumatic joints, in the form of the tincture of the seeds or bulb.} % Of late, it has been recommended, by Mr. Wansborough in gout ;§§ two drams of the tincture of the seeds being added to siv. of a spirit lotion. It is affirmed, however, that the local use of morphia had the same effect,|||| — the part being bathed in * See Wood and Bache's Dispensatory, Art. Colchicum ; and Lewins, Op. chat. | Amer. Journal of the Medical Sciences, for Nov. 1835, p. 66. \ Pathology of Consumptive Diseases. Lond. 1822. § Inflammation of the Mucous Membrane of the Lungs. Lond. 1821. || Elements of Materia Medica, &c. ii. p. 947, Lond. 1842; or Amer. Edit, by Dr. Carson, Philad. 1843. % Lancet, Aug. 2, 1834. ** Amer. Jour, of the Medical Sciences, May, 1838, p. 205. ff Rust's Magazin, B. xxi. S. 270 ; and Osann, in art. Colchicum, in Encyc. Wbrterb. der Medicin. Wissenschaft. B. viii. S. 136. Berlin, 1832. XX Diet, de Matiere Medic, par. MM. Merat and De Lens, ii. 361. §§ Lancet, July 29, 1837. (HI Ibid. Aug. 5, 1837. COLCHICTTM. 181 hot water for a minute, and then lint being applied, spread with simple cerate, on which about three grains of acetate of morphia were distributed. Still more recently, Mr. Laycock* has advised the tincture of the root as an external application in rheumatism, alone or com- bined with tinctura camphorse. It has been used in the author's Clinique at the Philadelphia Hospital, and often with advantage; but whether much or any of the benefit was produced by the colchicum, he was unable to decide. MODE OF ADMINISTERING. Colchicum is not so frequently given in substance, although it is often prescribed in this form. The dose of the powdered root is from three grains to ten, several times in the day. The offici- nal preparations of this country and Great Britain are : — acetum colchici (United States and London) ; oxymel colchici (Dublin) ; syrupus colchici (Edinburgh) ; vinum colchici radicis (United States and London) ; and extr actum colchici aceticum (Lon- don). These are made from the bulb. The officinal preparations from the seeds are tinctura col- chici seminis (United States and Dublin) ; and vinum colchici scminis (United States). t The London Pharmacopoeia has, like- wise, a spiritus seminis colchici ammoniatus or tinctura col- chici composita, which is much used by the English physicians, and is formed by macerating two ounces and a half of bruised colchicum seeds in a pint of aromatic spirit of ammonia. Bat- tley recommends an extractum colchici e succo bulborum recenter expresso, and such a preparation is in the Pharmaco- poeia of Austria, j The dose is two grains every two hours. Dr. A. T. Thomson recommends a saturated vinous tincture, made by macerating an ounce and a half of the dried bulb in twelve ounces of white wine. From thirty to sixty minims are given to gouty patients when in pain. The dose of the powdered root or seed is, as we have said, from three to ten grains ; of the acetum colchici, from thirty mi- nims to one fluid dram ; of the syrupus colchici, from one fluid dram to half a fluid ounce ; of the vinum colchici radicis, from fifteen minims to one and a half fluid dram ; and of the vinum colchici seminis, from one to two fluid drams. Dr. Copland§ suggested the use of the fresh flowers in the form * Lond. Med. Gaz. March 1G, 1839, and Juno 8, 1839, p. 388. f See the Author's General Therapeutics, Philad. I8.'{(;, and his General Therap. and Mat. Med. Philad. 1813 ; also, the Dispensatory of Messrs. Wood and Bachc. X Jourdan's Pharmacopce Universelle, i. 436. Paris, 1828. § Lond. Med. Repos. 1823. 16 1S2 C0LCHICT7M. of vinegar, tincture, &c, as milder than the seeds or bulbs, and yet equally efficacious in rheumatic and other affections ; but they are not employed. Mistura colchici. Mixture of colchicum. Scudamore's mixture. R. Magnes. sulphat. 5J. ad 3*ij. Solve in Aquae menth. crisp, f. ^x. Adde Acet. colchic. f.3J. ad f.giss. Syrup, croc. f.gj. Magnes. 9viij. M. To be well shaken. Three table-spoonfuls to be administered, so that from four to six evacuations may be produced in twenty- four hours. Given in paroxysms of gout. Sir C. Scudarnore. Guttse colchici composite. Compound drops of colchicum. R. Extract, aconit. ^i. to Jss. Solve in Vin. colchic. sem. f.3"ss. M. Fifteen, twenty, thirty, or forty drops to be given three times a day. Weber. R. Tinctur. colchic. sem. guaiac. aa. f.Jiij. M. Dose. — Thirty or forty drops three times a day, in chronic rheumatism. Blasius. R. Tinct. colchic. sem. digit, aa. f.3'j- Sp. aether, nitric. 3ss. M. Dose. — Twenty drops, on sugar. Hildenbrand. COMPRESSIO. 183 Pilulffi colchici. Pills of colchicum. R. Colchic. pulv. gr. iij. Saponis q. s. ut fiat pilula. Dose. — Three daily, increasing the quantity to five or six. Ritton. Linimentum colchici et camphorrc. Liniment of colchicum and camphor. R. Tinctur. rad. colchic. Tinct. camphorze, aa. partes sequales. M. Laycock. LIII. COMPRES'SIO. Synonymks. Compression, Methodical Compression. German. Druck. This valuable method of modifying the condition of the capil- lary or intermediate system of vessels, and, through it, the func- tion of nutrition, has lately become more extensively employed in the treatment of disease. As a sorbefacient,in various hyper- trophies and dropsies, it has long been used wherever its agency was applicable, and its effects have been very decided.* Of late, it has been proposed in inflammatory and other affections, in which it had been previously esteemed inapplicable. Up- wards of twenty years ago, it was highly recommended in rheu- matic affections, by Dr. William Balfour,t of Edinburgh; and numerous cases were brought forward by him, and by others, to attest its efficacy. Since then, it has been advised by G uerin,J * Clinique Mcdicalede l'HOpital Necker, p. 2-17, Paris, 1835; or the trans- lation in Dunglison's American Medical Library, first year. See, also, the Author's General Therapeutics, p. 228, Philad. 1836 ; and his General Therap. and Mat. Med. ii. 289, Philad. 1813; likewise, Morelli, Annali Universali di Medicin. Marzo, 1840, and Brit, and For. Med. Rev. Jan. 1841, p. 237. f A new mode of curing Rheumatism and Sprains without Debilitatino. Edinb. 1817. \ Journ. Analyt. i. 90. 184 COMPRESSIO. in cases of phlegmonous erysipelas of the extremities ; by Vel- peau,* in severe barns, and phlebitis, and in inflammation of the synovial apparatus ;t and, still more recently, Mr. James AllanJ has related three cases of phlegmasia benefited by a similar treatment; — two were of erysipelas of the lower ex- tremities, and one of the face. In these, compression was of speedy and permanent benefit, — the pain caused by it being very transient. He states, moreover, that he has found the bandage of very great service in removing the pain and swelling of joints affected with acute rheumatism, after the more active degree of inflammation had passed away. In cases of external inflammation, compression acts probably in two ways, — first, by diminishing the circulation in the inter- mediate system of vessels concerned in the pathological condi- tion ; and, secondly, by restoring tone to the over-dilated vessels ; for it is in erysipelatous affections, in which this form of hyper- emia more especially exists, that we have found it of greatest advantage. Numerous cases of erysipelas of the extremities have been treated by the author by compression, and with the greatest benefit. He is constantly, also, in the habit of employ- ing compression, under the circumstances mentioned by Mr. Allan, in arthritic affections, which are usually attended with great effusion, and with the most satisfactory results. From an observation of the good effects resulting from com- pression in analogous cases, it occurred to Dr. Fricke,§ of Hamburg, that it might be employed with advantage in cases of orchitis, or swelled testicle (hernia humoralis) ; which is fre- quently very tedious, and requires means, that are by no means easy of application. He, accordingly, had recourse to it, and the result was most satisfactory : he found, that " the disease could be removed by it in a simple, easy, and surprisingly rapid way." Dr. Fricke was not, however, the first to employ compression in this disease. It would seem, that as long ago as the year 1803, it was used at the Pennsylvania Hospital, by Dr. Physick, and by Dr. Hartshorne.|| Dr. Fricke is of opinion, that, gene- rally speaking, compression may be employed in every kind of inflammatory engorgement of the testicle, whatever may have been its cause, and at all stages of the disease. In many cases, the pain was at first, in some degree, increased ; and in some — especially when applied too tightly — it induced great suffering ; but this nevercontinued long, — thepatient,ina short time, finding * Ibid., and Bulletin General de Therapeutique, No. 16, Aout 30, 1836. f Nouv. Bib. Med., Aout, 1826; and Merat and De Lens, Diet, de Mat. Med. Art. Compression. X British Annals of Medicine, Jan. 27, 1837. § Zeitschrift fiir die gesammt. Medicin. B. i. H. 1, Hamburg, 1836. See, also, Brit, and For. Med. Rev. for July, 1836, p. 253. || American Journal of the Med. Sciences, Jan. 1842, p. 258. COMPRESSIO. 1S5 himself so much relieved as to be able to leave his bed and walk about the room. In many cases of recent origin, a single ap- plication of the compression was sufficient ; but when the dis- ease was of longer duration — say from three to eight days — it was found necessary to repeat the compression two or three times. Swelling of the spermatic cord, if not very considerable, did not contraindicate its use ; nor did other coexistent local affections, as buboes, ulcers, &c. When a general febrile state accompanied the orchitis, compression was found to be the best means for removing it, where the vascular action was not too considerable ; although, in extremely rare cases, such was the effect of the compression itself. When the pain was very severe, it was generally owing to the compression having been too strong, and the same was the case with certain signs of gastric derangement, that occasionally supervened. In these cases, it was necessary to suspend the remedy, until the derangement was removed, by the use of an emetic, or the application of a poultice to the stomach. Such cases were, however, extremely infrequent. The good effects of compression exhibited themselves very soon after its employment, and the speedy abatement of the pain was always the surest sign of its efficacy. If it continued for some hours in any considerable degree, a general disorder of the system might be looked for to explain the failure of success. In the summer of 1835, Dr. Fricke treated, in this manner, seventeen cases. Of these were cured ; — in one day, one ■ in three days, four ; in four days, two ; in five days, three ; in nine days, one ; and in ten days, two. The last three were severe and unfavourable cases. For the purpose of compression, he employed sticking plaster, made very adhesive, but not of too irritating materials, and spread on strips of linen, of the breadth of the thumb. No preparatory measures, as leeches, cataplasms, &c, are required. In slighter cases, the patient may stand before the surgeon leaning against the wall, or he may sit on the edge of a bed or sofa, in such sort that the scrotum may hang freely down. If the scrotum and neighbouring parts are much covered with hair, this must be removed ; but, generally speaking, it is unneces- sary. The following is the method he adopts for applying the com- pression : — The surgeon takes the scrotum in one hand, and separates the diseased from the sound testicle ; whilst, with the other, he gently stretches the skin of the scrotum over the former : the spermatic cord is isolated in the same manner. If the swell- ing of the testicle be considerable, it must be held by an assistant. The surgeon now applies the first strip over the isolated sper- matic cord, about a finger's breadth above the testicle, holding 16* 1S6 COMPRESSIO. the end of the strip with his thumb, and passing it round the cord. He proceeds in the same manner with the second strip, which must cover the former either in part or altogether. The first part of the process must be carefully done ; the strips must compress the cord closely ; for this purpose, the cord must be kept approximated to the skin, which must be tightly stretched over it ; otherwise, when the other extremity of the testicle is compressed, the upper end will be apt to slip upwards through the loose rings of adhesive plaster, which will not only occasion pain, but render the whole operation abortive. In this manner, the surgeon proceeds, applying strip after strip, the last always lying over its precursor by a third of its width, until the thickest part of the testicle — where it begins rapidly to decrease in dia- meter — is reached. The mode of procedure is now changed ; the surgeon lays hold of the part of the testicle already covered, and passes his strips longitudinally from above downwards over the lower portion of the testicle. In this way, the rest of the testicle is closely enveloped and compressed. The proper degree of compression will be indicated, in most cases, by the speedy disappearance of the pain which had previously existed. When both testicles are affected, they must both be included in the circular strapping — the testicle already covered serving as a point of support for the other, as there is not room enough for the application of the circular strips over the second, in the same way as over the first. In some cases, where the skin is irritable, ulcerations take place : small slits may then be cut in the plaster, and a Goulard lotion be applied. Generally speaking, the patient may leave his bed immediately after the strapping has been attached, and walk about the room ; and, where the inflammation has not been great, he may even attend to light labour out of door. When the strapping becomes loose, it may have to be reapplied, but often one application is sufficient. In orchitis, caused by blows or pressure, compression is re- garded by Dr. Fricke as the best agency. If the inflammation runs very high, he usually applies leeches, in the first instance, and keeps on poultices for a day or two ; but, in slighter cases, he has recourse immediately to compression. The principal advantages, which he considers this mode of treating orchitis to have over others, are : First. The speedy removal of the pain ; Secondly. The quick removal of the disease itself; Thirdly. The simplicity of the plan, and the slight trouble given thereby to the patient ; Fourthly. Its small expense : and, Fifthly. The comparatively slight care and attendance required on the part of the surgeon. The last two points, as he properly remarks, are of considerable importance in hospital practice. C0MPRESSI0. 1S7 Since this plan of treating orchitis was suggested by Fricke, it has been successfully employed by our hospital and other sur- geons, although it has been by no means extensively adopted. Several cases, too, have been mentioned by M. Dechange,* of Liege, formerly chef de clinique chirurgicale at the Hopital de Baviere. Of twelve cases of acute orchitis, thus treated, three were cured in three days ; and the remainder before the seventh day. Mr. Langston Parkert has also recently extolled this re- medy not only in ordinary swelled testicle, but in chronic ox sub- acute inflammation of the testes, whether dependent on syphi- litic causes or not ; and a still more recent writer:): affirms, that he has adopted the practice in many cases, and can speak most unequivocally in its praise. It may be employed, he remarks, in very acute forms ; and he has seen several instances, where the patients had not lain in bed an hour, " whilst under the ordi- nary antiphlogistic treatment they would have been confined from ten days to a fortnight." Methodical compression has been employed with advantage in mammary abscess, by MM. Trousseau and Contour. § They found it frequently to produce a cure when used at the com- mencement of the inflammation ; to relieve the pain when sup- puration was established ; and to be of great service after the abscess was emptied. The compression was made by means of strips of diachylon plaster, an inch broad, and several feet long, carried round the body, so as to produce regular compression of the whole breast. || Of late, compression op the arteries, as an antiphlogistic agent, has been revived by Goyrand, Malapert, and others ; the object being to prevent the afflux of blood to a part labouring under hypersemia. The origin of this idea has been a matterof controversy ;TI but, as Dezeimeris** has remarked, it certainly is not due to the gentlemen who have engaged in it. Blaud com- pressed the carotid in brain fever ; Autenrieth did the same, before Bland, in cases of convulsions. Earl, in epilepsy ; Living- ston and Kellie, in rheumatism ; Ludlow, in gout ; and Parry, of Bath, half a century earlier, employed compression of the * Bulletin Medical Beige, Aout, 1838, p. 218. f London Lancet, July 25, 1810, p. 610. See, also, J. Dixon, Lond. Lan- cet, Dec. 5, 1810. \ British and Foreign Medical Review, Oct. 1840, p. 393. § .Journal des Connaissances Med. Chirur. Fevrier, 1841. See, also, J. Bell, Lond. Med. Qaz., and Dunglison's Med. Intelligencer, Dec. 1841, p. 121. [| See, also, Littrc, .Tourn. des Connaiss. Med. Chirurg. Janvier, 1841 ; and Encyclogr. des Sciences Med. Marz, 1811, p. 523. If Gazette Medicale de Paris, No. 40, Nov. 18, 1837, and No. 47. ♦* Ibid. 1SS COMPRESSIO. vessels in different diseases, with the clearest appreciation of its modus operandi. Compression of the carotids has been used by M. Strohlin* in hysteric convulsions, and has almost always succeeded in modifying the form of the attack. He used it in two cases of epi- lepsy with similar success. Compression of the carotids at the commencement of the paroxysm always caused them to cease in a minute afterwards. M. Alliert has published a case of intermittent neuralgia of the lobe of the right ear, cured by compression of the primitive carotid of the same side : half an hour before the paroxysm, the compression was exerted, with interruptions of five minutes every quarter of an hour. He has, also, reported a case of neu- ralgia of the orbito-frontal nerve; and, subsequently, of the nervus pudendus superior, respectively cured by compression of the carotid, and abdominal aorta. The compression of the carotid of the affected side was continued the whole forenoon, with pauses of five minutes every quarter of an hour. For the pudic neuralgia, the abdominal aorta was compressed for the space of three-quarters of an hour : the neuralgia, in both in- stances, gradually ceased. M. DufresneJ has published a case of hemicrania and facial neuralgia of the right side, cured by the same means. Com- pression of the right primitive carotid for ten seconds occasioned instantaneous disappearance of the pain, which returned in one minute after the removal of the pressure. Compression of the same vessel for twelve seconds caused instantaneous disappearance of the pain, but it shifted to the posterior part of the head. This pain ceased with the removal of the pressure, and in two minutes afterwards the original pain reappeared on the right side. When graduated compression was made on the same vessel for thirty seconds, the pain, as before, moved to the posterior left part of the skull. M. Dul'resne then pressed on the left carotid, and, increasing the force as he diminished that on the right side, the posterior pain disappeared, and no return of either had taken place ten minutes afterwards. The patient slept well, and made no complaint of pain in the morning. Compression of the abdominal aorta has likewise been revived by M. Baudelocque, and many others, with the view of arresting uterine hemorrhage occurring in labour, as well as the hemor- rhages which follow wounds' of the arteries of the inferior half of the body.§ In a case of uterine hemori-hage, detailed by Dr. * Archives Getieral.de Medecine, Mars, 1841. t L'Experience, No. 16, Jan. 20, 1838. I Ibid. No. cxxviii. Dec. 1839. § See an account of M. Baudelocque's views, by Mr. J. C. Christophers, in Lancet, July 20, 1839, p. 599. COMPRESSIO. 1S9 Ehrenreich,* external compression by the hand on the abdomen, which is the only way of acting on the aorta when any obstacle exists to the introduction of the hand into the uterus, was tried without success, owing to the thickness of the abdominal parietes. The hemorrhage was, however, completely controlled by intro- ducing the entire right hand into the uterus, and making forcible pressure with the fingers in a conical shape on the aorta imme- diately above its bifurcation. Many similar cases have been published, and referred to by M. Piedagnel, in a memoir communicated to the Societe Medi- cate d y Emulation, of Paris, on which an excellent report was read by MM. Velpeau and Briere de Boismont, giving a history of the process. It is necessary, at times, that the compression should be continued for a considerable period, even for an hour or two, should the case seem to require it. The gentlemen, last cited, advise that it should be associated with ergot.t Lastly : M. AllierJ employed compression of both carotids in a case of hydrophobia at the commencement of an attack ; im- mediately, the convulsion ceased, and the patient became appa- rently exanimate. The family were alarmed, and would not permit a repetition of the experiment. The case ended fatally. In paroxysmal diseases, the ratio medendi of compression is not the same as in inflammatory diseases. In the latter, the flow of blood towards the inflamed part is prevented by the com- pression of the arterial vessels proceeding to it ; but when com- pression is exerted on the vessels in neuralgia and congenerous diseases, the new impression caused by the resulting irregularity in the circulation, and the modification in the nervous function induced thereby, break in upon the morbid catenation like the different agents that are classed under the head of antispasmo- dics, of which class we have elsewhere endeavoured to show — what, by the way, is not now contested by any eminent thera- peutist — that we have none that can be regarded in any other light than as indirect agents.§ * Medicinische Zeitung. No. xxxvii. 1839, and British and Foreign Medi- cal Review, July, 1840, p. 279. f La Lancette Francaise, May 12, 1840. X Medicinische Zeitung, No. xxxvii. 1839, and British and Foreign Medi- cal Review, July, 1840, p. 279. § See the Author's General Therapeutics, p. 380; and his General Thera- peutics and Mat. Med. i. 395. Philad. 1843. 190 CONTRA-IRRITATIO. LIV. CONTRA-IRRITATIO. Svnonymes. Counter-irritation, Counter-action. German. Gegenreizung. It is not the object of the author to enter into an explanation of the therapeutical application of counter-irritants, or revellents in general; this he has done at considerable length elsewhere;* but to refer to some agents not mentioned in the body of the work, to which attention has been revived, or first directed, of late years more especially. AMMONIATED COUNTER-IRRITANTS. Gondrct's ammoniacal ointment; Granvillei's counter-irri- tants— Antidynoust counter-irritants, — Raspail's coun- ter-irritant. Ammonia has long been used in different formulas for exciting rubefaction and vesication of the cutaneous surface. When two parts of liquid ammonia are united with one part of suet, and one of oil of sweet almonds, the mixture forms the Pommade ammoniacale of Gondret, which has been used for a long time to excite a speedy revulsion in cases of chronic affections of the brain, incipient cataract, amaurosis, &c.,as well as to cauterise the integuments deeply. J To the advantages of this preparation, as well as of derivation in various diseases, M. Gondret has re- cently recalled the attention of practitioners in an ex professo treatise.§ The formula, given above, is that of the French Codex ; but, according to M. Trousseau, || it is much too hard for use, unless the weather is warm. He proposes two different formulas, — * General Therapeutics, p. 333 ; and Genera] Therapeutics and Mat. Med. ii. 216. Philad. 1843. f A term coined by Dr. Granville. It ought to be " Antodynous," from etvt-t, "against," and oJW», " pain." | Considerations sur l'emploi du feu en medecine, suivies de l'expose d'un moyen epispastique propre a suppleer la cauterisation, et a remplacer l'usage des cantharides. Paris, 1819; and Nouv. Biblioth. Med. iii. 441, 1828. § Traite theorique et pratique de la Derivation contre les affections les plus communes en general, telle que la Plethore, I'Inflammation, l'Hemor- rhagie, &c. Paris, 1837. || Journ. des Connaiss. Med. Chir., cited in Medico-Chirurgical Review, July, 1840. CONTRA--IRRITATIO. 1.91 one for summer, and the other for winter. In the former, he directs three parts of lard, one of suet, and four of liquor ammo- nias ; in the latter, equal parts of lard, and liquor ammonias. Since the appearance of M. Gondret's last work, Dr. Gran- ville* has published a treatise on counter-irritation, which has given rise to much attention on both sides of the Atlantic, — partly in consequence of the strong encomiums he has passed on certain counter-irritant applications employed by him ; and still more in consequence of the mystery, which he threw around them, by keeping their preparation a secret, until the united voice of the profession had expressed the mingled feelings of surprise, indignation, and regret, which such conduct on the part of an individual, holding an elevated position in the ranks of the pro- fession, naturally engendered. It is due, however, to Dr. Gran- ville to remark, that on subsequently publishing his formulas, he stated, that he addressed his work to the public to impress all with the value of the agency, but that it would have been unwise in him to give precise formulae to those who could not estimate the proper proportions of the ingredients ; that every physician can apportion them ; and that he had never concealed the for- mulas from his friends, and always intended to give them to the world, t Dr. Granville describes two sorts of ammoniated lotions, of different degrees of power, which are prepared in the following manner : — Each kind of lotion consists of three ingredients : — 1st. The strongest liquor of ammonia, A. 2d. Distilled spirit of rose- mary, B. 3d. Spirit of camphor, C. These are made as follows : — A. The strongest liquor of Ammonia. — Saturate a given quantity of distilled water, contained in a glass receiver sur- rounded by ice, with ammoniacal gas, obtained in the usual way from a mixture of equal parts of muriate of ammonia and recently slacked lime, both reduced to a fine powder. The water may be made to take up nearly 800 times its bulk of ammoni- ated gas under the circumstances described ; its specific gravity will then be about .872, and 100 parts of it will contain thirty- three parts of real ammonia, according to Sir H. Davy's tables. This solution of ammonia will, therefore, be more than three times the strength of the liquor ammonias of the Pharmacopoeia of London, 100 parts of which, at a specific gravity of .960, con- tain only ten parts of real ammonia. Dr. Granville, therefore, called this ^liquor ammonias fortissimus." The liquor a mmo- * Counter-irritation, its Principles and Practice, illustrated by one hundred Cases of the most painful and important Diseases effectually cured by Exter- nal Applications. London, 1838 ; or Dunglison's Amer. Med. Lib. edition. Philad. 1838. f London Lancet, Oct. 27, 1838. 192 CONTRA-IRRITATIO. nix fortior, of the last United States' Pharmacopoeia (1842), which is of the specific gravity 0.SS2, is of sufficient strength. B. Distilled spirit of Rosemary. — Take two pounds of the tips or small leaves of fresh ?'osemary, and eight pints of alco- hol; leave the whole in infusion for twenty-four hours in a well covered vessel, and after adding as much water as will just pre- vent the empyreumatic smell, distil over seven pints. The Pharmacopoeias of London and the United States direct the essential oil of rosemary to be distilled with alcohol to form the spirit of rosemary. Such a preparation Dr. Granville found unsuited for his purpose. C. Spirit op Camphor. — To four ounces of pure camphor add two pints of alcohol, so as to dissolve the camphor, which solu- tion should be filtered. The three ingredients, thus prepared, every medical man should keep always ready at hand, in well-stoppered glass bottles, so as to be able to make, extemporaneously, a counter- irritating lotion of any requisite strength, according to the nature of the case. But, for ordinary purposes, Dr. Granville advises, that both a milder and a stronger ammoniated lotion should be kept ready for use. Lotio amiuoniata initior. Milder ammoniated lotion. . Assuming the quantity of lotion desired to be divided into eight parts, the proportion of the ingredients will stand thus : — A — four-eighths. B — three-eighths. C — one-eighth, or as follows : — R. Liq. ammon. fort. f.Jj. Spirit, rosmarin. f.3vj. Tinct. camphor, f.Jij. M. Lotio ammoniata fortior. Stronger ammoniated lotion. If the quantity desired be also divided into eight parts, then the proportions of the ingredients will run as follows : — A — five-eighths. B — two-eighths. C — one-eighth, or as follows : — J&. Liq. ammon. fort. f.Jx. Spirit, rosmar. f.gss. Tinct. camph. f.^ij. M. C0NTRA-IRRITATI0. 193 Although the changes of proportion may be deemed trifling, yet the strength of this lotion is such, that Dr. Granville never employs it, except in cases of apoplexy, and for the purpose of cauterization. Directions in Mixing the Ingredients. — A and B are gradu- ally mixed together. The mixture becomes opalescent and somewhat turbid, and a peculiar, highly agreeable, ethereal smell is given out, different from the individual odour of either ingredient, although the extreme pungency of the ammonia is still discernible. " I have strong reasons to believe," says Dr. Granville, " that, at this point of the operation, some particular change takes place, which imparts to the mixture of the two ingredients some of its valuable peculiarities as a counter-irritant described in my work : but what that change is, it is not my business to enter upon in this place : suffice it to say, that in a great number of experiments made with the ingredients sepa- rately, (for each of them acts as a counter-irritant on the skin,) and with them combined, the effects were uniformly different ; those in the former case being found unequal to the production of those complete results which I trust I have justly promised to the prefession. Ammonia alone (however strong) will not give rise to the effects I have described, though it has often stopped internal pain, and produced small blisters ;, but never has it succeeded in almost immediately producing a full vesica- tion, as I have seldom failed to produce with the two ingredi- ents mixed together, particularly after the third ingredient had been added." Before, however, that third ingredient is so added, it is desir- able to clear the previous mixture, by the addition of a small quantity of alcohol, and to set the whole in a cool place. All the various precautions here mentioned may, upon an emergency, be dispensed with, when an immediate action is required, either to arrest pain or relieve deep-seated inflammation. But for the more delicate uses, particularly for instantaneous vesication, Dr. Granville recommends, that the preparations should be obtained in the manner specified. The lotion must always be kept in bottles with a glass stopper. M. Raspail* has recommended the following lotion, the effects of which, he says, are often instantaneous in relieving intolerable headach: R. Liquor ammon. p. 100 Aqu, ' I preserve :' — o-utv, ' preserver.' Fresh meat, placed in creasote water for half an hour or an hour, and then taken out and dried, may be * Dispensatory, p. 374, Edinb. 1842. t Journal de Chim. Med. and Amer. Journal of Pharmacy, July, 1841, p. 112. 204 CREASOTUM. exposed to the heat of the sun without undergoing putrefaction. Nay, when flesh has begun to be putrid, the process ceases after it has been washed with creasote water, and if suffered to remain immersed in it for an hour, it does not subsequently putrefy. There can be but little doubt, consequently, that creasote is the main antiseptic and conservative principle of pyroligneous acid, and of tar water. From the experiments made by Reichenbach to determine the exact components of the flesh on which the creasote acts, he arrived at the following results. It unites with the albumen and red particles of the blood in the flesh, which it coagulates, without acting on the fleshy fibre, which serves merely as the frame-work for the coagulated matters ; and it is well known that dried albumen does not putrefy, but becomes hard, brittle, and transparent. EFFECTS ON THE ECONOMY IN HEALTH. Reichenbach has properly remarked, that the excessive burning pain in the tongue, which creasote causes, must have at once suggested it to be a poisonous substance. It was soon found, that plants, sprinkled with creasote water, died ; that fish placed in it were convulsed ; and that small animals, as wasps and flies, died when touched with the pure article. If a small quantity of it be spread upon the hand, and washed off a minute after- wards, the place is found to present a white appearance, but without pain or inflammation. In the course of a few days, the place becomes dry, and the cuticle desquamates. When creasote is applied to a part where the epidermis is deficient, or to a wound, instantaneously an extremely violent burning pain is ex- perienced, which continues for eight or ten minutes ; but if the part be carefully washed, it gradually ceases. The cause of this is conceived to be the property which creasote possesses of coagu- lating albumen ; and, where blood is flowing, of arresting it. If the rapid disturbance which it excites, affects important organs, death results sooner or later according to their import- ance in the economy : relief, however, may be afforded by those substances that dissolve coagulated albumeu, as caustic alkalies, acetic acid, &c. It is probable, however, that the poisonous properties result from its acrid character. To appreciate the physiological effects of creasote, experiments have been undertaken by many individuals. Miguet gave a young dog, for eight days, an ounce a day of distilled water con- taining four drops of creasote, without any effect. When, how- ever, he doubled the dose, nausea, languor, subsultus tendinum and tremors occurred, followed, in the course of a few days, by marked emaciation. On discontinuing the creasote, the functions CREASOTUM. 205 gradually resumed their pristine condition, and the animal reco- vered its flesh. To another dog, he gave at once two drams in half an ounce of water, and immediately thereafter great prostration of the muscular system ensued, — vertigo, fixed eyes, stupor, dyspnoea, accumulation of mucus in the air passages, spasmodic cough, discharge of large quantities of foamy saliva, with vomiting of a milky matter, although the animal had taken nothing of the kind. After two hours of suffering, the animal died of convulsions. The body was immediately opened : all the tissues, except the liver, exhaled a strong smell of creasote ; and the whole of the mucous membrane of the intestinal canal was inflamed. The matters contained in the stomach coagulated when placed in contact with albumen. When heated, they yielded a thick smoke, and a marked smell of creasote. In the heart and large vessels, the blood was more firmly coagulated than usual : the lungs were gorged with blood ; in the brain there was no evidence either of congestion or hemorrhage. In another dog, into whose carotid equal portions of water and creasote were injected, death resulted with similar phenomena, but more rapidly. The precise quantity of creasote used in this experiment is not stated. Simon, in his experiments, found that when ten drops of creasote, diluted, were injected into a vein, scarcely any effect resulted, Reiter and Miiller, who, likewise, made experiments on ani- mals, agree with Simon as to the result of injections of creasote into the veins ; no special symptoms were induced by it, but this appeared to be owing to the blood being instantaneously coagu- lated by it, which not only prevented the farther progress of the creasote, but also of the blood; hence no evil consequences re- sulted ; and it is probable, as Riecke has suggested,* that the weaker the solution of creasote, within certain limits, the greater may be its effect on the mass of blood. Corneliani,t an Italian physician, has also instituted a series of experiments with creasote on lambs, rabbits, &c. All these animals bore small doses of creasote — however unwillingly it might be taken — without any remarkable results, and without loss of appetite. Large doses, however, immediately occasioned general torpor, sudden inclination to pass the urine, paralysis — especially of ihc lower extremities — with or without convul- sions, and frequently the ejection of a bloody foam. When the doses were large, and it was but little diluted, death took place in a few minutes, and on examination, the inner lining of the * Die neuern Arzneimittel, u. s. w. S. 153. f Giornale delle Scienze Mcdino-Chirurgiche, No. 8. Febrajo, 1835 ; Brit, and For. Med. lievicvv, p. 2G5, Jan. 1830, and Journ. de Chimie Medicale, F6v. 1836. IS 206 CREASOTTJM. stomach was generally found corroded, yet not so constantly as to allow of death being ascribed to that circumstance. It followed, farther, from his experiments, that pure creasote applied to a denuded nerve, or injected only in small quantities into a vein, may occasion death suddenly, and that the applica- tion of the creasote to extensive wounded surfaces in the same animals may be ultimately followed by fatal consequences. Where a very large dose of creasote was administered, imme- diate death was produced without organic lesion. In the trials made with it by Dr. Elliotson* he found no action produced upon the bowels ; but it sometimes augmented the quantity of urine. He once saw it, in the dose of a minim three times a day, cause micturition nine times in an hour. In another case, in doses of three minims, it produced severe strangury. According to Simon, when applied to the muscles, it destroys the surface Tike a caustic. Muller and Reiter, in their experi- ments, found, that it speedily rendered the muscular fibres of a dirty-whitish appearance, and readily lacerable. When applied to the fresh blood of the hog, it converted the colour in an instant to an ashy-gray; after which it became black and quickly coagu- lated. Mixed, either pure or diluted, with blood, it thickens it; the mixture assumes a brown-red colour, and is found studded with small white points, which are nothing more than coagulated albumen. On exposing the coagulum to the air, it assumes a yellowish-red colour. Reich, on the other hand, who appears to have made many experiments with creasote, both in internal and external diseases, affirms, that he has never observed any caustic effect from it ; from which assertion, as Riecke has remarked,! the only inference to be deduced is, that he must always have applied it largely diluted. Fremanger likewise asserts, that when pure creasote is applied to the epidermis, it does not destroy it; but merely occasions more or less redness of the skin. When applied to a suppurating surface, it caused, instantaneously, the formation of a white pellicle, owing to its coagulating the albu- men contained in the secretion from the wound. Adventitious tissues, with which it is brought in contact, are destroyed by it. When placed between the lips of a wound, it prevents healing by the first intention, by coagulating the albumen ; and, conse- quently, it may be employed in all cases where it is desirable to prevent the growing together of parts. Fremanger, is, indeed, disposed to refer all its efficacy to the action which it exerts on albumen. Its long continued use often occasions an inflammatory condi- * Medico-Chirurg. Transact, vol. xix. Lond. 1835. f Op. cit. S. 154. CREASOTUM. 207 tion which, as Dr. J. L. Da Luz* observes, has nothing in com- mon with the disease for the cure of which it may have been prescribed. In a case of porrigo favosa, treated by it recently by the author, febrile irritation supervened, and the head was covered by an artificial eruption, which induced, however, a new action in the system of nutrition of the scalp, and after its subsidence, the porrigo was cured. Dr. Cormack, of Edinburgh, has likewise instituted various experiments on the lower animals to test the physiological effects of creasote.t In three experiments, about twenty-five drops of pure creasote were injected into the venous system of dogs. All the animals died. In every case of poisoning by it, which he has observed, Dr. Cormack found the following to be the symp- toms : — Its first deleterious action was a powerful one of seda- tion on the heart ; the vital energies of that organ seeming to be instantaneously paralysed. In some instances, hurried and sonorous respiration went on for more than a minute after the heart had ceased to beat. In general, one or two convulsions, resembling the tetanic, preceded death ; and, almost invariably before expiring; the animal uttered one or more shrill cries. In every instance, the atony of the heart immediately after death was very striking. From other experiments it appears, that when creasote is injected into the arteries the deleterious effects are of a much milder character, and if the dose be not large, the animal may experience but little inconvenience ; a circumstance, which proves the importance of a thorough admixture with the blood before the poisonous article reaches the heart ; such admixture not taking place to the necessary extent, when the poison is injected into the veins, but being readily effected when injected into the arteries, and consequently distributed through the system of nutrition. When taken for any length of time, the urine acquires a black- ish hue, and in some cases creasote may be recognised in it.| EFFECTS ON THE ECONOMY IN DISEASE. Creasote has been administered in various diseases ; the fol- lowing may be esteemed a summary of the chief therapeutical experiments made with it. 1. Hemorrhage. — The discovery of creasote happened at a * Jornal da Sociedade das Sciencas Medicas de Lisboa, torn. v. Lisboa, 1837 ; reviewed in Zeitschrift fur die gesammte Medicin. Oct. 1838, S. 224. f Op. cit. p. C6. % Dr. Macleod, in Med. Gaz. xvi. 599, and xvii. C53. 208 CREASOTUM. time, when the Acqua Binelli enjoyed more confidence as a styptic than it does now ; and the fancied probability, that the nostrum was indebted to creasote for its properties, gave rise to many experiments with the latter in cases of hemorrhage. One of the first, who instituted experiments with it on rabbits, was G. Simon. Not being able to obtain any striking results from the Acqua Binelli, he tried creasote, pure, as well as in the form of creasote water, and of an emulsion prepared with gum arabic ; and from the results of these he was led to affirm, that although creasote occasioned the coagulation of the albumen of the blood, it acted no better as a styptic than cold water. With the Acqua Binelli he was not able to coagulate albumen. The rapid sepa- ration of the albumen in the form of a reddish-gray coagulum under the influence of creasote, he found to be of no advantage, as the mass remained soft and pulpy ; and the wound in the vessel could not close, but was immediately opened by the stream of blood. Neither did he esteem it adapted for arresting trifling hemorrhages ; for, when very much diluted, it is still too exciting to the injured parts, and markedly delays their union. This, indeed, might, he thinks, be expected from the fact, that pure creasote, when placed on the skin for ten or twenty minutes, induces superficial inflammation. The experiments of other physicians have been decidedly more favourable. Muller and Reiter,* for example, in theirs, found that creasote was far more efficacious than the Acqua Binelli, for, when the latter was prescribed, it was always necessary to have recourse to other agents, before the hemorrhage was arrested. In their experiments on dogs, they found the hemor- rhage from a divided crural vein quickly cease, when a com- press of cotton, wetted with creasote, was placed on the vessel, with a moderate degree of pressure. Three days afterwards, the crural artery was exposed on the same dog, and divided; but it was afterwards necessary to tie it, as the creasote, in con- sequence of the excessive hemorrhage, could not be brought into immediate contact with the vessel, but merely acted on the superficial layer of blood, and therefore did not arrest the hemor- rhage. The crural artery of a young and tolerably strong dog was cut a short distance above its division, compression being at the same time exerted upon the trunk. The artery did not bleed. Nine minutes afterwards, a compress of cotton soaked in creasote was applied immediately to the divided extremity of the artery, with some degree of pressure. When the compress was re- * Schmidt's Jahrbuch, cited in Encyclographie des Sciences Medicales, Mars, 1837. See, also, Burdach, Medicin. Zeitung. Jahrgang, 1840, No. 31, cited in Lond. and Edinb. Monthly Journal of Med. Science, May, 1842. CREASOTUM. 209 moved, the bleeding was entirely arrested, and the wounded surface was dry, and had an ashy-gray hue. In an old dog, hemorrhage from a divided crural artery was arrested by the same means, but not so speedily. When the artery was examined, it was found to be wholly closed, having a navel-like depression at the extremity, which disappeared when the vessel was pressed upon, and ultimately became conical. Within the vessel there was a conical coagulum, which could be readily detached ; and for the space of a line, the artery appeared inflamed through its coats. In arteries that had been divided for a longer time, the union was likewise complete ; but there was this difference, that the inflammation at the end of the vessel had disappeared, and a pointed fibrous caruncle was observed in the vessel, which was doubtless the fibrinous portion of the previous coagulum. From their experiments, Miiller and Reiter were led to con- firm the hsemastatic properties of creasote, both when the hemor- rhage occurs from veins and from arteries. The arteries divided were of considerable size, larger than the radial artery of an adult male. They consider pressure indispensable to occasion the creasote to act immediately on the artery ; and the arrest of the hemorrhage, they ascribe, not alone to the coagulation of the blood, but to the contraction of the arteries. In parenchy- matous hemorrhage, creasote water was generally sufficient ; as well as in tolerably extensive wounds of the surface. Horing, also, obtained satisfactory results from his experiments on animals. He exposed, on an old cat, the crural artery and vein of the right side ; made a small incision into the latter, and pressed upon it to stop the copious flow which ensued : he then applied over the wound, for two minutes, a small compress of lint, wetted with a solution of creasote — two drops to one hun- dred of water — and the bleeding ceased. The artery was now opened, and a similar compress placed upon it with the same result. Two days afterwards, a second experiment was made of the same kind, except that, owing to the struggles of the ani- mal, a larger opening was made into the crural artery. In this case, it was necessary to apply the compress for four minutes before the hemorrhage ceased. In another cat, a large trans- verse incision was made on the inner surface of the right thigh, above the middle, by which muscles, arteries, veins, and nerves were divided. Two large compresses of lint, wetted with a solution of creasote, were then pressed on the parts for five minutes, and the bleeding entirely ceased. The like result was obtained in the case of an old horse, whose jugular vein was opened. But the creasote solution did not succeed in wholly arresting the hemorrhage in the same horse, when an opening was made into the crural vein and artery. 18* 210 CREASOTUM. To these experiments on animals may be added some that were instituted on the human subject, and which testify, more or less, to the efficacy of creasote as a heemastatic. Hahn applied it in some insignificant cases, but saw no better effect from it than from cold water. Most found it speedily arrest slight he- morrhage from small vessels. Horing applied it successfully in cases of epistaxis, which had obstinately resisted other agents, — two plugs of lint, dipped in a solution of creasote being inserted in the nostrils, after which the hemorrhage soon ceased. Ficht- dauer employed it with equally advantageous results in violent bleeding from leech bites, after several hsemastatics had been used in vain ; and Heyfelder extols it for arresting hemorrhage from large wounded surfaces. Berthelot differs with Frernanger and Simon, who affirm that union by the first intention is prevented by it. The results of his observation were entirely opposite. Miguet applied it suc- cessfully as a haemastatic in fresh wounds on man and animals. Both pure creasote and a solution of it were, however, unsuc- cessfully used by Bardiliin hemorrhage from the arteria tibialis poslica, which he ascribed to the blood having lost its albumen, owing to the excessive discharge. Reich and Hauff found injec- tions with creasote water very useful in hsemorrhagia uteri. Schneider had a case of hemorrhage that had continued for seven hours in a man eighty years old, and which proceededyrow the gums of the upper jaw ; the blood oozing as from the pores of a sponge. He directed the man to take as much creasote water into his mouth as he was able ; and after three repetitions the hemorrhage ceased, and did not recur. Kohler* endeavoured to test the haemastatic operation upon himself. He made an incision in his forearm an inch long, and three or four lines deep, to which he applied creasote water. A lancinating pain was felt in the wound, but no other sensible ef- fect. A drop of pure creasote was now let fall between the lips of the wound : this was followed by a sensation of burning and drawing ; for a moment coagulated flakes of a whitish-gray co- lour covered the wound, and there was a temporary cessation to the flow : it soon, however, recurred. After a time the hemor- rhage ceased; but not sooner — Kohler thinks — than if cold water had been applied. The feeling of burning and drawing continued, however, for some time ; the edges of the wound were somewhat swollen, and oedematous, and, in about four hours, were covered with a yellowish-brown lymph ; but there seemed to be no delay in the cicatrisation. In a case of lithotomy, it was found impossible to arrest the * Neue wissenschaftlich. Annalen, u. s. w. B. i. H. 3. S. 285. Berlir 1835. CREASOTTTM. 211 hemorrhage by any of the usual means, and no particular vessel could be discovered from which the blood flowed. The patient was at last reduced to the lowest ebb, from the continued loss of blood, and had already lost consciousness, when a sponge, dipped in pure creasote, was introduced into the wound, and pressed against the bleeding parts for an instant or two. The hemorrhage was immediately arrested. No particular pain was experienced ; no unpleasant symptoms occurred ; thin eschars were thrown off, and the patient recovered.* J. L. da Luzf found it an excellent styptic in capillary hemor- rhage; but in hemorrhage from great vessels it did not prevent a recurrence of the bleeding. In haemoptysis, the internal use of creasote has been found beneficial. SantiniJ prescribed it in a desperate case with com- plete success, and with Schmalz it was equally effective ; on the other hand, it was of little avail in Guitti's hands. In hsematemesis, it succeeded in the hands of Dr. Isaac Par- rish of Philadelphia, § after the remedies generally employed in such cases had failed to produce any effect. 2. Burns. — Most used creasote with decided relief in burns of the second and third degree, applied by means of rags wetted with creasote water. Berthelot also cured two cases quickly with it ; the slightly burnt places becoming desiccated ; the more severe healing by the formation of a crust. Guitti applied both creasote water and creasote ointment with advantage in burns which had proceeded to profuse suppuration; hence, it has been advised, — 3. In profuse suppuration, on the authority of Levrat and Berthelot, but according to J. L. da Luz,|| it has no marked in- fluence on the secretion of pus, and is therefore useless in suppu- rating abscesses. In otorrhcea it has been especially beneficial. 4. Lesions of the integuments. — According to Reichenbach, creasote is of essential service in the intertrigo of children, as well as in the excoriation induced by lying. In the latter case, Guitti used it with success. Hahn also frequently employed it. In cases where ulceration had not taken place, he washed the parts several times a day with creasote water, and was of opi- nion that he had prevented, in some cases, the occurrence of ulceration. Where ulceration had already taken place, he co- vered the parts with linen rags, folded two or three times, which he soaked in creasote water, and fixed them on by means of ad- * Dr. Daser, Edinb. Medical and Surgical Journal, Oct. 1841. | Op. cit. X Gazetta Therapeutica di Verona, Mars, 1834 ; and Amer. Journal of the Med. Sciences, Feb. 1836, p. 502. § Medical Examiner, Aug. 10, 1839, p. 501. || Op. cit. 212 CREASOTUM. hesive straps. The superficial ulcers soon healed ; and the deeper were transformed into hollow surfaces, secreting a homogeneous serous fluid, but no pus. Horing employed creasote water with advantage in sore nip- ples ; and creasote ointment has been recommended by Dr. Fife,* in sprains and contusions. 5. In chilblains, whether ulcerated or not, Hahnt used crea- sote washes successfully ; — the affection yielding in a few days ; and Dr. HerndonJ regards creasote ointment as the best remedy in that affection with which he is acquainted. 6. Ulcers. — Fissures of the skin and superficial ulcers, accord- ing to Hahn, were changed, under the application of creasote water, into a blackish-brown scab, which adhered for a long time, and when it fell off, left the parts healed ; or by occasioning too much shrinking, gave rise to fresh inflammation and suppura- tion. Deeper ulcers were affected in the same manner as those caused by long lying. The efficacy of this agent in atonic and varicose ulcers, espe- cially of the leg, has been attested by Levrat, Berthelot, Rossi, Hechenberger, and others ; but Guitti, Heyfelder, and Schmalz were less satisfied with it. A case of indolent ulcer between the knee and ankle, accompanied with a good deal of inflamma- tion, was cured by Dr. Crary, in five weeks, by the application of a solution of creasote (ten drops to the ounce of water), with methodical compression to the limb, by means of a bandage.§ Meister found the application of creasote water, in cases of carious, scrojihulous, syphilitic, fistulous, and sanious ulcers, to be strikingly, and almost uniformly advantageous. Heyfelder, likewise, found it extraordinarily useful in scrophulous ulcers, and Dr. Cormack|| states, that he had an opportunity of seeing a case of the kind treated by Dr. Shortt, in the Royal Infirmary of Edinburgh, where an extensive scrophulous ulcer of the hip, after resisting a variety of treatment, at last yielded to creasote, and was ultimately completely cicatrised. On the other hand, Otto tried both pure creasote and the watery solution in ulcers of various kinds, especially the scrophulous : the ulcers very generally put on, in the course of twenty-four hours, a cleaner appearance ; still they did not cicatrise, on which account Otto prefers, in old ulcerations at least, the use of a solution of chlo- rinated lime ; for notwithstanding creasote diminished and im- proved the character of the suppuration from scrophulous ulcers, * Lond. Med. Gaz., April 7, 1838, p. 66. f Gazette Medicale de Paris, Dec. 1834. \ American Med. Intelligencer, for March 15, 1838, p. 425. § Boston Medical and Surgical Journal, July 3, 1839, p. 332. |j Op. cit. p. 106. CREASOTUM. 213 and rendered them cleaner, it did not ameliorate the general condition ; — after the diminution of the suppuration, local pains, loss of sleep, and slight febrile movements generally supervening. On these accounts, Otto does not think creasote applicable to scrophulous ulcers in general. Many observers depose to the good effects of creasote in scrophulous caries. Among these may be mentioned Hahn, Coster, Ritgen, Fremanger and Hauff. In fistulous ulcers — also of syphilitic origin — several physicians have employed it beneficially. Dr. Fife,* of Newcastle-upon-Tyne, found it useful not merely in obstinate but in malignant ulcers. In no case of ulceration, he affirms, in which he tried it, did it disappoint his expectations. In a sloughing carbuncle, the alcoholic solution, (thirty drops to the ounce,) mixed with carrot poultices, was applied with advantage by Dr. Herndon,t of Culpeper C. H., Virginia. In scurvy and in scorbutic ulcers, M. CoenJ found its use fol- lowed by excellent results, and he refers to cases in which it has been administered internally with very great advantage. J. L. da Luz§ considers it an excellent cleansing remedy in atonic ulcers, but its prolonged use, he thinks, retards cicatrisa- tion. In hospital gangrene, he esteems it the best antiseptic, and the most powerful means for checking its terrific progress. In gangrenous or sloughing ulcers, Hahn used it. Several times a day he penciled the slough with pure creasote, and, in the intervals, fomented it with creasote water. According to Reichenbach, two offensive affections of the labia pudendi — the consequences of infiltration of blood — were cured by it ; and Reich and Sir Francis Smith || treated with success cases of cancrum oris, and the former, one of scorbutic ulceration of the gums. In herpetic ulcers, Horing and Berthelot observed favourable effects from creasote water ; and it has been found especially useful in carcinomatous and syphilitic ulcers, in which it has been often employed. In cancer of the uterus, Wolff injected creasote water, in two cases, into the vagina. In one, the pain was so great, that, on the ninth day, after six pints of creasote water had been used, it was obliged to be discontinued. In the other case, the treatment was continued twenty-six days, and sixteen pints were used : in it, also, the pain was sensibly aggravated. The secretion was * Lond. Med. Gaz., April 7, 1838, p. 65. f Dunglison's Amer. Med. Intelligencer, March 15, 1838, p. 425. \ Giornale per servire, &c. di Venezia, 1836. \ Jornal da Sociedade das Sciencas de Lisboa, T. v. Lisboa, 1837 ; noticed in Zeitschrift fur die (jesammie Medicin. Oct. 1838, S. 224. || Dublin Journal of Med. Science, for May, 1837. 214 CREASOTUM. not improved in either case ; nor was hemorrhage prevented by it ; for one of the patients died immediately after an attack of this kind : the other lingered a long time. Heyfelder found injections of creasote water, in conjunction with the extractnm calendulas, of no use in cancer uteri. On the other hand, in a case of superficial ulceration of the os uteri, with copious discharge of a puriform mucus, which had been treated unsuccessfully by other agents, for several months, Hahn found an injection of creasote water effectual in fourteen days. Tealier* has likewise given a case of superficial ulcerations around the os uteri, to which nitrate of silver had been applied at least twenty times without inducing a cure. By touching the ulcers with lint fixed upon the end of a probe, and dipped in a mixture of one part of creasote and three parts of water, excessive pain was induced ; but this gradually passed away, and in six days the signs of ulceration had disappeared. It is more than doubt- ful, however, whether either of the two last cases was carcino- matous. In a case of cancer of the breast, a solution of creasote was applied by the same gentleman. This excited, instantaneously, violent pain, but after a time the pain ceased, and relief was ob- tained. Rossi saw a cancerous ulcer of the face healed by creasote ointment, but it soon broke out again. The same gentleman cured a. fungous tumour on the alveolar margin of the right os maxillare — which had occasioned the loss of all the teeth of that side except one, and which even the actual cautery had not prevented from returning — by a collutory of six drops of crea- sote in six ounces of water. Heyfelder saw creasote used without effect in a case of cancer of the skin, and Cormackt in one of lupus of the nose. On the other hand, Guitti cured an ulcer, in appearance cancerous, by the application of pure creasote, for which, at a later period, the solution was substituted, and Marchal has published a case of cancer of the lip in which he believes he accomplished a cure by means of creasote.J Garbiglietti cured a fungous ulcer with caries of 'the fbulaby creasote, but it is questionable whether the ulcer was carcino- matous ; and Meisinger saw a cancer of the face improved by the use of creasote ointment. It has been before remarked, that Meisinger used creasote with advantage in syphilitic ulcers. Hahn also applied creasote water in primary syphilitic sores ; the small, superficial ulcers * Revue Medicale, Fevrier, 1834. For similar cases, see Dr. Friese, in Berlin. Medicin. Zeitung, Nro. 13, 1837. t Op. cit. p. 115. \ Gazette Medicale de Paris, Fev. 1835. CREASOTUM. 215 healed soon, the larger and deeper remained stationary. In a phagedic ulcerated bubo, the spreading was arrested, but this was all. According to Heyfelder,creasote — probably the pure — excited, in a case of primary syphilitic ulcer, in a plethoric individual, violent inflammation, and so much sensibility, that it was obliged to be discontinued. Berthelot cured a chancre, which had resisted caustics and other cicatrising agencies, in a few days, by creasote water. Rehfeld, also, treated secondary syphilitic ulcers successfully with it, giving, however, at the same time, the corrosive chloride of mercury inwardly. Chronic venereal ulcers have in some cases yielded to it, after they had resisted every other kind of treatment.* Dr. Biirkner, of Bres- lau,t reports a case, which, after having proved rebellious to every kind of general and local management that could be de- vised, at length yielded to the application of pure creasote by means of a camel's hair brush. The character of the secreted pus immediately improved ; the wound began to heal by granu- , lations from the base ; and, at the end of four weeks, Dr. Biirk- ner found his patient quite well. In condylomata, it has been equally successful. By the application of creasote water, Hahn found them contract and disappear ; but the more obstinate required to be penciled with pure creasote. Heyfelder, Reich,J Fricke, and Coen,§ also found creasote efficacious in these cases. The last gentleman but one had the most frequent opportunities for observation ; by him creasote, in a dilute state, was applied to the top of the condyloma by means of a pencil. In cases of small condylomata, touching them once or twice was sufficient for their removal ; of larger, it had to be more frequently re- peated. In some obstinate cases, it required two or three weeks before they disappeared ; but when once, they fell off, they did not return. 7. Gonorrhoea, and Fluor albus. — Most extols creasote water as a remedy in gleet. He applies it either in the way of injec- tion, or by small tents wetted with it and introduced into the urethra. Influor albus,he strongly recommends both its inter- nal and external use. Reich injected creasote water in a case of gonorrhoea, and in one of malignant fluor albus ; yet its agency in these cases was doubtful, as copaiba was given at the same time. Hahn,§ also, used injections of creasote water in the second stage of gonorrhoea and in gleet ; but he did not think * Cormack, Op. citat. p. 107 ; and in Lond. and Edinb. Monthly Journ. of Med. Science, Oct. 1842. See, also, Kiinchel, in Bulletin Gener. de Thera- peutique, p. 313. Paris, 1833. f Casper's Wochenschrift, Sepr. 9, 1837, S. 583. X Hufeland's Journal, Jan. 1831, and Revue Modicale, Mai, 1834. § Giornale per servire a progressi della patologia, &c. di Venezia,An. 1836. || Gazette Mcdicale de Paris, Dec. 1834. 216 CREASUTUM. ' that the discharge ceased sooner under its agency than under the ordinary means ; whilst in some cases, the inflammation was even augmented. In two cases oibenignjiuor albus, after many other remedies had been employed in vain. Schmalz saw good effects from the use of a solution of creasote ; but in a third case it afforded no relief. Dr. Elliotson* gave it internally to a female labouring under gonorrhoea, at first, in the dose of two minims to an ounce of water, and afterwards in the dose of four, six, and even eight minims, but no good resulted from it. The author has administered it not unfrequently in leucor- rhcea and other mucous discharges, and when persevered in, it has at times appeared to be of decided service.! Dr. Robert Dick,J of Glasgow, has called the attention of the profession to its use in the chronic stage of gonorrhoea, and in gleet. He thinks its beneficial effects are more obvious than those of copaiba. He administered it in doses of two drops with loaf sugar beaten into a syrup with water. S. Chronic cutaneous affections. — Reich treated a case of crusta lactea externally by creasote, and internally by the mild chloride and the black sulphuret of mercury. The result was favourable. In itch, it was recommended by its discoverer. Wolff, too, saw three cases of not very recent itch, cured in eight days by lotions of creasote water. Reich and Coen§ extol the water and the ointment in inveterate itch. J. L. Da Luz|| con- siders it as valuable as sulphur, but Otto did not find the water particularly efficacious. He gives strong testimony, however, in its favour, in herpetic eruptions: in a very short time, it induced evident improvement, and often removed the affection in from eight to fourteen days. When the cases were more chronic, a longer time was of course required for the cure. He never administered it, however, without attaining his object. His rule was, to bathe the affected parts twice a day with creasote water, and in particular cases he directed, in addition, general baths of warm water. The eruption commonly disappeared very rapidly under this management, but it speedily recurred unless general bathing was used at the same time. It again yielded, however, very readily to creasote water. Grandjean, Reich, and Kohler, also employed the water successfully in herpes; and Guitti found both the water and the ointment most serviceable in herpetic affections when combined with appropriate internal treatment. Heyfelder recommends that alterative drinks, as the decoctum * Lancet, for Dec. 1835, p. 435. f See, also, Coen, in Giornale per servire, &c. di Venezia, 1836. % Edinb. Med. and Surg. Journ. Apl. 1838, p. 602. \ Op. cit. || Jornal da Sociedade das Sciencas Medicas de Lisboa, torn. v. Lisboa, 1837, noticed in Zeitschrift fur die gesammte Medicin. Oct. 1838, S. 224. CREASOTUM. 217 sarsaparillae, should be combined with them. Even in herpes exedens, the external application of creasote was found effectual by Ritgen, Grandjean, and Rossi. Wolff* cured a case of an- cient impetigo in about eight weeks, by a solution of creasote ( Creasot. 3ss. ; Aq. destillat. f-3 v.). At first, the application caused so much#heat and inflammation, that in eight days it was obliged to be discontinued, and afterwards it was alternated with fomen- tations of warm water from day to day until the cure was com- pleted. Dr. Herndon, of Culpeper C. H., Va., derived much benefit from the ointment in psoriasis. In a case of acne rosacea of seven years' standing, accompa- nied with headach, nervousness, thirst in the morning and acid eructations, for which the patient — a female — was put under treatment for a month, without success, Dr. Elliotsont deter- mined on trying creasote. The advantage was soon manifest, as in three days the eruption was evidently diminished. At first, she took two minims three times a day ; this was gradually augmented to twenty minims, — the farther increase of the dose being prevented by the supervention of giddiness and tremors. At the end of seven months, she was discharged ; the eruption being scarcely perceptible, and the dyspeptic symptoms entirely removed. In a chronic pustular disease, not curable by anti- phlogistics, the same gentleman observed better effects than from any remedy previously prescribed.J Dr. Copland, it is affirmed, found a saturated solution in water answer well as a lotion in porrigo favosa.^ The author has often used in porrigo both creasote water and creasote ointment (see the formulas at the end of the article) ; they have always appeared to him sufficiently strong, and when the quantity of creasote was increased, so much inflammatory irritation was induced, that they had to be dis- continued for a time. 9. In cases of chronic inflammation of the free edge of the eyelids, cures were effected by Coster, and Mr. G. T. Black ;|| by the former from the use, twice a day, of a dilute solution of creasote (Creasot. gtt. xij. ; Aq. destillat. f.Sij.) applied by means of a camel's hair pencil. The cure was effected in ten days. The formula for the lotion used by Mr. Black is given after- wards. An ointment of creasote has also been found of essential service in various forms of strumous ophthalmia by Dr. C. C. Hildreth, of Zanesville, Ohio.T In different kinds anophthalmia, * Medicin. Zeitung, u. s. w. No. 30, 1834. f Lancet, July 4, 1831, p. 459. I Medico-Chirurg. Transact, xix. 237. Lond. 1835. § Gully's Kdition of Magendie's Formulary, p. 204. Lond. 1835. See, also, Sir F. Smith, in Dublin Med. Jour, for May, 1837, and J. L. Da Luz, Op. cit. || London Lancet, Aug. 7, 1841. •j]" American Journal of the Medical Sciences, Oct. 1842, p. 364. 19 2 IS CREASOTUM. M. Sanson used creasote, but never observed the disease to be modified by the treatment.* 10. In a case of prolapsus vaginal, Schlesier tried the external use of a solution of creasote. After astringent injections, and the application of the decoctum Kramerias by means of a sponge, had been used in vain, he injected diluted creasote for seven weeks, omitting it only at the time of menstruation. It excited a burning sensation of a few minutes' duration. At the expiration of the time mentioned, the prolapsus had strikingly diminished, and the great sensibility of the prolapsed parts had disappeared. Owing, however, to the supervention of irritation in the urinary bladder, it had to be discontinued, when there was every prospect of ulti- mate success. 11. Dr. Buttmann,t of Vietz, circle of Landsberg, has given the case of an old lady, upwards of seventy years of age, who had laboured for several years under oedema of both legs to such an extent as to interfere materially with progression. She expe- rienced lancinating pains in both feet, and irregular paroxysms of fever. Many external and internal remedies had been used in vain, when Dr. Buttmann, by way of experiment, applied cata- plasms of creasote, soon after which the swelling, very much to his astonishment, gradually disappeared, and with it the febrile attacks. 12. In toothach from carious teeth, creasote has often been used, being applied to the hollow of the tooth by means of a pencil, or of cotton imbued with it. The testimony in its favour has been very great, — Coster, Reich, Hahn, Kneisel, Hey- felder, Fichtbauer, Hauff, Otto, Guitti, Kohler, Meisinger,J and numerous others. Some have advised a collutory of creasote, but this is more disagreeable, whilst it is less efficacious than creasote applied immediately to the carious tooth. It excites instantaneously acute pain and a considerable secretion of saliva. The pain is often relieved by it, but it generally recurs ; and per- haps the advantage derived from this agent is not greater than from the stronger essential oils. As a palliative, it is very useful. In rheumatic toothach, the insertion of a little cotton, imbued with creasote, in the ear of the same side, has been found ser- viceable^ Although, however, it alleviates the pain of toothach, it has been considered to hasten the destruction of the tooth. || * Compte rendu des Seances de la Societe de Medecine, Seance du 7 Mars, 1834. | Beitragen zum Sanitats-Berichte des Frankfurter Regierungs-Bezirks : and Medicinische Zeitung, Dec. 7, 1836, S. 252. X Medicin. Jarbuch. des k. k. tisterreich. Staates, B. xv. S. 553. Wien, 1834. § Riecke, Op. cit. S. 167. || Cormack, Lond. and Edinb. Monthly Journ. of Med. Oct. 1842. CREASOTTJM. 219 13. In deafness, apparently owing to a deficient secretion from the ceruminous follicles, advantage has been found from the use of creasote, after the ear had been syringed. Perhaps as good a form as any is that recommended by Mr. Curtis,* which consists of one dram of creasote to four drams of lard. A little of this oil is inserted into the meatus night and morning, with a camel's hair pencil. He considers the preparation contra-indi- cated in cases of otorrhoea, where there is any pain or inflam- mation. Dr. Partridge,! who has seen many excellent effects from creasote in such cases, prefers to commence with half a dram of creasote to four drams of oil of almonds, applied by means of a camel's hair brush. After a few days, he usually increases the quantity of creasote as occasion may require, often using it as strong as one part of creasote to three of the oil. So far we have spoken mainly of the external use of creasote. Reference has been made to its internal administration in cases of haemoptysis, hsematemesis and fluor albus only. In the fol- lowing diseases, it has been chiefly given internally : — 14. Phthisis. — Reichenbach excited considerable expectations from the use of creasote in phthisis, — pulmonary, laryngeal, and bronchial; and as in so intractable a disease every sugges- tion is immediately and eagerly embraced, numerous trials were instituted with it, the results of which were by no means ac- cordant. Reich} affirmed, that he gave it both in laryngeal and tubercular phthisis with distinguished success. In a case, in which the disease appeared to be considerably advanced, the offensive expectoration was changed into one of a tasteless, mu- cous character, although the fever and the night sweats expe- rienced no modification. Subsequently, haemoptysis supervened , with violent fever ; on which account the dose of creasote was diminished. Under the use of the remedy the condition of the patient appeared to improve, — except the cough, which was not mitigated ; an anodyne was consequently substituted for the creasote; under which, his patient — a female — 'improved so much, that Reich was led to believe she might be saved, al- though the cough still remained severe and frequent. In another case, creasote allayed the hectic fever, and transformed the puru- lent expectoration into one of a mucous character ; yet, although the general condition of the patient seemed to be improved, the cough and uneasiness of the chest continued almost unchanged. Grandjean, also, had a case of phthisis in the third stage, the expectoration of which was soon diminished ; the pain in the * London Lancet, vol. i. p. 328, 1838-9 ; and Mr. Wright, ibid. p. 580. f Medical Examiner, May 30, 1840, p. 348. \ Hufeland's Journal, Jan. 1834 ; and Revue Mcdicale, Mai, 1834. 220 CREASOTUM. side removed ; the appetite, sleep, and strength restored, under the administration of creasote ; but the result of the case is not known. Levrat asserts, that he found it highly useful in chro- nic bronchitis, and in some kinds of phthisis. Hechenberger saw good effects from the inhalation of creasote in the form of vapour in a case of ulcerated lungs ; five, ten, or fifteen drops, according to the degree of tolerance of the lungs, being dropped into hot water in an appropriate vessel, and the vapour received through the tube of an inverted funnel. Hechenberger was of opinion, that this mode of exhibiting creasote prevented the disagreeable effects apt to be induced by its internal use ; and farther experiments have confirmed his view. In the chronic mucous affections of the lungs of old people, it appears to have been especially useful. On the other hand, Elliotson* derived no favourable results from his trials with creasote in phthisis ; even inhalation of the vapour was generally unattended with any advantage ; yet, he is of opinion, that it may be useful where there are only one or two ulcers in the lungs, and there is no tendency to their farther production, as well as where there is much secretion from the bronchial mucous membrane. Either no advantage, or an injurious influence was derived from its use in phthisis, by Rehfeld, Haupt, Treumann, Gunther, Schmalz, Meisinger, Otto, Kohler,t and others. The published experiments by Wolff, in the Charite at Berlin, cannot be esteemed more favourable. It was tried in eleven cases of tubercular phthisis, of which one was in the first, eight were in the second, and two in the third stage. In two cases, there was scarcely any advantage after the remedy had been given for fourteen days. In one case, it had to be discontinued on the eleventh day, owing to the supervention of obstinate vomiting. The case ultimately terminated unfavourably. In six cases, the symptoms appeared to be aggravated, and the patients died soon afterwards. In two cases, in which the dis- ease was in its second stage, death supervened unexpectedly early, on the fourth, and the seventh day of the treatment, — in one case by suffocation ; in the other, by sudden hydrothorax. The pulse, according to Wolff, was generally quickened under its use ; the hectic augmented ; the urinary secretion diminished ; the expectoration neither changed in quantity nor quality ; the cough not mitigated ; nor the dyspnoea diminished : on the other hand, in four cases, they were manifestly increased : once, epis- taxis occurred, and twice, haemoptysis. From the results of all his trials, Wolff is disposed to think, that creasote should be banished from our list of agents em- * Medico-Chirurg. Transact, xix. 221 ; Lond. 1835. f Hecker's neuen wissenschaft. Annal. B. i. H. 3. CREASOTUM. 221 ployed in phthisis ; both as respects the radical and the palliative treatment ;* but although they may not sanction us in placing much value on creasote in the treatment of phthisis, it may be improper to ostracise it altogether,t as, according to the testimony of others, it would seem to have rendered service. Rampold and Spath assert, that they have derived advantage from it in con- firmed phthisis where no inflammatory complication was present ; the expectoration and colliquative sweats being diminished under its use. M. Petrequin,J from his trials with it, considered its effects to be more beneficial — as might be presumed — in incipient than in confirmed phthisis ; but in no case did he observe anything approaching the radical cures described by some. He indeed gives the preference to tar water (see Aqua Picea, p. 59). 15. In bronchorrhcea, or that state of the bronchial mucous membrane which consists in a profuse secretion without inflam- mation, the inhalation of creasote has been found of essential service. § 16. Rheumatism and Gout. — The success, obtained by Reich|| from tincture of soot in gouty and rheumatic affections, and the probability that the efficacy might depend chiefly on the creasote it contained, induced him to prescribe the latter remedy internally in those diseases. He made the first trial upon himself. After exposure to cold, he was attacked with lancinating pain in the whole of the right leg, for the removal of which the ordinary remedies were employed in vain : it yielded to the use of crea- sote given for nine days. He relates another case of rheumatism and one of atonic gout, in which creasote was equally successful. Marcus, of Hadersleben, recommends it in cases of rheumatism, unaccompanied by excitement of the vascular system, or ten- dency to congestion and febrile reaction. It is proper, however, to observe, that he combined other agents with it, so that his experiments are by no means decisive as to its efficacy. Of the three patients, to whose cases he refers, one only was cured : the other experienced improvement. Karsten found none of the advantages, described by Reich, in rheumatic and gouty cases, from its use. In a case of rheumatic headach, Tschopke found surprising benefit from frictions of creasote, and plugging the ear with cotton dipped into it. The creasote im- mediately excited acute pain, and some rubefaction of the skin ; and as the burning ceased, the pain ceased along with it. * See, also, Kohler, in Rust's Magazin, B. xlvi. and Amer. Journ. of the Med. Sciences, Feb. 1837, p. 497. f Riecke, Op. cit. S. 170. X Gazette Medicale de Paris, Nov. 1836. § Elliotson, in Med. Chirurg. Transact, xix. 221. Lond. 1835. || Hufeland's Journal, Jan. 1834, and Revue M6d., Mai, 1834. 19* 222 CEEASOTUM. In Most's experience, lotions of creasote water greatly alle- viated the pain of the joints in rheumatism and atonic gout. 17. In vomiting, not arising from inflammation or other organic disease of the stomach, Elliotson* found creasote very efficacious. In the vomiting of pregnancy it has beenfound highly efficacious. If the sickness comes on regularly after rising in the morning, Dr. Cormackf prescribes two or three drops to be taken five or ten minutes before getting out of bed. This he has generally found effectual ; but if it should not be, the patient is directed to repeat the dose in two hours. In more troublesome cases, when the sickness occurs at intervals during the day, one or two drops are given every two, three, or four hours. He has also found it serviceable in the sickness and vomiting following a drinking debauch. Even in Asiatic cholera and in sea-sickness, it appeared to allay the vomiting. In various af- fections of the stomach, as in cardialgia and gastrodynia, it may be found useful. J In cases of vomiting from nervous excitability it has been affirmed to excel all known medicines.^ After Dr. Elliotson had recommended it, Dr. Shortt tried it in about a dozen cases, and found it equally successful, as did also Prof. A. T. Thomson, of London, Dr. Bodington of Erdington in Warwick- shire, Dr. Christison,|| and many others. Dr. John Walker of Glasgow, in a case published by him,H does not appear to have been equally fortunate ; and with Dr. Paris it entirely failed.** The author's own success has been by no means as great as that of Dr. Elliotson. In many cases, indeed, it has developed irri- tability of the stomach, where it did not previously exist.tt Dr. Elliotson admits, that in large doses it seems to excite vomiting, and that when given in such quantities with a view to check it, no good, but evil, results from a large dose. As a pre- ventive of sea-sickness it has been extolled by Dr. Elliotson, and by Mr. A. B. Maddock.JJ It has been administered, also, as an excitant to relieve gas- trodynia and flatulence, and where hydrocyanic acid and crea- * Medieo-Chirurgical Transactions, vol. xix., and Lancet, Aug 20, 1836. f Lond. and Edinb. Monthly Journal of Med. Science, Oct. 1842. % Riecke, Op. cit. S. 172. § Cormack, on Creasote, p. 133. I Dispensatory, p. 377. Edinb. 1842. T Lancet, Dec. 19, 1835, p. 447. See, also, Mr. Taylor, Ibid. Aug. 15, 1835, and Dr. Macleod, in Lond. Med. Gazette, xvi. 598, and xvii. 653. ** Pharmacologia, 8th edit, append. Lond. 1838. See, also, Pereira, Elem. of Mat. Med. and Therap. 2d edit. p. 420, Lond. 1842 ; or Amer. Edit, by Dr. Carson, Philad. 1843. tf Cormack, Lond. and Edinb. Monthly Journal of Med. Science, Oct. 1842. XX Amer. Journ. of the Med. Sciences, Feb. 1838, p. 496. CREASOTUM. 223 sote have been separately tried unsuccessfully, Dr. Elliotson re- commends, that they should be combined. 18. Several portions of taenia having been observed to be dis- charged after the administration of creasote, Kraus was induced to prescribe it as a powerful anthelmintic. This he did in nume- rous cases, and with the best success ; from five to eight drops being given to adults with castor oil ; or where the bowels were not freely opened with half a drop or a drop of croton oil. 19. In diabetes mellitus, creasote was first given by Bemdt,* and with striking success. One or two cases of the same kind are related by Gadolin ; but Rehfeld used it without advantage. Dr. Elliotson agrees with Bemdt in the opinion, that it is some- times of use in diabetes, and may even be greatly instrumental in accomplishing a cure.f 20. Dr. ElliotsonJ tried creasote in nervous diseases. In some cases of epilepsy, the paroxysms appeared to be rendered less frequent and more mild ; but in the generality of cases, they re- turned with fresh violence. In some cases, the remedy had no influence on the disease ; in others it appeared to aggravate it. In neuralgia, great advantage was at times derived from it, although, here, again, it was frequently of no service. § Dr. El- liotson also observed good effects from it in hysteria, where there was no inflammatory complication, in spasmodic erethism of the nervous system, and in palpitation ; and Dr. Herndon,|| of Vir- ginia, used it with much benefit as an inhalation in hysteric croup (thirty drops to the quart of hot water). In asthma, dependeut upon morbid excitability of the bron- chial mucous membrane, Dr. ElliotsonlF found its inhalation to be often useful. 21. In two cases of chronic glanders, the same gentleman** accomplished a cure in the course of a few weeks, by the sedu- lous use of an injection of a dilute solution of creasote (Creasot. gtt. 1 ; Jiquae, 3j.) thrown up the affected nostril; combining the treatment, in one of the cases, with the internal use of the re- medy ; and a similar case of success is given in a more recent number of a British medical periodical.tt * Kleinert's Repertorium, Jan. 1835, and Lancet, July 18, 1835. t Medico-Chirurgical Transactions, xix. 132-135. Lond. 1835. $ Op. cit. ) Cormack, loc. cit. [j Dunglison's Amer. Med. Intelligencer, Mar. 15, 1838, p. 425. T Op. cit. ** Lancet, for June 20, 1833. ft Ibid. Jan. 20, 1831), p. 145. 224 CREASOTUM. MODE OF ADMINISTERING. The dose for internal use is one or two drops, given several times a day, in gum water.* In cases of tape-worm, the dose should be larger. Some give it in emulsion, but this form is objectionable on account of its disagreeable taste. It is best administered in pill. Externally, it is at times applied pure ; at others diluted, — commonly with water, with or without the addition of alcohol, or in the form of ointment. Carminatif affirms that oil and mucilage, when combined with it, render it milder, but that vinegar increases its action. Dr. Cormack,i however, doubts the assertion in regard to vinegar. In three comparative experiments, which he made with a view of testing the justice of Carminati's conclusion, there was no apparent difference in the activity of creasote, when given with acetic acid or alone. He was led to believe, however, that the addition of albumen caused it to act more powerfully, which, if true, would be singular. The inhalation of creasote vapour may be accomplished by diffusing a few drops of creasote through water or a mucilagi- nous liquid, in an ordinary inhaling vessel, or in the mode described under the head of Chlorine.§ Pilulae ereasoti. Pills of creasote. R. Creasoti, tt^x. Glycyrrhiz pulv. Ji. Mucilag. acac. q. s. ut fiat massa. in pilulas xx. dividenda. Dose. — Two pills three times a day. In neuralgia, atonic rheufnatism, and chronic bronchitis. The number of pills may be gradually increased to eight or ten at a time. Joy.\\ * It may be well to remark, that the fluidram contains one hundred and fifty drops of creasote. f Op. cit. X Op. citat. p. 88. § Seepage 150. || Tweedle's Library of Medicine, v. 282. Lond. 1840; or 2d Amer. edit, iii. Philad. 1842. CREASOTUM. 225 R. Creasot. Jj- Ext. glycyrrhiz. Galban. aa. 3ss. Althaea? pulv. 3ij- Fiat raassa in pilulas cxx. dividenda. Dose. — Six pills, four times a day. In consumption. Reich. R. Creasoti, Ext. glycyrrhiz. aa. §i. Althseae pulv. 3ij. Fiat mass, in pil. cxx. dividend. Dose. — Five pills morning and evening, in atonic gout. Reich. Haustus creasoti. Creasote draught. R. Creasut. tt\,i. Aquae camphors, Infus. gentian, compos, aa. f.Jvj. M. flat haustus. To check vomiting. Mistura creasoti. Mixture of creasote. R. Creasot. gtt. v. Mucilag. acaciae, f.^iij. Syrup, althaeae, f.^j. M. Dose. — A spoonful every three hours in haemoptysis. Santini. Tinctura creasoti pro gingivis. Tincture of creasote for the gums. R. Creasot. 3j- Alcohol.' f.^ij. M. As much of this to be added to cold water as is necessary to give it a piquant taste, with which the teeth may be washed and 226 CREASOTUM. the mouth rinsed. Used in cases of feet or of the mouth from carious teeth, and to limit the caries. Buchner. R. Alcohol. (36° B.) f.3iss. Creasot. f.3J. Tinct. cocci, t.^v'j. 01. menthee, gtt. xxxvj. Used for the toothach : and, diluted, as a wash for the gums. R. Creasot. Alcohol, aa. Jss. M. To be applied to carious teeth. Radius. R. Creasot. p. i. Alcohol, p. viij. M. This is the ordinary strength of the tincture. Used where fractions of a drop of pure creasote are prescribed. Lotio creasoti. Lotion of creasote. R. Creasot. gss. Aquse destillat. f.§v. M. Used as a lotion in impetigo sparsa and itch. Wolff. The author has occasionally found a lotion composed of f.Jss. of creasote to Oj. of water too irritating. R. Creasot. gtt. xij. Aq. destillat. f.gij. M. To be applied by means of a hair pencil twice a day to in- flamed eyelids. Coster. R. Creasot. TTLiij. Tinct. lavand. compos. tt\,xx. Aquse destillat. f. ^ss. M. G. T. Black. * Journal de Chimie Med. Avril, 1841. CREASOTUM. 227 R. Creasot. gtt. iv. Aq. destillat. f.^ij. M. In irritation of the gums. Frimanger. R. Creasot. f.Jss. Acaciee, §iss. Aquae camphor, f.^xss. M. Used every two hours, in cases of aphthous ulceration of the mouth. Magendie. R. Creasot. gtt. x. Aceti, f.Jij. Aqusa, f.^ij. M. Used in cases of phagedenic ulceration, and to chancres ; ap- plied by means of a camel's hair pencil. Shortt* Unguentum creasoti, Ointment of creasote. R. Cerati, 01. amygdal. aa. 3*j. Creasot. gtt. xxx. M. A dressing in scrophulous caries. Fremanger. The Unguentum Creasoti of the London and United States Pharmacopoeias is composed of half a fluidram of creasote to an ounce of lard. linimentum creasoti, Liniment of creasote. R. Creasot. gtt. v. — xx. 01. oliv. 588. M. To be rubbed two or three times a day on the diseased parts, in chronic herpes. Corneliani. * Cormack, Op. cit. p. 112. 228 LVIII. CUBE'BA. Synonymes. Cubebse, Piper Cubeba, P. Cubebarum, P. Caudatum, Cubebs. French. Poivre a queue, Cubebe. German. Kubebenpfeffer, Schwanzpfeffer. Cubebs are the fruit of Piper cubeba, which grows in India, Java, Guinea, &c. Sexual System, Diandria Trygynia ; Natu- ral Order, Piperaceae. The corns of this plant have been long known in the shops; and in the old Wirtemberg Pharmacopoeia they figure as calefacient, inciting, discutient, antinervous, and carminative agents, which seem to have a specific action in vertigo ; hence they obtained the name " Schwindelkorner" or " grains for vertigo." They had, however, fallen into oblivion, until they were re-introduced in modern times into practice, especially by the English physicians and surgeons. The shell of the dried berry has a weak taste, but smells agreeably ; the kernel has a bitter aromatic flavour, which is biting at first, but afterwards cooling. The corns were analysed by Tromsdorff and by Vauquelin ;* but the most recent analysis is by Monheim.t He found, in 100 parts, of lignin 65, of extrac- tive matter 6, of Cubebin (Piperin) 4.5, of a matter like wax 3, of green volatile oil 2.5; of yellow volatile oil 1.0, of balsamic resin — which, according to Vauquelin, is very analogous to balsam of copaiba — 1.5, of chloride of sodium 1.0, and 15.5 parts lost. Cubebin appeared to Monheim to be identical with piperin, but to be united with an acrid soft resin. The volatile oil may be obtained separately by distillation with water. EFFECTS ON THE ECONOMY. In addition to the general excitant properties of the peppers, the action of cubebs is exhibited on the urinary and genital or- gans. Under their use, the secretion of urine is augmented ; it becomes of a darker colour, and assumes an aromatic odour. Cubebs have been advised, in modern times — first, in cases of gonorrhoea, in which they have been esteemed a specific by many. Yet the considerations that apply to copaiba are equally applicable to cubebs. Although the revulsive effect induced by * Memoir, du Museum, vi. 225. t Journal de Pharmacie, xx. 403. CUBEEA. 220 both on the kidneys may mitigate the inflammatory condition of the lining membrane of the urethra, which constitutes gonor- rhoea ; yet, in violent inflammatory cases, and in the early stages of ordinary cases, they may be injurious, and there are many cases on record in which bad consequences appear to haAfe re- sulted from their improper administration. Still, there are many physicians who administer both them and the copaiba in every stage of the disease. Of 50 patients, treated by Mr. Broughton* by cubebs, 10 were cured in from 2 to 7 days ; 17 in from S to 14 ; IS in from 15 to 21 ; 1 on the 55th day ; and in 4 only Was no success obtained. In the chronic stage of gonorrhoea, M. Ricordt prescribes cubebs in combination with sesquioxide of iron ; and in addition the pa- tient is directed to inject, four times a day, a solution composed of Aq. destillat. f.|viij., Argent, nilrat. gr. ij. It has been affirmed, that different evils have ensued from the use of cubebs ; which ought to suggest care in their administra- tion : for example, — ardor urinae ; fever ; inflammation of the urethra, bladder, and testicles ; retention of urine ; cutaneous erup- tions, &c.± In the blennorrhcea of females, cubebs are equally extolled by many practitioners, as well as in leucorrhoea.§ Spitta found them very efficacious in old and obstinate cases of coryza, when given in the form of lozenges : they are said, likewise, to have been administered with advantage in defective audition, caused by a catarrhal affection of the Eustachian tube. Rosen found the chewing of cubebs very serviceable in cases of aphonia. They have also been prescribed successfully in cases of chronic rheumatism. Pul|| gave them with striking advantage in intermittent fever ; and in India, they are regarded to be aphrodisiac.1T According to Dr. Paris, it is important to keep the bowels open during their use, for when hardened fasces are allowed to accu- mulate, the spice insinuates itself into the mass, and occasions excoriations in the rectum.** * Medico-Chirurgical Transactions, xii. 1. Lond. 1822. f La Lancette Francaise, No. 33. Paris, 1838. \ Lond. Med. and Physical Journal, Mar. 1832, and Merat and De Lens, Diet. Univers. de Maticre Medicale, &c. Art. Piper Cubeba. } Edinb. Med. and Surg. Journal, xviii. 319. Blundell, Diseases of Wo- men, p. 158, Lond.; or Dunglison's American Medical Library Edition, Phi* lad. 1840; also, Lisfranc by Pauly, translated by Lodge, p. 243. Boston, 1839 ; and Ricord, Practical Treatise on Venereal Diseases, by Drummond, Amer. Edit. Philad. 1843. || Recueil de Med. Chirurg. et Pharm. Militaire, xvi. If Merat and De Lens, Art. cit. ** Brande, Dictionary of Materia Medica, p. 205. Lond. 1839. 20 230 MODE OF ADMINISTERING. Cubebs are commonly given in the form of powder, and in doses of from 1 to 2 and even 4 drams, repeated once or oftener in the day. Lozenges, boluses, and electuaries, are likewise prepared of them ; and the London, Dublin, and United States Pharmacopoeias have a Tinctura Cubeb;e (Cubeb.$iv.,J2lcohol. dilut. Oij, Dose, f.Ji. — f-5ij-)- In consequence of the disorder, at times induced by them in the digestive function, Velpeau pro- posed, that they should be given in the form of glyster, to the amount of one or two drams of the powder, suspended in five or six ounces of an oily vehicle ; and this method has its advan- tages.* To attain the same object, M. Dublanc, Junr., prepared an oleo-resinous extract, one-sixteenth part of the weight of which possessed equal virtues with one part of cubebs ; five grains, three times a day, acting like the ordinary quantity of powdered cubebs.t The volatile oil is sometimes given in the dose of 10 or 12 drops, suspended in water by the aid of sugar, or associated with oil of copaiba. Gelatinous capsules of cubebs, containing the oil, are sometimes taken. Recently, M. PiorryJ has strongly recommended an Infusion of Cubebs (Cubed, gi., Aquse Oij.) to be used six or eight times a day as an injection in urethritis and vaginitis. Pnlvis cubeuas compo situs. Compound powder of cubebs. R. Cubebs pulv. 31. Ergotae pulv. Jss. Pulv. aromat. ^ij. Sacchari, gj- Divide in chartulas viij. • Dose. — One, three, or four times a day in gonorrhoea, leucor- rhoza, gleet, prostatic and involuntary seminal discharges. Ryan.§ * Archives Generates de Medecine, xiii. 47. f Journ. de Chimie Medicate, iii. 491, and Journ. de Pharraacie, xiv. 40. X Gazette des Hopitaux, Mai, 1842. § Universal Pharmacopoeia, or a Practical Formulary of Hospitals, both British and Foreign, by Michael Ryan, M. D., &c, &c. 3d edit. p. 160. Lond. 1839. 231 R. Cubeb. pulv. §ij. Aluminis pulv. §ss. M. et divide in chart, ix. One to be taken three times a day. Ricord. Electuarium cubebae. Electuary ofcubebs. R. Cubeb. pulv. §ss. ' Mellis despura. q. s. Fiat electuarium. Dose. — A tea-spoonful, three or four times a day, in catarrhus vesicae, c. urethrse, &c. Radius. R. Copaib. 3ivss. Subige cum Vitello ovi unius, et Adde Cubeb. pulv. 3ivss. Confect. rosae, ^ss. M. fiat electuarium. Dose. — A tea-spoonful, three or four times a day. Vogt. R. Copaib. Cubeb. pulv. aa. §ij. . Aluminis, gj. Extract, opii, gr. v. M. Dose. — A dram, night and morning, in the pulp of a prune. The quantity may be rapidly increased to two drams morning and evening. R. Copaib. part. i. Cubeb. pulv. part. xij. Tinct. vanillae, q. s. M. Dose. — 5J. three times a day. CazenaveA * Mathieu, Journal desConnais. M£d. Chirur. Juin, 1840. f Bouchardat, Annuaire de Th6rapeutique pour 1842, p. 44. Paris, 1842. 232 Trochisci cubebsc Lozenges of cubebs. Be. Cubeb. pulv. 3ij. Tolut. gr. vj. Admisce Syr. myroxyl. Ext. glycyrr. aa. ^j. Acacias q. s. ut fiat massa in trochiscos pond. gr. x. dividenda. Used in coryza. Spitta. Soli cubebae. Boluses of cubebs. R. Copaib. Acac. pulv. aa. 3ij. Aquas flor. aurant. ^ij. Terendo bene mixtis adde Cubeb. pulv. Jij. Misce, et fiant boli No. vj. Dose. — One, three times a day. Henschel. M. Labelonye* has recently proposed the following method for separating all the principles of cubebs from the ligneous matter. Cubebs, reduced to coarse powder, are placed in an appa- ratus for displacement and exhausted by ether, which dissolves the wax, volatile oils and balsamic resin. The residue is sub- mitted to the action of dilute alcohol at 20° (.935), which dis- solves the extractive principle, and chloride of sodium. The alcohol and ether are separated by distillation in part, and sepa- rately. Evaporation of the hydro-alcoholic solution is then carried on in a water bath until it possesses the consistence of a soft extract, to which the ethereal product is added ; the evapo- ration being continued for a short time, the ether is completely volatilised, and a strongly aromatic extract is obtained, as con- sistent as honey. This it is improper to subject any longer to the action of heat, on account of the contained volatile oils ; the presence of which in all cases interferes with complete desi- cation. * Bulletin General de Therapeutique, and Amer. Journ. of Pharmacy, 2d series, vol. 2, p. 316. Philad. 1837. CTJBEBA. 233 One part of this extract is conceived to be equal to five of the cubebs. This extract can be readily mixed with water by means of mucilage, and can be administered in potions, injections, &c. The best form of exhibition, according to M. Labelonye, is in lozenges, or in an emulsive syrup. Trochisci extracti hydro-alcoholici rctherei cubebs. Lozenges of the ethereal hydro-alcoholic extract of cubebs. R. Ext. hydro-alcohol, aether, cubeb. fviij. Alcohol. Oij. Solve etadde Sacchar. in pulv. ten. J^j. 01. menthae pip. gtt.xviij. Pour the mixture into flat vessels upon a stove, and allow the alcohol to evaporate at a moderate heat. When the mass is completely desiccated, reduce it to a fine powder, and add a suf- ficient quantity of mucilage of gum tragacanth to form lozenges — 18, 12, 9, or 6 grains each. Most persons, M. Labelonye says, can swallow with facility those weighing eighteen grains, and containing six grains of the extract : ten of these are equi- valent to half an ounce of the powder, Syrupns extracti hydro-alcoholiei aetherei cubebae. Syrup of the ethereal hydro-alcoholic extract of cubebs. R. Ext. hydro-alcohol, aether, cubeb. |iij. Suspende ope mucilaginis in Aq. menthae pip. Jfy. Adde Sacchar. f^ij. M. Four ounces of this syrup contain two drams of extract, equi- valent to ten of powdered cubebs. Dose. — A tea-spoonful. M. Labelonye envelopes the extract also in sugar, as in the ordinary sugar-plumb. An extract of cubebs has been recommended to be prepared as follows: — .The cubebs are exhausted by repeated digestion in alcohol, which readily takes- up all the active principles of the pepper ; viz., a resin resembling that of copaiba, and a coloured resin, with an almost concrete essential volatile oil. The alcohol 20* 234 DELPHINIA. is distilled from those tinctures at a temperature so moderate as not to volatilize the essential oil. When the operation can be carried no farther in this manner, the evaporation must be con- tinued in an open vessel by the aid of a water bath, at a still lower degree of heat ; a little finely pulverized Spanish soap must now be added to prevent the separation of the resin, and preserve the extract of a uniform consistence. The ordinary dose of this in blennorrhea is about fifteen grains three times a day.* Dr. Puchet employs a liquid aqueous extract of cubebs ; a liquid alcoholic extract ; a syrup of the alcoholic extract ; a bolus of cubebs ; and one of cubebs, copaiba and turpentine. The last he covers with a gelatinous mixture to obviate the un- pleasant taste. LIX. DELPHINIA. Synonymes. Delphinina, Delphininum, Delphininium, Delphium, Delphina, Delphia, Delphinine, Delphine. German. Delphinin. This alkaloid was discovered in 1819, by MM. Feneulle and Lassaigne,J and, almost at the same time, by Brandes,§ in the seeds of Delphinium Staphisagria, in which it is united with acetic acid. As a therapeutical agent, it has been chiefly re- commended by Turnbull ; but he did not employ it in its pure state. METHOD OF PREPARING. The plan recommended by Magendie|| is to boil a portion of the seeds of delphinium, cleared of their coverings, and reduced to a fine paste, in a little distilled water ; to pass the decoction through linen cloth, and filter. Pure magnesia is now added, and the mixture is boiled for some minutes ; the filtration is re- peated ; and the residues washed carefully and digested in alco- hol. On evaporating the alcoholic tincture, delphinia is obtained in the form of a white powder, having some crystallised points. * Mr. W. H. Judd, Medico-Botanical Transactions, vol. i. p. 4. Lond. 1839. f Journ. de Connaiss. Medical. Aout, 1840. j Annales de Chimie, torn. xi. xii., and Journal de Pharmacie, vi. 47 and 366. § Schweigger's Journal der Chimie, xxv. 369. U Formulaire, &c. DELPHINIA. 235 This is esteemed the most simple mode ; but if a large quantity- be required, the following plan is advised — on account of the time and patience necessary to decorticate the seeds. Submit the unclean seeds, when well bruised, to the action of iveak sulphuric acid. Precipitate the liquor by ammonia, and redissolve in alcohol the delphinia, which is still slightly coloured. To purify it, draw off the alcohol by distillation, dissolve the residuum in muriatic acid, and boil with magnesia. The plan recommended by Couerbe, and adopted by Turnbull,* is to evaporate a saturated tincture of the seeds to the consist- ence of a thin extract, and then to treat it with water acidulated with sulphuric acid. This solution, when filtered, is to be pre- cipitated by ammonia. The precipitate — after being freed from its water — is to be taken up by alcohol, and again re- duced to the consistence of an extract, which is likewise to be dissolved in acidulated water ; to this solution, filtered, a small quantity of nitric acid is added, as long as any precipitate is thrown down. The liquid, freed from this precipitate, is again to be subjected to precipitation by ammonia, and the powder is dried. This is the delphinia of commerce ; but like veratria, it is a compound substance, and consists of resinous matter, staphy- sagrin and delphinia ; the delphinia is obtained by treating the powder with ether, which takes up the delphinia, and leaves the staphysagrin. When in a state of purity, delphinia is white, pulverulent, and devoid of smell ; but like veratria, when applied to the mucous membrane of the nose, it occasions sneezing, along with an abun- dant secretion of mucus. Its taste is at first bitter, and after- wards acrid, and it acts upon animals in the same manner as — but more energetically than — the seeds whence it is prepared. It is very sparingly soluble in water, but yet in sufficient quantity to communicate a bitter taste to the fluid. In alcohol and ether it dissolves readily ; and these solutions have the property of rendering syrup of violets green, and of restoring the blue colour of litmus, when reddened by acids. It combines readily with acids, and forms neutral salts, which are possessed of much bitter- ness and acridity ; and it may be precipitated from solutions of these in the form of a jelly by the addition of an alkali. EFFECTS ON THE ECONOMY. From the experiments of Orfila,t delphinia appears to belong to the class of acro-narcotic poisons. In the dose of about five grains, it proves fatal to dogs; and the fatal result is more * On the Medical Properties of the Natural Order Ranunculaceie, Chapter II. Lond. 1835. f Nouveau Journal de M£d. x. ; and Toxicologic Gen. i. 739. 236 DELPHINIA. speedily induced when the delphinia is dissolved in weak acetic acid ; the animal, in the latter case, dies in the space of from forty to fifty minutes. When diffused through water introduced into the stomach of a dog, and retained there by a ligature placed around the gullet, efforts to vomit supervened, with restlessness, giddiness, immobility, slight convulsions, and death in two or three hours. In this case, the mucous membrane of the stomach was generally found injected. From his administration of delphinia and its salts, Turnbull concludes, that the pure alkaloid has little effect on the mucous membrane of the stomach and bowels. It may be given, he says, in some cases, to the extent of three or four grains a day, in doses of half a grain each, without exciting vomiting ; in this quantity, however, it sometimes operates upon the bowels, but causes very little irritation. In most instances, it acts as a diuretic, and occa- sions a considerable flow of pale urine. When taken to the ex- tent of a few grains, it induces heat and tingling in various parts of the body, similar to those produced by rubbing it upon the skin ; and its other effects are very nearly the same as those of the salts of veratria. The preparations of delphinia have been used in the same diseases as those of veratria, and they appear to exert a similar action : the test laid down by Turnbull, in the case of vera- tria, applies equally to delphinia ; — namely, unless a solution of delphinia in alcohol, in the proportion of four grains to a dram, occasions a distinct sensation of heat and pricking, when rubbed for three or four minutes on the forehead, the specimen ought not to be used, as no beneficial effect would arise from its application. When rubbed upon the skin, it gives rise to a sen- sation of burning, not unlike that which manifests itself a short time after the application of a blister, but not to an unpleasant degree, unless the friction has been carried too far. The effects of delphinia differ from those of veratria in being generally more powerful and durable. The diseases in which delphinia has been chiefly used, like veratria, are — tic douloureux, paralysis, and rheumatism. In the first of these, when the affection is seated in the tongue, or at the point where the infra-orbitar nerve escapes from its fora- men, the use of delphinia, according to Turnbull, is to be pre- ferred, because it can be applied to the tongue, or rubbed on the gums, without occasioning irritation of the mucous membrane. He thinks it, also, upon tiie whole, better adapted for the treat- ment of paralytic cases than veratria, but principally on account of the property it has " of exciting the circulation in the diseased part." 237 MODE OF ADMINISTERING. The manner of applying delphinia is the same as that recom- mended for veratria. It may be used either in the form of oint- ment or in solution in alcohol ; and the proportions to be employed, in either case, may vary from ten to thirty or more grains to the ounce, according to the severity of the affection, for the treatment of which it is prescribed. The duration of the friction should be regulated in the same manner, or it should be continued until the pungent sensation, produced by the rubbing, exhibits itself. LX. DIOS'MA. Synonymes. Diosma Crenata (folia) ; Barosma Crenata (folia) ; Agothosma Crenatum (folia) ; Bocchoe, Bocho, Boocho, Buckha, Buchu Leaves. German. Buccublatter ; Duftstrauchblatter. Diosma crenata is indigenous at the Cape of Grood Hope. It belongs to the Natural Family Rutacese ; Sexual System Pentandria Monogynia. The smell of the leaves is penetrating and peculiar, but resem- bling that of rue and camphor. By some, it has been compared to that of oil of juniper ; by others, to rosemary ; by others, to cumin, and by the others, again, to that of the urine of the cat. The name is, therefore, by no means expressive. It appears to be derived from the smell, — ft°s , " divine," and **(*■», " odour." The taste of the leaves is aromatic ; somewhat pungent ; and, in the opinion of Buchner, resembling that of peppermint ; without any particular bitterness, yet disagreeable. According to the analysis of Buchner, Brandes, and Cadet, the most important constituents appear to be a volatile oil of a greenish-yellow colour, a peculiar principle — diosmin, and a semi-resinous substance. Diosmin is a very tenacious adhesive matter, similar to Peruvian balsam, and can be drawn out in fine threads. It has the same smell as the leaves, only somewhat weaker ; the taste is pungent and bitter. The semi-reshvms matter has a resinous lustre ; is of a dark brown colour, becomes fluid when heated, and burns with a flame. Its odour is not remarkable : the taste is somewhat pungent and sourish.* * See Journal de Chimie Mcdicale, iii. 13, and Journal de Pharmacie, xiii. 106. 23S EFFECTS ON THE ECONOMY IN HEALTH. The Hottentots have long used the leaves of several varieties of diosma both internally and externally ; but they give the pre- ference to Diosma crenata. Through them its virtues became known to the European settlers. It was first brought to the no- tice of British practitioners by the notorious Richard Reece, who is more known for the part he took in the farce of Joanna South- cote than for any thing else. In Germany, it was chiefly promul- gated by Jobst, who published an extract from Reece's obser- vations in the Repertorium of Buchner.* Bardili instituted experiments for testing the action of the remedy on the healthy organism. It first acts — he says — as an excitant on the stomach, whence arises a feeling of increased heat in that organ, and the appetite becomes augmented : from the stomach, the excitement spreads to the vascular system ; the heat of the body is increased ; the pulse becomes more frequent, and the transpiration is favoured. It acts, likewise, on the uri- nary secretion ; the urine is separated in larger quantity, contains flocculi, deposits a purulent (?) sediment, and exhales an aro- matic odour. On the digestive function, it seems to produce somewhat of a constipating effect. Bardili thinks, that he has also witnessed some narcotic operation in his experiments. The same results were produced by Diosma on animals. EFFECTS ON THE ECONOMY IN DISEASE. The inhabitants of the Cape administer this agent as a sto- machic, and the Dutch physicians give it with success in indi- gestion. It is said, also, to have afforded essential service in chronic cases of rheumatism and gout. Autenrieth extols it in rheumatic pains, which have had their foundation in repelled itch (?) ; and its utility in chronic rheumatism has been confirmed by numerous others. It has been extolled, moreover, in he- maturia, calculous pains, and in irritated and suppurative con- ditions of the bladder, urethra, and prostate. The author has repeatedly administered it, but has observed no other effects than those of a moderate excitant and tonic.t Reece says he found it efficacious in incontinence of urine, and in catarrhus vesicae ; and he gave it — united with tincture of cubebs — in spasmodic stricture of the urethra, gonorrhcea, sivelling of the prostate, and impotence. * Band. xxii. S. 51. f See his General Therapeutics and Materia Medica, vol. i. p. 302. Philad. 1843. DIOSMA. 239 By the inhabitants of the Cape of Good Hope, buchu leaves are often applied externally, both in the form of liniment and of baths, in luxations and rheumatic pains, — as well as of fomen- tations and cataplasms • and in wounds, especially the contused. It may be remarked, that this — like almost every similar remedy — has been given in cholera ; and, as the Riga physicians assert, frequently with favourable results. MODE OF ADMINISTERING. The close of the powder is ^ij. in the day ; this, at least, is the common dose at the Cape. The infusion necessarily contains more of the volatile oil than the decoction ; but, on the other hand, the latter has more of the diosmin : as respects their action, however, there is not much difference. A vinegar, oxymel, liniment, extract, and tincture of diosma have been advised. The London, Edinburgh, Dublin, and United States Pharma- copoeias have an Infusum Diosmje (gss. of the leaves to Oss. of water, Pharm. U. S.) ; dose,fJiss : and the Dublin, a Tinctura Buchu (§ij. of the leaves to Oj. of proof spirit) ; dose, f.^ij. or f.3iij . Infusum diosmrc compositum. Compound infusion of buchu. R. Diosm. Uvse ursi, aa. ^ss. Aq. bullient. Oss. Digere leni calore in vase clauso per semihoram. Colaturse adde Syrup, seneg. f.^ss. Dose. — One or two spoonfuls every two hours, in blennor- rhea, and in atony and paralysis of the bladder. Clarus. R. Infus. diosmte, f.^vij. Tinct. diosmae, Cubebse, aa. f.Jiv. M. Dose. — Two tabic spoonfuls three times a day. This for- mula is recommended by Dr. Joy* " in chronic diseases of the prostate, bladder, and kidneys, gravel, &c," as if the patholo- gical condition to bo rectified wore, in all these cases, identical ! (See page 145.) ■* Tweedie's Library of Medicine, v. 311. London, 1840; or 2d American edit. vol. iii. Philad. 1842. 240 ELECTROPUNCTURA. LXI. ELECTROPUNCTU'RA. Synonymes. Electropuncture, Electropuncturation. Electropuncture consists in a union of acupuncture with elec- tricity. The idea of the conjunction appears to have originated with Berlioz ; but Sarlandiere was, doubtless, the first who put it in practice, although J. Cloquet has contested the priority with him — a matter, by the way, as in all such cases, of extremely small moment. The operation consists in employing acupunctu- ration in the usual way, either with a single needle, or with two or more ; and making a communication between them and the prime conductor of an electrical machine in action ; or they may be made to form part of the circuit in the discharge of a Leyden jar. In this way, the electrical influence may be graduated from the simple aura to a full shock. Sarlandiere appears to have employed electropuncture with great success, but he restricts its use to rheumatic or neuralgic pains, uncomplicated with organic mischief or inflammation : when such complications exist, he advises bloodletting and general antiphlogistics to be premised.* Guersent thinks it better, in all these cases, to use simple acupuncturation, and only to employ electropuncture, when the first proves to be inadequate, as in paralysis, and in tremors produced by the immoderate use of mercury ; — in all cases, indeed, in which the malady depends on a diminution of the nervous energy. A case of success from its use, in paralysis of the right arm, in which voluntary motion and sensibility were destroyed, has been published.t The patient was, in the first instance, subjected to the use of blisters and moxas along the course of the radial nerve, from which he obtained some advan- tage. The remedy, which succeeded best, however, was electro- puncture along the nerves from the shoulder to the hand. Ail first, the punctures were but little felt ; but afterwards they were very painful. The sensibility, mobility, and strength of the fingers and hand gradually returned ; and, three months after his admission, the patient left the hospital completely cured. Magendie affirms, that he has treated many cases of incom- plete amaurosis with great success by this agent. He employed, it, however, in the form of what has been more properly termed galvanopuncture ; by fixing a needle in the frontal nerve, and * E. Grafe, Art. Electropunctura, in Encyclopad. Worterb. der Medicinisch. Wissensch. x. 550. Berlin, 1834. f La Lancette Frangoise, Dec. 20, 1836; and Amer. Med. Intelligencer, Oct. 16, 1837, p. 265. ELECTROPTJNCTTJRA. 241 another in the superior maxillary, and making these communi- cate respectively with the poles of a galvanic pile of twelve pairs of plates, each six inches square. Whenever the contact was made, the patient experienced a painful commotion in the course of the nerves, and at the bottom of the orbit ; the light became better appreciated, and the pupil contracted. The author has frequently used both electropuncture and galva- nopuncture in rheumatic and neuralgic affections ; but he does not think the advantages were more marked than those of simple acupuncture, whilst the suffering from the operation was certainly greater. Magendie, however, regards electropuncture as the remedy par excellence in the treatment of obstinate neuralgia.* In cases of asphyxia, galvanopuncture has been proposed to arouse the dormant energies. The effect of electricity, in the different forms in which it is adopted in medicine, on the func- tions of sensibility and muscular contraction, could not fail to suggest it early to observers as a fit agent for this purpose ; but it is rarely at hand, and, therefore, seldom available. J. P. Frank, Thillaye,t and others have highly recommended it; — the latter gentleman, on the strength of numerous experiments on animals. As the object, in these cases, is to arouse trie respiratory muscles to action, the electric shock may be passed through the shoulders or the chest in any direction. Neither common nor galvanic electricity is possessed of much — if any — power to restore the action of the involuntary muscles. The author has frequently attempted to re-excite the action of the heart, intestines, fibres of the uterus, &c, soon after the cessation of respiration and cir- culation, by means of the galvanic stimulus, but without the slightest success, although the voluntary muscles responded to it energetically. Besides, were the action of the heart re-excited by it, this could be but momentary. A necessary stimulating agency to that viscus is distension by the proper fluid, and unless the respiratory movements were restored, and conversion of venous to arterial blood effected, so that the latter could reach the left heart, the action of that organ could not be maintained. Every attempt, therefore, is properly made to restore the action of the respiratory muscles, so that hsematosis may be accom- plished.! M. Leroy d'Etioles§ has suggested galvanopuncture in a man- * Medico-Chirurg. Rev. July, 1841, p. 202 ; and Dunglison's Amcr. Med. Intel. Sept. 1841, p. 69. f Archives Generates de M^decine, xii. % Art. Asphyxia, by the author, in the American Cyclopedia of Practical Medicine, part x. p. 486, Sept. 1836'; and in his Practice of Medicine, i. 428. Philad. 1842. § Magendie's Journal de Physiologie, torn. vii. 1827; torn. viii. and torn, ix. ; also, Recherches Expcrimentales surl'Asphyxie, Paris, 1829; and Bour- 21 242 ELECTR0PTJNCTURA. ner which, at the first aspect, appears most formidable ; but which is really less so than it seems to be, in consequence of the impunity with which fine needles can be made to penetrate, as has been seen,* even the most important organs. He introduced an acupuncture needle on each side between the eighth and ninth ribs, until it reached the fibres of the diaphragm. He then established a galvanic current between the needles by means of a pile of twenty-five or thirty pairs of plates, an inch in dia- meter. The diaphragm immediately contracted, and an inspira- tion was accomplished. He then interrupted the circle, when the diaphragm, urged by the weight of the abdominal viscera, and aided by gentle pressure made on the abdomen by the hand, returned to its former position, and an expiration was effected. In this way, the two respiratory acts were made to succeed each other, and regular respiration was reinduced. A continuous current was likewise employed in some cases : but the respira- tory movements were irregular, and nothing like natural respi- ration resulted. Leroy tried his method on animals asphyxied by submersion, and when they had not been under water more than five minutes, they were often restored. These experiments were witnessed by Magendie.t On different occasions, M. Leroy asphyxied animals of the same kind, and apparently of the same strength, and while those that were left to themselves perished, those that were treated by galvanism recovered. As anaid,therefore,to pulmonary insufflation,and an important one, galvanism, — combined or not with acupuncturation, — might be advantageously employed in asphyxia,but,as has been already remarked, it can rarely be available. Certainly no time should be lost in adopting the other energetic and indispensable mea- sures that are demanded4 It has been recommended, that as only a very small apparatus is necessary, batteries, consisting of a few plates, might be kept wherever there are station-houses for the reception of persons in a state of asphyxia.§ The sug- gestion is good ; and they might also with propriety form apart of the cabinet of apparatus of the private practitioner ; but whilst an assistant is preparing the apparatus for action, the practitioner should be assiduously engaged in applying other means of resus- citation. || geois, Observations sur la possibility du retour a la vie dans plusieurs cas d'Asyhyxie. Paris, 1829. * See Art. Acupuncture, p. 45. t Journal de Physiologie, ix. % See Art. Asphyxia, Op. cit. p. 486. \ Kay, in Edinb. Med. and Surg. Journ. xxix. and in his work on Asphyxia. Lond. 1834. IJ See Most, Art. Galvanismus, in Encyklopad. der gesammten medicin. und chirurgisch. Praxis, u. s. w, 2te Auflage. Leipz. 1836. EMETIA. 243 M. Zenobi Pechioli* has detailed a case of double hydrocele, in which he employed electropuncture, Two needles were in- serted, one into the upper, the other into the under, part of the tumour. These were connected to opposite poles of a voltaic pile, and the electric fluid was passed in a continued current for five minutes, when it had to be discontinued in consequence of the right testicle becoming painful. Five minutes after the re- moval of the needles, both hydroceles disappeared completely. In the evening, redness and heat of the scrotum occurred, and the right side of the scrotum became cedematous. The operation was repeated in ten days, and was followed by a like result. Ten days afterwards, it was again resorted to, after which he had no return of the disease. M. Pechioli is of opinion, that the openings made by the common mode of acupuncturation are too small to allow the fluid to escape, and he thinks, that by passing a current of electricity through the hydrocele, the contained fluid is forced out through the sac into the cellular tissue of the scrotum, whence it is removed by absorption. LXII. EMETIA. Synonymes. Emetina, Emeta, Emetinum, Emetine. French. Emetine, La Matiere Vomitive. German, Emetin, Brechstoff. In the year 1S17, MM. Pelletierand Magendie,t by a series of chemical and physiological experiments, discovered, that the various kinds of ipecacuanha are indebted for their emetic pro- perties to a peculiar substance to which they gave the name Emetine. This substance possesses the emetic power in a very concen- trated state, and has neither the disagreeable smell, nor the nau- seous taste of ipecacuanha. They considered, therefore, that it might be advantageously substituted for ipecacuanha on all occasions. There are two varieties of the active principle — the coloured and the pure, which, as Magendie remarks,:]: bear the same re- lation to each other as moist sugar does to the white and crystal- * Bulletin delle Scienze Medic, di Bologna, Sept. 1841 ; and Dublin Journ. of Med. Sciences, Nov. 1812, p. 311. f Journal de Pharmacie, iii. 145 ; and Magendie's Formulaire pour la pre- paration de plusieurs nouveaux medicamens, &c. \ Op. cit. . 244 EMETIA. Used. Ipecacuanha, derived from Cephaelis ipecacuanha, con- tains the most emetia. Emetia has been received into many of the Pharmacopoeias, as the Parisian, Batavian, Hanoverian, &c. MODE OF PREPARING. 1. Coloured Emetia. — Powdered ipecacuanha is digested with ether at 60° (.720) to dissolve the fatty matter, whence it derives its disagreeable odour, and which possesses no emetic virtue. When the powder yields nothing more to ether, it is ex- hausted by means of alcohol : the alcohol is then evaporated in a water-bath, and the residue is dissolved in cold water. It thus loses some of the wax, and a little fatty matter, which still ad- hered to it ; it is then only necessary to mix it with carbonate of magnesia, whereby it loses its gallic acid, — to redissolve it in alcohol, and to evaporate to dryness. By a similar process, M. Boullay obtained from the roots, leaves, flowers, and seeds of Viola odorata, an active, alkaline, bitter and acrid principle, similar to emetia from ipecacuanha, which he denominates Emetine of the violet, indigenous emetine or violine. According to Orfila, it possesses highly poisonous qualities.* 2. Pure emetia. — This is obtained by substituting calcined 'magnesia for the carbonate used in the process just described, in such quantity, that the acid existing in the liquid may be neutralised, and that which is associated with the emetia be separated from it. The precipitate of magnesia and emetia must now be washed with a little very cold water, to remove the colouring matter, which is not combined with magnesia ; and after being care- fully dried it must be treated with alcohol, which dissolves the emetia. The emetia, obtained by the evaporation of the alcohol, must then be dissolved in a dilute acid, and treated with pure animal charcoal. After this purification, the emetia must be precipitated by a salifiable base. The waters, used to wash the magnesian precipitate, still con- tain emetia, which may be separated by a second series of oper- ations. Coloured emetia appears in the form of reddish-brown, trans- parent scales ; is almost inodorous, and of a bitter, but not nau- seous taste. It can withstand the heat of boiling water without experiencing change ; is very deliquescent, soluble in water, and not crystallisable. * Journal de Pharmacie, Janvier, 1824. EMETIA. 245 Pure emetia has a white and frequently a somewhat yellowish appearance ; is pulverulent, and does not deliquesce, like the former, in the air. In cold water, it is but little soluble ; more so in warm. In ether and alcohol, it dissolves readily. Its taste is feebly bitter. It has an alkaline reaction, is dissolved by all the acids — diminishing their acidity, but without wholly neu- tralising them. With the acids it forms crystallisable compounds, from which it may be precipitated by galls, which are the best agents for obviating the effects of emetia, when given in too large a dose. EFFECTS ON THE ECONOMY IN HEALTH. According to Magendie,* from half a grain to two or three grains of coloured emetia given to dogs and cats, excited vomit- ing, at times followed by long sleep. In larger doses, — ten grains for example, — it occasioned, in dogs, repeated vomiting, after which the animal fell asleep, and generally died in twenty-four hours. On dissection, violent inflammation was found in the lungs, and in the mucous membrane of the stomach and bowels throughout their whole extent. The effects were the same when the emetia was injected into the jugular vein, or absorbed from any part of the body. In a healthy man, two grains of coloured emetia, taken fasting, produced repeated vomiting, to which succeeded decided disposition to sleep. Even a quarter of a grain at times induced nausea and vomiting. It acted also on the bowels. The effects of pure emetia are analogous, but more powerful ; two grains were sufficient to kill a strong dog. EFFECTS ON THE ECONOMY IN DISEASE. The same effects are induced on the morbid as on the healthy economy. Magendie recommends the administration of coloured eme- tia — as the pure is much too dear — in every ease where it is desirable to excite vomiting, and especially where ipecacuanha is indicated. It has not, however, been much used, except by Magendie himself. Lerminier, who prescribed it, says that one or two grains of coloured emetia are equal in strength to from ten to twenty of ipecacuanha ; but that he observed no difference in their operation, and Dr. Domeiert appears to have arrived at. * Op. citat. + London Med. Gaz. Sept. 11, 1839, p. 929. 21*= 246 EMETIA. the same results. The obvious advantages it possesses are — the convenient and agreeable form under which it may be admin- istered, and the circumstance, that several spurious sorts of ipeca- cuanha are frequently passed off in commerce, and occasion, in consequence, considerable disappointment in the mind of the practitioner. The employment of the active principle of course precludes these inconveniences.* Prollius, of Wolfhagen, has frequently administered pure emetia, which he recommends as a substitute for ipecacuanha, on the grounds above mentioned ; and he properly adds, that the price is not a matter of so much moment as it might seem to be by reason of the very small quantity required to produce the desired effects. MODE OF ADMINISTERING. To produce vomiting, three grains of coloured emetia may be dissolved in any vehicle, and given in divided doses, at short intervals. In several cases, Dr. Domeiert found one grain amply sufficient. Of pure emetia, Magendie found, in a man eighty- five years of age, one-sixteenth of a grain sufficient to induce vomiting. He remarks, however, that the man was easily made to vomit. Prollius found the medium dose of pure emetia, for an adult, to be from two-sixteenths to three-sixteenths of a grain ; sometimes it was requisite to give another sixteenth. Very rarely was it necessary to give more than four-sixteenths, or one-fourth of a grain. As, on account of its sparing solu- bility, pure emetia, when given alone, might be restricted in its operation, Prollius adds an equal portion of tartaric acid, and a little sugar. Mistnra emetia Tomitoria. Emetic mixture of emetia. R. Emet. colorat. gr. iv. Infus. flor. aurant. gij. Syrup, flor. aurant. gss. M. Dose. — A dessert-spoonful every half hour, — to excite vomit- ing. Any simple distilled water and syrup may be substituted for those of the orange flowers. Magendie. * CliniqueMedicale, vol. i. Paris, 1823. f Op. citat. 247 Pastilli emetiae pectorales. Pectoral lozenges of emetia. R. Emetiae colorat. gr. xxxij. Sacchar. 51 v. Mucilag. q. s. ut fiant pastilli, pond. gr. ix. sing. These lozenges are commonly coloured red, to distinguish them from those of ipecacuanha. A little carmine may be added for this purpose. Given in cases of catarrh, hooping-cough, chronic diar- rhoea, &c. Dose. — One lozenge occasionally. Magendie. Pastilli emetiae vomitorii. Emetic lozenges of emetia. R. Emetiae colorat. gr. xxxij. Saech. §ij. Mucilag. q. s. ut riant pastill. pond. gr. xviij. singul. Dose. — One of these lozenges, taken fasting, is generally enough to make a child vomit : three or four are required for an adult. Magendie. Mistura emetiae purificatae vomitoria. Emetic mixture of purified emetia. R. Emetiae purif. — in pauxil. acid. nitr. solut — gr. j. Infus. flor. tiliae, f.giij- Syrup. althaeae, f.gj. M. Dose. — A dessert-spoonful to be given every quarter of an hour, until vomiting is induced. Magendie. 24S LXIII. ER'GOTA. Synonymes. Secale Cornutum, Clavis Secalinus, Calcar, Secalis Mater, Secale Luxurians, S. clavatum, Ustilago, Clavis Siliginis, Spurred Rye, Corned Rye, The Spur, Ergot, Hornseed. French. Seigle ergote, Ble cornu, Clou de Seigle, Mere de Seigle, Bled avorte, B. farouche, Faux Seigle, Seigle cornu ou corrompu ; S. a eperon, S. ergo- tise, S. ivre, S. noir. German. Mutterkorn, Gebarpulver, Afterkorn, Schwarzkorn, Aetzroggen. The effects, which this substance is capable of exerting on the uterus, are so well known as not to need any lengthened de- scription. Its employment in parturition having been revived in this country, there are but few who are ignorant of its re- puted properties. Certain other effects have, however, been ascribed to it, in very recent times, which require mention. Spurred rye or ergot — the latter being the common name from its " spurred" appearance* — is generally considered to be the result of a disease in rye, occurring most frequently when a hot summer succeeds a rainy spring.t Decandolle, however, regards it as a parasitic fungus, and calls it Sclerolium clavus ; whilst Leveille esteems it to be a fungus giving a coating to the diseased grain — the medical virtues re- siding in the coating. This fungus he calls Sphacelia segetum. Brande refers it to the Natural Order Fungaceae, and terms it Spermoedia clavus, and in the last edition of the London Phar- macopoeia, it is referred to the Acinula clavus of Fries ;J but, according to Lindley, Fries has no such plant in any of his works, and the only species of Acinula known, Acinula candicans, is found on the rotten leaves of the common alder, and among melting snow ; its organization is of another kind from that of the spermoedia ; and Fries, who regards the other as a morbid state of the grain of certain grasses, considers acinula as a true fungus.§ M. Debourge considers, that ergot is an animal product from the telephorous family. The insect deposits a liquid of its own formation on a grain of rye and produces the ergot ; whence * French, ergot, " a spur." f Dr. Wright, Edin. Med. and Surg. Journ. Jan. 1841. % Syst. Mycol. § Brande's Dictionary of the Materia Medica, p. 233, Lond. 1839. See, also, Venus, Grundriss der medicin. Receplirkunst, u. s. w. S. 347. Weimar, 1838; and the opinions of Schreber, De Geer, Parmentier, Buffon, Von Mun- chausen, Tessier, Zuckert, Rbssig, Hube, Aymen, Robert, Tillet, &c, in Wright, op. cit. ERGOTA. 249 it follows, he conceives, that ergot may be produced at plea- sure by expressing this liquid upon all the grains of rye that are within a certain period of their maturity.* Recently, Mr. Smitht and Mr. QuekettJ have maintained, that ergot is not a fungus, but a diseased state of the grain oc- casioned by the growth of a fungus not previously detected : to this fungus the latter gives the name Ergotselia\ abortans or Ergolsetia abortifaciens. By the microscope, they discovered sporules, sporidia, or jointed bodies, which appeared to be the reproductive particles of the fungus. Mr. Francis Bauer, || however, who has made the ergot a sub- ject of particular study, and who, about thirty years ago, under- took, at the suggestion of Sir Joseph Banks, a series of careful microscopical observations with a view to determine the nature and cause of that singular production, does not consider the ques- tion as to the cause of the ergot to be finally and satisfactorily settled. He states, that he is not convinced that the filamentous fungi with numerous sporidia, pointed out by various recent observers, are the cause or the consequence of the ergot : — be- cause, first — every gramineous plant is equally infected with that minute filamentous fungus, yet very few of these plants produce ergots ; and amongst agricultural grains, the rye is the only one that is subject to the disease ; and secondly, in autumn all decay- ing plants are infected with such filamentous fungi and minute sporidia. Mr. Bauer's investigations lead him, however, to de- termine the ergot to be a morbid condition of the seed. Ergot is in grains, from a third of an inch to an inch and a half long, and from a line to three lines in diameter, usually curved like the spur of a cock, having commonly two longitu- dinal furrows, and often irregularly cracked and fissured. Ex- ternally, it is of a dingy-purple hue ; internally, of a pale gray- ish-red or grayish-white. Its odour is peculiar, fishy and nau- seous ; taste obscurely acrid and disagreeable. Unless excluded from the air, it swells and softens, acquiring a deep black colour and heavy smell ; and becoming infested by a little acarus, which is about one-fourth the size of the mite of cheese, and destroys the interior of the ergot, leaving the grain as a mere shell. In * Socittts Savante.i,\n Encyclographie des Sciences M^dicales, Avril, 1838. t Transactions of the Linnean Society of London, xviii. Pt. 3, p. 449. London, 1840. ^ Ibid. p. 453, and London Lancet, June 22, 1839, p. 465. See also an abridgment of a communication read by Mr. Quekett before the Linnean Society, Dec. 4, 1838, with illustrative woodcuts, in American Journal of Pharmacy, for July, 1839, p. 116. For remarks on an insect met with in the diseased grain, see a paper by Mr. Muller, of Butler county, Pa., with comments by Dr. Carson, in Amer. Journal of Pharmacy for Jan. 1839, p. 269. $ From ergola, and a/ Dose.— Six, three times a day. Marker. R. Ferri carburet. 3ij. Zinci. oxid. Jss. Adipis, 5j. M. Mayer. FERRI CITRAS. 273 Unguentum ferri carbnreti. Ointment of carburet of iron. R. Ferri carburet. Sulphur, aa. 5'j- Adipis, q. s. ut fiat unguentum. Brera. Emplastrum ferri carbnreti. Plaster of carburet of iron. R. Ferri carburet. Jij. Emplast. sapon. 5iv. Misce intime. Weinhold. LXVIII. FERRI CITRAS. Stnokyme. Citrate of Iron. French. Citrate de Fer. German. Citronsaures Eisenoxydul. Two citrates of iron have been proposed, of late years, by M. Beral* — the one the sesquicitrate or citrate of the ses- quioxide op iron ; the other the citrate of the protoxide of iron. MODE OF PREPARING. The citrate of the sesquioxide, according to Mr. Duhamelt is prepared as follows : — Take of Citric acid, crystallized, iij. or 3 parts ; Hydrated oxide of iron, dry, §ij. or 2 parts ; Distilled water, oxij. or 12 parts. If the moist hydrate be used, about 3vj. are required ; but as the degree of moisture is not always the same, Mr. Duhamel suggests, that the oxide should be in excess. The ingredients above mentioned are boiled together in a matrass until the whole of the oxide is dissolved. The solution is filtered, * Journ. de Chimie M^dicale, and Amer. Journ. of Pharm. April, 1841, p. 72. f Amer. Journ. of Pharmacy, Oct*. 1842, p. 225. 274 FERRI PR-EPARATA. and the filter washed with distilled water sufficient to obtain 12 parts of liquid. This forms what is kept by the French Phar- maciens under the name Liquid Citrate of Iron, marking 24° of Beaume. It holds in solution one-third of its weight of dry- citrate of iron. Its taste is acid, but not disagreeable, and it is said to be of all chalybeate salts the least unpleasant to the taste. The citrate of protoxide of iron is prepared by M. Beral,* by treating iron filings with citric acid previously dissolved in distilled water. It has a strongly marked chalybeate taste. EFFECTS ON THE ECONOMY IN HEALTH. The citrates of iron resemble, in their properties, the tartrate and the lactate of iron, and may be given in the same cases. MODE OF ADMINISTERING. The dose of citrate of iron may be the same as that of the salts above mentioned. It has been long administered in wine, of which the following are two forms ; — the first from the Ham- burg, and the latter from the Wirtemberg, Pharmacopoeia. Vinum ferri citratis aromaticum. Aromatic wine of citrate of iron. R. Ferri limatur. §j. Limon. succ. liij. Macera per noctem, et adde Gentian. 3ss. Cinnarn. Jij. Vini,3xvj. Dose. — Of the decanted wine, f.^ss. to f.Jij. and more. This preparation or one analogous to it is said to be prescribed by certain physicians of this country — of Charleston, for example.! Take of Iron filings, four ounces; Bitter oranges, four. Remove the peel, the white, and the seeds; beat them in^a stone mortar, and let the paste remain at rest for two days ; then pour upon it Madeira wine, ten ounces, and Spirit of orange- peel, two ounces. After sufficient digestion, express and filter. * Ibid. April, 1841, p. 72. t Duhamel, loc. cit. FERRI FERROCYANURETUM. 275 This preparation is called, in the Wirtemberg Pharmacopceia, Tinctura Ferri Aurantiaca sen Martis cum Vino Malvatico et Pomis Aurantiis.* According to Mr. Gore,f it possesses the most agreeable odour and taste of any medicinal compound ever introduced into practice. It is aromatic, carminative and tonic ;" and he adds, that he has no doubt it will supersede the prepa- rations in general use, when once it has been fairly tried. In strumous habits ; in passive uterine hemorrhage ; in anasarca from general debility ; in chlorosis ; in malignant disease, in which iron has been extolled by Mr. Carmichael and others ; and in all diseases, that arise from a general deficiency of tone, Mr. Gore considers this preparation to be " of exceeding utility, from its agreeable and chalybeate qualities." He suggests, also, its use in chronic bronchitis, in which he gives it in combination with ipecacuanha wine. M. Beral has likewise introduced a Citrate of Protoxide of Iron and Quinia — Ferri et Quinije Citr as, which is formed by the union of four parts of Citrate of iron with one part of Citrate of quinia ; and may be given in the form of pills, wherever a combination of these tonics is needed. LXIX. FERRI FERROCYANURE'TUM. Svnonymes. Ferri Cyanidum, F. Cyanuretum, F. Cyanogenatum, Kyanu- retum Ferri, F. Oxydulatum Hydrocyanicum, F. Rorussias, Ferri Sesqui- cyanidum, Ferri Ferrosesquicyanidum, F. Percyanidum, Ferrocyanas Oxydi Ferri, Ferri Ferrocyanas, Ferrum Cyanuretum, Ferrum Zooticum,F. Borus- sicum, Cccruleum Borussicum, C. Beroliniense, Prussiate or Cyanide of Iron, Cyanuret of Iron; Prussian Blue, Berlin Blue. French. Trito-hydro-ferro-cyanate de Fer; Deutoxicyanure de Fer Hydrate; Tritohydrocyanate Ferrure de Fer, Prussiate de Potasse et de Fer, Bleu de Prusse. (ierman. Cyaneisen, BlaustofFeisen, Blausaures Eisenoxydnl, Eisenblau- saures Eisenoxyd, Eisencyaniircyanid, Berliner Blau, Pariser Blau. In commerce, this preparation with us bears the name " Prus- sian blue," but in Germany it is called " Pariser Blau." It is not in a state of purity, and, consequently, that which the apo- thecary prepares is best adapted for internal use. * Jourdan, Pharmacopie Universale, i. 545, Paris, 1828. | Dublin Med. Press, April 29, 1810, and Braithwaite's Retrospect, vol. i. p. 24, 3d. edit. Lond. 1812. 276 FERRI PRJEPARATA. MODE OF PREPARING, The form given by Buchner is as good as any. Ferrocy- anuret of potassium, as commonly met with in commerce, is dissolved in warm distilled ivater, and to the clear filtered solu- tion is gradually added, in a glass vessel, a solution of chemically pure sulphate of iron so long as a precipitate is thrown down. After the precipitate has fallen to the bottom of the vessel, and the supernatant fluid, which contains sulphate of potassa, has been poured off, the precipitate is first digested with dilute sul- phuric or muriatic acid, in order to dissolve the excess of oxide of iron ; the beautiful dark blue precipitate is then collected on a filter, carefully washed with boiling water, and dried. The following form for the preparation of "pure Prussian blue," is admitted into the last edition of the Pharmacopoeia of the United States : — Take of Sulphate of iron, liv. ; Sulphuric acid, f.3iiiss. ; Nitric acid, f.5vj., or a sufficient quantity ; Ferro- cyanuret of potassium, givss. ; Water, 0\). Dissolve the sul- phate of iron in a pint of water, and, having added the sulphuric acid, boil the solution. Pour it into the nitric acid, in small por- tions, boiling the liquid for a minute or two after each addition, until it no longer produces a dark colour ; then allow the liquid to cool. Dissolve the ferrocyanuret of potassium in the re- mainder of the water, and add this solution gradually to the first liquid, agitating the mixture after each addition ; then pour it upon a filter. Wash the precipitate with boiling water until the washings pass tasteless. Lastly, dry it and rub into powder.* Ferrocyanuret of iron is of a beautiful deep blue colour, and devoid of odour and taste. It is decomposed by heat, and is in- soluble in water, alcohol, ether, oils and dilute acids. Potassa and soda decompose it. It adheres firmly to the tongue, which Riecke thinks, — though erroneously, — is owing to its contain- ing argil. EFFECTS ON THE ECONOMY. Of the effects of ferrocyanuret of iron on the human economy in health we have no evidence. Coullon gave it to various ani- mals, but observed no action from it. It has been given, how- ever, and not without success, in several diseases ; and Dr. L. W. Sachs, who has not unfrequently administered it, considers it one of the most important chalybeates with which we are ac- quainted. He thinks it probable, that hydrocyanic acid has not * Pharmacopoeia of the United States, p. 109. Philad. 1842. FERRI FERROCYANURETUM. 277 much agency ; yet it certainly seems to differ from all the other preparations of iron. It has been especially recommended in epilepsy by Kirck- hoff* of Ghent, In very obstinate cases, not dependent upon organic mischief, he succeeded entirely with it ; with the adult, he commenced with half a grain daily, and raised the dose gradually to three, four, and even six grains and upwards. When the patient was plethoric, he premised bloodletting, or applied leeches, from time to time, to the temples. Hildenbrand and Gergeres confirm its efficacy in epilepsy. It has also been administered by Dr. Zollickofferj- successfully in a case of chorea ; three grains being given in the form of pill, three times a day. In six days, the girl, twelve years old, was entirely cured, after camphor, opium, quinia, and assafoetida, nitrate of silver, and subcarbonate of iron had been given in vain. In intermittent fever Dr. Zollickofferj found ferrocyanuret of iron so efficacious, that he even gave it the preference over cinchona ; and his experience has been confirmed by that of Eberle,§ Hosack,|| J. E. Craighead,^ and others. Wutzer, in Germany, also exhibited it successfully ; and Stosch gave it advantageously, in combination with cinchona and rhubarb, in a case of obstinate intermittent. Sachs likewise tried it fre- quently, but as often without, as with, success. When it has proved efficacious in intermittents, the dose has been by no means large. Some have given six or eight grains every four hours during the apyrexia, and even as much as a scruple has been administered. Sachs found it several times efficacious, when four doses of two grains each were taken ; and Riecke,** affirms, that his father obtained essential service from it in the leucophlegmatic conditions resulting from intermittent fever. Zollickoffer extols the ferrocyanuret also in remittent fever ; and there may, doubtless, be periods when it may be adminis- tered with benefit ; but it is not often used. He recommends it, likewise, in dysentery. ,tt when the inflammatory condition has passed away, either spontaneously or under the efforts of art ; and Sachs remarks, that in atonic conditions of the intes- tinal canal, which supervene on dysentery, it may doubtless be * Journ. de Chimie Me"dicale, iii. 285. See, also, Journ. des Connais. Med. Chirur. Aoiit, 1841 ; and Encycl. des Scien. Med. Sept. 1841, p. 4G8. | Medical Examiner, May 16, 1840, p. 314. X American Medical Recorder, v. 540. § Materia Medica, 2d edit. i. 233. || New York Medical and Physical Journal, 1823. ^ Dunglison's Amer. Med. Intelligencer, May, 1842, p. 230. ** Op. citat. S. 217. ft Chapman's Philadelphia Journal, Aug. 1823. 24 27S FERRI PR^PARATA. of great service. Gergeres administered it successfully in chro- nic diarrhoea. L. W. Sachs enters into a long theoretical dis- quisition on the precise action of the remedy, in which there is, doubtless, much that is speculative. He used it, he says, with success, in many cases which it would be difficult to classify under any formal nosology ; their common bond, however, was, that they were dependent upon " nervous disorders, especially of the plastic functions of the abdominal organs, the mischief appearing first of all to be gastric." In such affections he found a combination of the ferrocyanuret of iron with rhubarb especi- ally serviceable. He gave it in not less than two grain doses, which he gradually augmented to six grains, three times a day. Dr. Moll saw decidedly good effects from its use in a case of immoderate menstruation from atony of the uterus with gene- ral elevation of the nervous excitability, after he had employed the remedies, commonly recommended, unsuccessfully. He found it also extremely beneficial to children of a strumous habit, and of great torpor. Stosch found it serviceable in a case of scrophula, in which haematosis was imperfectly accomplished ; and Dr. Bridges* obtained great advantage from it in a case of severe and pro- tracted facial neuralgia. Externally, the ferrocyanuret has been used in the form of ointment, in cases of ill conditioned, torpid and foul ulcers, and even of noli me tangere. Stosch applied it in a case of fungous ulcer with marked advantage; making it into a paste with water and applying it in that form. MODE OF ADMINISTERING. Pnlvis ferri f errocyanureti. Powder of ferrocyanuret of iron. R. Ferri ferrocyan. gr. iij. ad.xxxvj. Sacchar. 31J. M. et divide in pulveres vj. Dose. — A powder two or three times a day, in epilepsy. Kirckhoff. &. Ferri ferrocyan. gr. j., iv., vj., ad xij. Sacch. 5J- Fiat pulvis in partes xij. sequales dividendus. Dose. — A powder every two hours, in epilepsy. Hildenbrand. * Wood and Bache's Dispensatory, Art. Ferri Ferrocyanas. FERRI IODIDUM. 279 R. Ferri ferrocyan. Guaiac. pulv. aa. 3j. Misce et divide in chartulas xij. Dose. — One, three times a day. — Employed successfully in intermittens.* Pilulae ferri ferrocyannreti. Pills of ferrocyanuret of iron. R. Ammoniac. Rhei rad. Ext. taraxac. aa. £j. Ferri ferrocyan. gr. xviij. ad. xxxvj. M. et fiat massa in pilulas lx. dividenda. Dose. — Four to six, twice a day, in disorder of the ganglionic system. Radius, according to L. W. Sachs. Unguentum ferri ferrocyanureti. Ointment of ferrocyanuret of iron. R. Ferri ferrocyan. gj. Unguent, cetacei, gj. M. et fiat unguentum. Applied to foul ulcers. LXX. FERRI IO'DIDUM. Stnonymes. Ferri Ioduretum, Ferrum Iodatum, Iodated Iron, Iodide of Iron, loduret of Iron, Protoioduret or Protiodide of Iron. French. Iodure de Fer, Protoiodure de Fer. German. Iodeisen. In solution, Ferri Ilydriodas, Ferrum Hydriodatum, Ferrum Hydroiodicum Oxydulatum, Hydriodated Iron, Hydriodate of Iron, Hydriodate of Protoxide of Iron. French. Hydriodate de For. German. Hydriodsaures Eisenoxydul. Although attention had been directed, several years ago, to this preparation, it was not much used, until Prof. A. T. Thom- * Ellis's Formulary, 6th edit. p. 173. Philad. 1842. 2S0 FERRI PRjEPARATA. son,* of the London University, recommended it strongly in a special monograph several years since. It has been received into different Pharmacopoeias. MODE OF PREPARING. The following method is recommended by Dr. Thomson. One part of iron wire should be rubbed in a porcelain or wedgewood mortar, with about three or four parts of iodine, gradually adding distilled water, until fifteen parts of the fluid have been used : the whole is then to be introduced into a Florence flask, with an additional portion of wire and of distilled water. This ex- cess of iron is a matter of indifference in the preparation of the hydriodate, and in that of the iodide it is necessary for preserving the combination from decomposition during the evaporation of the solution. These materials are next to be boiled together, until the fluid acquires a pale greenish colour, when it must be filtered. This solution contains a hydriodate of the protoxide of iron ; and, if the exact quantity of the iodine be previously ascertained, so as to enable us to procure the solution of a defi- nite strength, it may be kept in this state for medicinal use. In general, however, the solution is evaporated to dryness, and, for this purpose, it may be poured into a clean flask, containing a piece of iron wire sufficiently long to reach from the bottom to the surface of the fluid, and the boiling should be continued until the bulk of the solution be reduced to one-third. It must then be filtered, after which the evaporation should be continued to dryness. It is necessary to break the flask as soon as the mass is cold, in order to obtain the solid iodide, which should be im- mediately transferred to a dry bottle, accurately fitted with a ground stopper. The bottle should not hold more than two ounces of the preparation ; for when it is large and not full, the iodide deliquesces nearly as rapidly as when it is exposed to the free action of the atmosphere. When the flask is broken, and the iodide bottled before the mass is cold, deliquescence also takes place, a peroxide of the metal is formed, and iodine is evolved. The form for the preparation of the solid iodide recommended in the last edition of the Pharmacopoeia of the United States is the following : — Take of Iodine, Sij., Iron filings, 3i., Distilled water, a pint and a half. Mix the iodine with a pint of the distilled water in a porcelain or glass vessel, and gradually add the iron filings, stirring constantly. Heat the mixture gently * Some Observations on the Preparation and Medicinal Employment of the Ioduret and Hydriodate oflron. 8vo. pp. 64. Lond. 1834. FERRI IODIDUM. 281 until the liquid acquires a light greenish colour ; then filter, and after the liquid has passed, pour upon the filter half a pint of the distilled water boiling hot. When this shall have passed, evaporate the filtered liquor at a temperature not exceeding 212°, in an iron vessel, to dryness. Keep the dry iodide in a closely stopped bottle.* The plan proposed by Mr. Durand,f of Philadelphia, after that by MM. Baup and Caillot,J for preparing the solution of the protiodide of iron (hydriodate of protoxide of iron) is the fol- lowing : — Take of Iodine, %x., Iron filings, perfectly pure and unoxidised, 3v., Distilled water, Ixiiss. Put the iodine into a porcelain capsule, with one-half the quantity of water, add the iron filings by small portions, stirring the mixture with a glass rod. The combination soon takes place ; heat is evolved with the disengagement of a small quantity of vapour of iodine, and the mixture acquires an orange colour, which gradually deepens to a dark red. When the whole of the iron has been added, the capsule is put in a sand bath, or over the flame of a spirit lamp, and heated slowly ; continuing to stir the liquid. An ioduretted hydriodate of iron is first produced, which, under the action of heat, soon passes to the state of a simple hydriodate. This point is indicated by the entire discoloration of the solution. In this state it is filtered ; and the dregs and filter are carefully washed with the remaining half of the distilled water, previously heated to the boiling point. In this manner, a solution forming twelve and a half fluid ounces is afforded, one ounce of which represents . one dram of iodide of iron. The solution, which is at first colourless, acquires a deep red colour by standing, and precipitates some oxide of iron ; by which it is reduced to the state of an ioduretted hydriodate of irOn ; but it may be easily restored to its former state by heating it again with a small quantity of iron filings, until the liquid be- comes colourless : or, to prevent these changes, a coil of soft iron wire may be kept immersed in it ; a fact, which has been long known, § but which M. Dupasquier has recently rediscovered. || The iodide of iron is obtained by evaporating to dryness the filtered solution, taking care, towards the end, to stir incessantly with an iron spatula, and to detach the salt from the bottom of the capsule as it forms. The heat must be managed most care- fully, diminishing it gradually, and removing the capsule quickly from the fire as soon as the odour of iodine is evolved. The solution of this salt, when the iodide is well prepared, is of a * Pharm. of the United States, p. 110. Philad. 1842. t Philad. Journ. of Pharmacy, iv. 287. Philad. 1833. % Ibid. i. 201. § Mr. Squire, Annals of Philosophy, May, 1836, p. 79. || Journal de Pharmacie, Mars, 1842, p. 224. 24* 282 FERRI PRvEPARATA. pale greenish colour, and deeper in proportion to the decompo- sition, which some parts may have undergone towards the end of the operation. Iodide of iron requires to be well secured from the influence of the atmosphere, both on account of its deliquescent property, the rapid oxidation which the metal undergoes when deliques- cence occurs, and the consequent decomposition which takes place. It is important to prevent this, as the peroxide of iron is comparatively inert as a medicinal agent ; whilst the free iodine extricated during its oxidation, according to Dr. Thomson, alters altogether the virtues of the medicine. This partial decompo- sition of the iodide is rendered immediately apparent on dissolv- ing it in twenty times its weight of distilled water, and filtering: instead of a permanent, clear, very pale greenish-yellow, we obtain an ochre-coloured, completely insoluble precipitate. Much of the iodide, usually prepared, is of this description, and to this may, doubtless, be referred some of the disappointment and dis- crepancy amongst practitioners as to the operation of the medi- cine in cases apparently similar. Even when the iodide has been carefully prepared, it often contains a little free iodine ; but, according to Thomson, it is chiefly owing to the careless- ness of assistants and apprentices in compounding prescriptions, by frequently exposing the iodide to the air, that its properties, and, consequently, its medicinal powers, are impaired : hence, it is preferable to keep it in solution, or in the form of hydriodate, which it becomes, whenever water is added to it. If the solution be prepared with a definite quantity of iodine, as described, it will keep without changing its characters ; but as it is usually made, by dissolving the iodide in distilled water, it requires to be rendered neutral by the following means : — Introduce into a flask the solution of any given strength, and place in it two or three doubles of clean and soft iron wire, suf- ficiently long to extend to the surface of the fluid; boil for a few minutes, and then leave it at rest, until the solution becomes clear, after which it may be either decanted off from the precipitate which forms, or filtered : no farther change takes place in a solution thus treated, provided it be kept in a blackened or a green bottle, however long it may be preserved. In this pro- cess, the wire affords iron to saturate any free iodine present in the solution, or that may have been extricated by the formation of the peroxide of iron in the iodide ; and a perfectly neutral solution being thus obtained, by the immediate conversion of the newly formed iodide into the hydriodate of the protoxide, no subsequent change takes place so long as the solution is kept secluded from the light. The best proportions, according to Dr. Thomson, for forming the medicinal solution, are three grains of the dry solid iodide to each fluidram of distilled water. If the FERRI IODIDUM. 283 water be not either distilled or filtered rain water, perfectly free from foreign ingredients, and particularly if it contain any earthy or saline carbonates, decomposition instantly takes place, iodine is extricated, and a carbonate of iron, which rapidly passes into the state of a peroxide of that metal, is precipitated. To protect the solution of iodide from decomposition, it has been advised to associate it with sugar, which appears to exert the same protective agency as it does on the protocarbonate of iron. With this view, the following preparation has been pro- posed by Mr. Wm. Procter, Junr.* Take of Iodine, 11 drams ; Iron filings, 4 drams ; Syrup, Uncrystallizable honey, or Un- crystallizable sugar, 4 ounces ; Distilled water, a sufficient quantity. Mix the iodine with eight fluid ounces of the dis- tilled water, and gradually add the iron filings, stirring con- stantly ; then apply a gentle heat until the solution shall have acquired a light green colour, or shall not give a blue colour to a solution of starch ; then add whichever of the three protecting saccharine substances may be chosen, continue the heat a short time, and filter. Lastly, wash the filter with as much distilled water as will make sixteen fluid ounces of solution of iodide of iron. The Liquor Ferri Iodidi or Solution of Iodide of Iron of the last edition of the Pharmacopoeia of the United States (1842), is essentially the same as this. The saccharine matter employed in it is prepared honey. The solution, thus obtained, is of a pale greenish colour. It has little or no sediment. M. Oberdorffer, of Hamburg,t gives the following form for the preparation of the sesqui-iodide of iron ; whose effects, and mode of administration, are the same as those of the iodide. It may be preserved for a long time without undergoing decompo- sition. Mix in a glass vessel half an ounce of iodine ; a dram and a half of iron filings ; and an ounce of tvater. When the reaction is completed, the mixture is to be slightly shaken, until it becomes of a clear green colour, which is due to the iodide of iron. It is then diluted with four ounces of water, filtered, and some water is passed through the filter. To the solution two drams of iodide are afterwards added, which are readily dis- solved. A deep reddish-brown liquid results, to which a suffi- cient quantity of water is added to make the weight of the whole ten ounces. Each dram contains about four grains and a half of iodine. When iodide of iron is carefully prepared, it is of an iron-gray colour, foliated texture, brittle, and exhibits a crystalline arrange- ment similar to metallic antimony, except that it is darker. Iu * American Journal of Pharmacy, for July, 1840, p. 13 ; and Ibid, for Jan. 1841, p. 323. f Zeitsclirift fiir die gesammie Medicin. Juin, 1840, S. 284 FERRI PR.EPARATA. the dry state, it is inodorous ; but when moist, it smells some- what of iodine : the taste, when dry, is simply styptic ; when moist, somewhat acrid, before it impresses the gustatory organs. At 350° of Fahrenheit it fuses ; and, at a higher temperature, is decomposed, — the iodine being volatilised, and the iron re- maining in the state of oxide. It dissolves in all proportions in water, — the changes supervening, which have been already indicated. It is decomposed by chlorine, the mineral acids, oxide of arsenic, meconic acid — consequently by opium and laudanum — gallic and tannic acids, the pure and carbonated alkalies, different metallic salts, and by the infusions of digitalis, belladonna, hyoscyamus, tobacco, amylaceous substances, &c. : such articles ought not, therefore, to be given in combination with it. EFFECTS ON THE ECONOMY IN HEALTH. From experiments made on his own person, Dr. Thomson states the following to be the physiological effects of iodide of iron. When taken in doses of from three to five grains, it makes no sensible impression on the stomach, although it sharpens the appetite, and improves the digestive function : it seems to stimu- late moderately the digestive canal through its entire length; for it opens the bowels ; and, whilst it produces the black colour of the alvine discharges characteristic of all the preparations of iron, it corrects their foetor. When it does not affect the bowels, it augments the action of the kidneys, increasing the flow of urine; and if the solution be taken two or three times a day, for several days in succession, the presence of both the iodine and the iron can be readily detected in the urine. The temperature of the skin is moderately elevated, and the insensible perspiration in- creased. On one occasion, having taken ten grains for a dose, it almost immediately caused an uneasy sensation at the epigas- trium, accompanied with nausea, that continued for several hours, and a slight degree of headach. These symptoms were relieved by a copious evacuation, which was perfectly black. Two hours after taking the medicine, a large quantity of urine was discharged ; which, on being tested, displayed the presence of both iodine and iron. The experiments on animals, made by Dr. Cogswell,* induced him to infer : — 1. That iodide of iron acts as a local stimulant, possessing the power of effecting peculiar disorganization. — 2. That its action is more particularly directed to the track of the alimentary canal. * Essay on the Iodine, p. 132. Edinb. 1837. FERRI IODIDUM. 285 When added to blood out of the body, it promotes its coagu- tinn * lation. EFFECTS ON THE ECONOMY IN DISEASE. From the chemical composition of iodide of iron, Dr. Thomson considered it might be specially adapted for cases in which aug- mented activity of the capillary or intermediate system, with a tonic effect, might be indicated, and particularly in scrophulous affections, tabes mesenterica, chlorosis, incipient scirrhus, rickets, amenorrhoza, bronchocele, atonic dyspepsia, — indeed in all cases accompanied by debility. In such affections, he con- ceives the iodide will act more efficiently than any of the other preparations of iron. In secondary syphilis, it may be combined, he suggests, with iodide of potassium ; and in incipient cancer, its efficacy, is aided by the administration of arsenic at the same time. Dr. Thomson has found it serviceable in atonic gastric dyspepsia, when combined with bicarbonate of potassa, and taken at the moment of admixture, in the dose of from three to eight grains or more.t A great advantage it possesses is its ready solubility, owing to which it can enter the circulatory system with facility, and modify the condition of the fluids. In chronic scrophulous cases, it produces all the good effects of the preparations of iron, without any of the concomitant and sub- sequent symptoms that are so apt to supervene, especially in impressible individuals. Where the case is accompanied by vascular erethism, or fulness, it must be reduced before the iodide can be esteemed appropriate. In chlorosis, occurring in stru- mous habits, it has been found most serviceable. Its efficacy in cancer is elucidated by Dr. Thomson, by the details of a case of scirrhous mamma, which, after protracted and fruitless treat- ment by other agents — as by other preparations of iron com- bined with conium — ultimately yielded to a combination of iodide of iron and conium. Some cases are also detailed in which iodide of iron was very effective in removing old syphilitic affections, especially of the skin. M. IJaumes,J who employed the iodide with the most satisfactory results in old and obstinate syphilitic ulcers, especi- ally when the patient was feeble and scrophulous, gave it in the form of pills with extract of opium, — increasing the dose of the * Magendie, Lemons sur le Sang, &c. ; and translation in the Lancet, Jan. 2G, 1839. f London Dispensatory, and Brande's Dictionary of Mat. Med. p. 252. Lond. 1839. See, also, Solon, in Diet, de Med. et de Chirurg. Pratiq. Art. lode; and Ashwell, in Guy's Hospital Reports, p. i. 128; and p. iii. p. 555. \ Medico-Chirurgical Rev. Oct. 1840. 286 PERRI PRJEPARATA. iodide from two or three to twelve or twenty grains in the twenty- -four hours. Along with the cicatrisation of the sores, the im- provement of the general health was most remarkable. Prior to the publication of Thomson, Pierquin had given the iodide in cases of leucorrhoea and amenorrhcea ; and Eager* had recommended it in scrophula. Ricordt found the very best effects from its internal use in cases where tonics required to be combined with antisyphilitic remedies, especially where any scrophulous vice (lymphatisme) constituted a complication. He administered it, likewise, with great success, to remove the con- sequences of syphilis ; and found it advantageous in atonic ulcers of the legs and in spreading ulcers of the throat, which had been aggravated or had not yielded to mercury. The strength of M. Ricord's solution was half a dram of iodide to ^viij. of water, given, we presume, in the twenty -four hours. M. RicordJ also uses it in the form of injection in cases of blennorrhosa. Wherever, indeed, tonic astringent injections are needed, the iodide, in his opinion, should occupy the first rank. Its use, he thinks, can only be contraindicated when there is much inflammation, or pain, in passing the urine, or when cys- titis exists. The strength of the injection should be three grains to the ounce of water. In consequence of its promoting the coagulation of the blood out of the body, Magendie§ prescribed it in the form of injection (3i. to tbij. of water) employed several times a day in a case of severe uterine hemorrhage. The hemorrhage ceased. Mr. B. Phillips || prefers the iodide of iron to any of the pre- parations of iodine. The minimum dose has been a grain twice a day ; the maximum three grains three times a day. In 232 cases, it was only necessary to intermit its use for a few days in three cases. In one it excited ptyalism. About once a week he gives an aperient or cathartic. In cases of scrophulous ulcer- ation, as a consequence of abscess, or from other causes, he em- ploys, with the best effect, a lotion containing three or four grains of the iodide to an ounce of distilled water. Where parts are irritable, he usually recommends the ointment of iodine to be applied to the part on lint. The author has frequently given this remedy in public and private practice, and has considered it especially adapted for those cases in which there appears to be torpor in the system of * Dublin Journal of Med. Science, 1834 ; also, Cogswell on Iodine, p. 138, Edinb. 1837. f J. J. L. Rattier, in La Lancette Francaise, Fev. 4, 1837. I J. J. L. Rattier, Ibid. Fev. 16, 1837; see, also, Revue Medicale, Janvier, 1838, and Dunglison's Amer. Med. Intelligencer, Sept. 15, 1838, p. 195. § Op. cit. II Lond. Med. Gazette, Jan. 10, 1840. FERRI IODIDUM. 287 nutrition, as in cases of asthenic dropsy, old visceral engorge- ments, and indeed of hypertrophy of any kind, accompanied by deficient action in the system of nutrition. In oligsemia, where there is paucity of red globules in the blood, and the fluid is alto- gether too thin, it would seem to be especially indicated, from its property, mentioned above, of promoting the coagulation of the blood, and therefore, of inspissating it. Hence, in all cases of scorbutic, hydropic and other dyscrasies, and in hemorrhages occurring in such pathological conditions of the system, the author has prescribed it largely, and with excellent effects. Tt appears to him to be the best remedy we possess wherever a entrophic and tonic are indicated. MODE OF ADMINISTERING. The dose of iodide of iron, administered in the cases above referred to, was generally three or four grains two or three times a day. The following formulae have been recommended by Pier- quin : Vinum fcrri iodidi. Wine of iodide of iron. R. Vin. Bordegalens, Oj. Ferri iodidi, gss. M- Dose. — A tea-spoonful, morning and evening. Pierquin.* Tinctnra ferri iodidi. Tincture of iodide of iron. R. Ferri iodidi, 3ij. Alcoholis, Aquae, aa. f.3 ij . M. Dose. — A tea-spoonful, morning and evening. Pierquin. * Journal de Chimie Medicale, p. 310, Mai, 1831. 288 FERRI PRJ2PARATA. Syrupns ferri iodidi. Syrup of iodide of iron. Various forms have been given for this preparation.* The following is the one admitted into the last edition of the Edin- burgh Pharmacopoeia : — Take of Iodine (dry), 200 grains ; Fine iron wire, recently cleaned, 100 grains ; White sugar, in powder, four ounces and a half; Distilled water, six fluid ounces. Boil the iodine, iron and water together in a glass matrass, at first gently,to avoid the expulsion of iodine vapour, afterwards briskly till about two fluid ounces remain. Filter this quickly while hot into a matrass containing the sugar ; dissolve the sugar with a gentle heat, and add distilled water to make up six fluid ounces. Twelve minims of this syrup contain one grain of the iodide. It ought to be nearly colourless or pale yellowish-green, and without sediment. Dr. Christison states, that it will always be defective in strength " when made with British iodine as now commonly met with in the market, unless allowance be made for the water, which it very generally contains in large pro- portion."! Troc hisci ferri iodidi. Lozenges of iodide of iron. R. Ferri iodidi, Jss. Croci pulv. 3U- Sacchar. sjiv. M. fiant Trochisci No. 120. Dose. — Six to ten, daily. Pierquin. * Frederking, Repertor fur die Pharmacie, 1839, and Amer. Journ. Med. Sciences, Feb. 1840, p. 449; Dnpasquier, Journ. de Pharm. Mars. 1841, p. 116, and Mars, 1842, p. 225 ; F. Boudet.Ibid. Sept. 1841, p. 335 ; M. Beral, Journ. de Chim. Med. and Amer Journ. of Pharmacy, April, 1841, p. 74 ; Dr. A. T. Thomson, Lond. Pharmac. Transactions, Aug. 1841 ; and Amer. Journ. of Pharmacy, April 1842, p. 60 ; and M. Leistner, Journ. de Pharmacie, Fev- rier, 1842, p. 122. t Dispensatory, p. 431. Edinb. 1842. FERRI IODIDUM. 289 Solutio ferri iodidi. Solution of iodine of iron. (French, Eau d'Hydriodate de Fer.) R. Ferri iodidi, ^ss. Aquae, Oij. M. Added to enemata, lotions, and injections. R. Ferri iodidi, gss. ad gij. Aquae destillat. Oj. M. To be added to a general bath, in cases of leucorrhcea, ame- norrhea, &c. Injectio ferri iodidi. Injection of iodide of iron. R. Ferri iodid. gr. iij. Aquae destillat. f.gvi. M. The quantity may be increased to nine grains to the ounce of water, care being taken to avoid irritation. Used in gonorrhoea. Ricord.* Ungucntum ferri iodidi. Ointment of iodide of iron. R. Ferri iodidi, Jiss. Adipis, §j. M. ut fiat unguentum. A piece of the size of a hazelnut to be rubbed, morning and evening, on the inner part of the thigh, in cases of leucorrhcea and amenorrhcea. * A Practical Treatise on Venereal Diseases, translated by Drummond, Amer. Edit. p. 237, 219. Philad. 1813. 25 290 FERRI PR.&PARATA. LXXI. FERRI LACTAS. Synonymes. Lactate of Iron, Lactate of Protoxide of Iron. This preparation has been recommended by MM. Gelis and Conte, internes at La Charite, in Paris, and has been favourably reported upon by M. Bouillaud, in the name of a committee, con- sisting of MM. Bally, Fouquier, and Bouillaud.* MODE OF PREPARING. MM. Gelis and Conte prepare lactate of iron by treating piwe iron filings with lactic acid, diluted with water. M. Loura- dourt extracts lactic acid from whey, which he collects from the dairies in the neighbourhood of Paris, where much cheese is made. The whey, exposed a long time to fermentation under the influence of an elevated temperature, becomes charged with a large quantity of lactic acid. It is evaporated to one-third or one-fourth of its volume, decanted and filtered ; and is then saturated with milk of lime, which produces an abundant de- posit, chiefly of phosphate of lime. The filtered solution is pre- cipitated by oxalic acid, and again filtered, and then concen- trated to a syrupy consistence. It is now diluted with alcohol, which precipitates the lactine and the salts. The solution on being filtered, and the alcohol distilled off, yields pure lactic acid. Lactate of protoxide of iron is prepared by digesting in a sand-bath, at a low temperature, this acid, diluted with ivater, upon iron filings. At the end of six or seven hours of reaction, the liquid is boiled, filtered, and concentrated ; when, on cooling, it deposits crystals. These crystals, drained on a flannel, and washed with alcohol by displacement, should be dried rapidly, and be preserved from any contact with the air. The salt presents itself under the form of crystalline plates, which are very white, and but slightly alterable. It is but spa- ringly soluble in water; reddens litmus paper, and possesses the ferruginous taste in a tolerable degree. When dissolved in water, it attracts oxygen, and quickly becomes yellow. The sparing solubility of lactate of iron has permitted M. Lou- * Journal de Pharmacie, and Amer. Journal of Pharmacy, July, 1840, p. 121. See, also, M. Beral, Journ. de Chimie Medicale, and Amer. Journ. of Pharm. April, 1841, p. 74. | Bulletin General de Therapeutique, Mars, 1840. FERRI LACTAS. 291 radour to simplify still more his process, by omitting the purifi- cation of lactic acid by alcohol, and treating it immediately by iron filings : the liquor, suitably evaporated, affords crystals of the lactates : the foreign salts, and the lactine remain in the mother waters, which are rejected. As the lactate would seem to be often adulterated with efflo- resced sulphate of iron, or the same precipitated with alcohol, or with starch or sugar of milk, M. Louradour recommends, that no lactate should be used except what is under the form of crystalline plates, which do not readily admit of fraud.* EFFECTS ON THE ECONOMY. Lactate of iron has been used in cases in which protocarbo- nate of iron is employed, and chiefly in chlorosis. MM. Gelis and Conte are disposed to refer the beneficial agency of the pro- tocarbonate to its becoming lactate of iron in the stomach, by uniting with the lactic acid, which has been presumed to be one of the gastric acids. This idea led them to administer lactate of iron, ready formed. In chlorosis the remedy has been given by MM. Fouquier, Bally, Bean, Rayer, Nonat, Andral, Bouillaud, and others, who have cofiected a great number of cases, which show its success in that disease.t M. BouillaudJ made trial of the lactate in twenty-one cases, 14 of which were treated at La Charite. One of the last, not being decidedly chlorotic, may be excluded. Of the thirteen, ten were females, and three males. Of the ten females, eight pre- sented well marked chlorosis ; two were rather anaemic. The dose of the lactate was carried to six, eight, ten, twelve, and fifteen lozenges, each containing about five centigrammes of the salt (gr. 3) in the twenty -four hours. The remedy was well borne ; and it always increased the appetite sensibly. MODE OF ADMINISTERING. MM. Gelis and Conte introduce freshly prepared lactate of iron into lozenges, in which the sugar prevents the superoxida- tion of the iron, and preserves the medicine, whilst, at the same time, a form is given, which allows of great facility of adminis- * Joum. de Pharmacie, and Amer. Journ. of Pharmacy, Oct. 1840, p. 230. f Bulletin General de Therapeutique, Mars, 1840 ; also, La Lancctte Fran- chise, London Lancet, Feb. 8, 1840, p. 707, and Dunglison's Amer. Med. In- telligencer, April 1, 1840, p. 13. \ Encyclopedic des Sciences Medicales, Mars, 1840, p. 226. Academie Royale de Mcdecine de Paris, Seance du 4 Fevrier, 1840. 292 FERRI PRiEPARATA. tration. MM. Andral and Fouquier selden exceed twelve grains of the lactate in the twenty-four hours ; and M. Bouillaud never gives more than twenty. The following formulae have been proposed by Mr. Cap :* Trochisci ferri lactatis. Lozenges of lactate of iron. R. Ferri lactat. 3vij. gr. 72 (30 grammes.) Sacchar. ^xiss. (360 grammes.) Mucilag. acacise, q. s. Make into lozenges each weighing gr. x. (65 centigrammes) which will contain gr. % (5 centigrammes) of the salt. Syrupus ferri lactatis. Syrup of lactate of iron. R. Ferri lactat. %i. (4 grammes.) Aqua destillat. bullient. 5viss. (200 grammes.) Sacchar. alb. ^xiij. (400 grammes.) M. Cap considers the use of this syrup to be more convenient than that of the lozenges, because the ferruginous taste does not remain so long in the mouth. Pilulse ferri lactatis. Fills of lactate of iron. R. Ferri lactat. Althseae pulv. aa. gr. xvss. (1 gramme.) Mellis, q. s. ut fiant pil. xx. Chalybeate bread has been administered in one of the largest hospitals of Paris to chlorotic patients, and with the best effects. From four to five grains of the lactate of iron may be mixed with every three and a half ounces of bread, without giving it any unpleasant taste or injuring its quality.! * Journal de Pharmacie, and Amer. Journ. of Pharmacy, Oct. 1840, p. 228. f Provincial Med. and Surg. Journ. June, 1841, cited in Amer. Journ. of the Med. Sciences, Jan. 1842, p. 217. FERRI NITRAS. 293 LXXII. FERRI NITRAS. Synonymks. Ferrum Nitratum, Nitrate of Iron. LIQUOR FERRI PERSESQUINITRATIS. SyNONyMES. Liquor seu SolutioNitratis Ferri, Liquor Ferri Nitrioi Oxydati, Solution of Persesquinitrate of Iron, Solution of Nitrate of Iron. MODE OF PREPARING. This preparation, which has been introduced within the last few years into practice, may be formed in the following manner : Take of small chips or pieces of Iron ivire, an ounce and a half; Nitric acid,thxce ounces by measure ; Water, twenty-seven ounces ; Muriatic acid, one dram. Put the iron into an earthen- ware vessel, and pour on the nitric acid, previously diluted with fifteen ounces of the water. Set the vessel aside till the whole of the acid has united with the iron, so as to form a persesquini- trate ; then decant the liquid from the portion of iron, which re- mains undissolved ; strain and filter. Add the muriatic acid with the remainder of the water, or with as much of that liquid as will increase the whole solution to thirty ounces. When the process is finished — which takes some hours — the liquid has a red colour, so dark, that when viewed by reflected light, it seems almost black. Three ounces of nitric acid of the usual strength (1.4) gene- rally dissolve an ounce of iron, so that when the process is com- pleted, a portion of the metal remains undissolved. The solution then consists entirely of persesquinitrate of iron ; and, if speedily decanted, it may be preserved in that state ; but if allowed to stand for a few hours longer on the iron, it will undergo a farther change, becoming gradually converted into pernitrate and pro- tonitrate of iron. The first of these is insoluble, and renders the liquid turbid ; and the latter, which remains dissolved, has not the medical properties, that render the persesquinitrate valuable. When the solution contains nothing but nitric acid and peroxide of iron, it slowly undergoes decomposition on standing, so that, at the end of a few weeks, the whole Liquid begins to become tur- bid. The addition of sonic muriatic acid prevents this decom- position, ami the quantity sufficient for this purpose is too small to alfect the medicinal powers of the persesquinitrate. The solu- tion, when properly prepared, is of a beautiful dark red colour, 25* 294 FERRI PR.2EPARATA. when viewed with transmitted light. Its taste is very astringent, and not at all caustic* EFFECTS ON THE ECONOMY. This preparation greatly resembles the solution of chloride of iron in its medicinal properties. Mr. Kerr considers, that to an astringent power it unites the property of diminishing the irrita- bility and tenderness of the mucous membranes with which it comes in contact. Kopp administered it with the greatest success in many cases of chronic diarrhoea, that had resisted every approved remedy. The faeces were blackened by it, as by the preparations of iron in general. He remarks, that it must be continued for some time. The dose he gave was ten drops several times a day in oatmeal gruel, and this was gradually raised to twenty and twenty-five drops. When the cure was accomplished, the remedy was gra- dually diminished, until it was left off altogether. Dr. Gravest speaks in equally high terms of the persesqui- nitrate in these cases ; and Dr. T. C. Adam of Lenawee County, Michigan, has recorded the remarkable assistance, which he has derived from its use in the treatment of several diseases, especially diarrhoea and other affections of the mucous mem- branes accompanied by discharges.% In chronic diarrhoea, de- pendingmainly on an excess in the sensibility of the organic nerves which supply the digestive tube, Dr. Adam rarely orders less than fifteen drops at the commencement, and after a few days' em- ployment of the remedy, he increases the quantity to twenty, twenty-five and thirty drops. In /eucorrhcea, occurring in such as are pale, exanguious, feeble and languid, the internal, conjoined with the external, use of the persesquinitrate has been found very advantageous. In these cases, Dr. Adam adds such a quantity of water as a diluent as will still leave in the vagina a gentle degree of heat or smarting. Dr. Adam recommends it, also, in cases of aphthous sores ; and he affirms that its application has afforded relief in toothach. It is, doubtless, a powerful astringent, but it is questionable whether it possess any advantage over the tincture of chloride of iron. * Mr. Kerr, in American Journal of the Medical Sciences, for May, 1832, cited from the Edinb. Med. and Surgical Journal. f Clinical Lectures, Dunglison's Amer. Med. Library Edition, p. 128. Phila. 1838. X American Journal of the Medical Sciences, May, 1839, p. 61. FERRI 0XIDTJM HYDRATUM. 295 LXXIII. FERRI OX'IDUM HYDRA'TUM. Synontmes. Ferri Sesquioxidtim Hydratum, Ferrugo, Hydras Ferricus, Ferrum Oxydatum Hydratum, Hydro-oxide of Iron, Hydroxide of Iron, Hydrated Oxide of Iron, Hydrated Peroxide of Iron, Hydrated Tritoxide of Iron, Hydrated Sesquioxide of Iron, Oxyhydrate of Iron. German. Eisenoxydhydrat. Hydrated oxide of iron has been introduced into practice as an antidote to white arsenic. Dr. Bunsen, of Gottingen, had already made frequent experiments with it, which satisfied him, that it was an efficacious agent, when, along with Dr. Berthold,* he subjected it to fresh trials. The results of their investigations were published, and since then it has received due attention everywhere. METHOD OF PREPARING. The best mode of preparing it, according to Dr. Bunsen, is to take a solution of pure sulphate of iron, increase its dose of oxygen by treating it with nitric acid, and precipitate the oxide by adding pure ammonia in excess, washing the precipitate. In order not to deprive the precipitate of its water, and to di- minish its loose state of aggregation as little as possible, it is not filtered, but is put aside, for a few days, until the precipitate is wholly deposited, after which the supernatant fluid is poured off. It is then kept in well-stopped vessels. Riecket has added the formula for pharmaciens, which is recommended by Von Specz : — R. Vitrioli ferri puri crystallizali librarn ; teratur in pulv. subtiliss. et detur in vas. porcellan. aut murrhinum, impositum balneo arena?, dein adde acidi nitrici conccntrati ft,ss. ; terantur ope baculi vitrei usque dum massa resolvitur in pultem ; nunc, igne animato, massa; pultaceiccalidie affunde sensim terendo, sensim acid, nitric, concentrut. q. s. donee nullum amplius evolvatur gas nitro- sum. Massa tunc leni igne evaporetur ad siccitatem et solvatur demum in aq. destill. q. s. ; solution! filtrata; iustilletur ammonise purx q. s. donee preci- pitatio cesset ; stent nunc per horam unam alteramve et liquor limpidus a sedimento bruneo decantetur; massa; residua; fundum petenti adfunde aq. des- * Das Eisenoxydliydrat ein CJegengift dcr arsenigen Saure. Gb'tting. 1834. f Die neucrn Arzneimittel, S. 227. Stuttgart, 1837. 296 FERRI FRiEPARATA. tillat. jfjiij. et agitentur ; nunc filtra, et prrecipitatum in filtro aq. destill. q. s. edulcora donee aqua insipida defluat. Preecipitatum bene edulcoratum in umbra siccatum convertat. in pulv. subtilissim. qui servetur vase vitreo bene clause* Lassaigne advises it to be prepared as follows : — Take iron filings ; pour gradually upon them four times their weight of the nitric acid of commerce in small portions. Heat is thereby developed, and deutoxide of azote, which is transformed by the atmospheric air into nitrous acid vapours. When the evolution of gas has ceased, ten or twelve parts of water are added ; the mixture is then filtered, and ammonia added until the mixture begins to exhibit an alkaline reaction. The precipitate, thus formed, is the hydrated oxide of iron, which is collected on the filter, and washed with boiling ivater until it is tasteless, and ceases to exhibit any alkaline characters. The mode of preparation, recommended by Majeste, agrees with this, except that he boils one part of iron filings with four of nitric acid and four of muriatic acid. The following form has been advised by Dr. William R. Fisher,t who asserts that it was subjected to practice by Mr. Durand, an able pharmacien of Philadelphia, who obtained a perfect result, with a satisfactory economy of material. Take of Sulphuric acid (67° Baume), S oz. or 16 parts ; Iron wire, 8 oz. or 16 parts ; Nitric acid (49° Baume), 5§ oz. or 11 parts; Water of ammonia, as much as is sufficient ; Water, a gallon and a half, or 384 parts. Mix the sulphuric acid with the water in a glass vessel. Add the iron, and, after the effervescence has ceased, filter. Add the nitric acid in divided portions, and apply heat so long as orange-coloured fumes are given off. To the heated solution, pour in the water of ammonia until a decided excess has been added ; then wash the precipitate by decantation, until the washings give no precipitate with nitrate of baryta. * "Take of pure crystallised sulphate of iron a pound : rub it into a subtle powder, and place it in a porcelain or glass vessel in a sand-bath ; then add half a pound of concentrated nitric acid ,- stir them with a glass rod until the mass is resolved into a soft paste; then — the fire being raised — pour gra- dually on the hot pultaceous mass concentrated nitric acid, until no more nitrous gas is evolved. Let the mass be evaporated by a gentle heat to dryness, and at last be dissolved in a sufficient quantity of distilled water. Into the filtered solution drop pure ammonia as long as any precipitate occurs ; let it now stand for an hour or two, and then pour off the limpid liquor from the brown sedi- ment. On the residuary mass, remaining at the bottom, pour three pounds of distilled water, and shake thern together: filter and wash the precipitate on the filter with distilled water, until the water is tasteless. The well-washed pre- cipitate dried in the shade forms a subtle powder, which may be kept in a well closed vessel." f Amer. Journ. of Pharmacy, vol. vi. No. 1, April, 1810. FERRI OXIDTJM HYDRATUM. 297 The water is then to be drawn off until just enough remains to give the consistence of thick cream. It has been supposed that this preparation is not injured by keeping ; but some careful experiments by Mr. Wm. Procter, Junr.,* show, that even when kept under water its power of neutralizing arsenious acid gra- dually decreases ; that if kept in the form of a thick magma, it will retain its properties longer than when mixed with much water ; and that this decrease of power is probably owing to a change in the relative proportion of the oxide, and the water chemically combined with it, as well as to an alteration in its state of aggregation. Mr. Procter advises, that a ferruginous solution similar to that advised in the United States Pharmacopoeia should be kept in every shop as a source for obtaining the peroxide ; and that the solu- tion of ammonia should be added to it when the demand occurs, and the peroxide be separated in the manner advised in the Pharmacopoeia. In this mode the first doses may be given in ten or fifteen minutes. In the mean time, however, the moist peroxide prepared according to the Pharmacopoeia should be given, and if recently prepared it may be sufficient ; but for the reasons adduced by Mr. Procter it is advisable, that the recent oxide should always be administered, especially where the amount of poison taken has been large. t The form for its preparation admitted into the last edition of the Pharmacopoeia of the United States (1S42), is the following : Take of Sulphate of iron, §iv. ; Sulphuric acid, f.^iijss. ; Nitric acid, f.Jvj., or a sufficient quantity ; Solution of ammonia, a suf- ficient quantity ; Water, Oij. Dissolve the sulphate of iron in the water, and, having added the sulphuric acid, boil the solution ; then add the nitric acid in small portions, boiling the liquid for a minute or two after each addition, until the acid ceases to pro- duce a dark colour. Filter the liquid, allow it to cool, and add solution of ammonia in excess, stirring the mixture briskly. Wash the precipitate with water, until the washings cease to yield a precipitate with chloride of barium, and keep it in close bottles with water sufficient to cover it. J EFFECTS ON THE ECONOMY. If a solution of arsenious acid be decomposed by freshly preci- pitated oxyhydrate of iron suspended in water, traces of arsenic can no longer be detected in the filtered liquid, made acid and tested by a stream of sulphuretted hydrogen gas. To throw * Amer. Journ. of Pharmacy, April, 1812, p. 37. f Procter, loc. citat. % Pharmacopoeia of the United States, p. 112. Philad. 1842. 298 FERRI PR.EPARATA. down one part of arsenic, in this manner, requires a quantity of the oxyhydrate, which contains at least ten or twelve parts of oxide of iron. Yet, even where a smaller quantity is employed, the arsenious acid is almost wholly separated, as a stream of sul- phuretted hydrogen gas affords only very slight traces of sul- phuret of arsenic in the filtered and acidulated liquid. When the substances are previously heated, or the arsenious acid is exposed in small portions to the precipitating agent, the reaction is still slighter. Ifafewdropsofammoniabeaddedto water in which the oxyhydrate of iron is suspended, and the mixture be digested with finely powdered arsenious acid, an insoluble arsenite of iron is formed ; a circumstance, which would encourage the belief — even had it not been sanctioned by experience — that freshly prepared oxyhydrate of iron may serve as an antidote to arsenic : the union between it and arsenious acid forming — as has been seen — an insoluble compound, devoid of all poisonous influence on the economy, and only exciting gastric oppression, when given in large doses. Accurate microscopical investigation, in experiments on ani- mals that had taken arsenious acid in the solid form mixed with the oxyhydrate, exhibited to the discoverer of the antidote, that under the influence of animal heat and the peristaltic motion, it had become completely converted into arsenite of iron, and thus rendered innocuous. Such was the result of the observations of Boulet,* Orfila, Chevalier, Lassaigne, Soubeiran and Miquelt Nonat, Borelli and Demaria,i Lesueur, Boulay, fils,§ Monod,|| Von Specs, Mackenzie, IF D. Maclagan** and others.tt On the other hand, the experiments of Brett, J J Reginald Orton,§§ and Cramer, were unfavourable ; but Messrs. Bunsen and Ber- thold remark, that the experiments of those gentlemen could not be expected to be successful, as they were made with doses of arsenic of from two to nine grains ; and the stomach of the rabbit cannot retain more than from one-ninth to one-half the quantity of the antidote prepared according to their formula, which is necessary to neutralise that quantity of the poison.|||| Messrs. Bunsen and Berthold,from the results they have ob- tained, recommend the oxyhydrate as the chief antidote in all * Gazette Medicale de Paris, 1834. | Bullet. General de Therap. Dec. 1834. X Br. and For. Med. Rev. April, 1836, p. 594. § Journal Hebdom. des Progres des Sciences Medic. Mars 14, 1835. || Gazette Medicale, Aug. 22, 1835, and Annales d'Hygiene, &c. xiv. 134. IT London Lancet, April 4, 1840. ** Edinb. Med. and Surg. Journal, July, 1840. ft See T. R. Beck, Amer. Journ. of the Medical Sciences, July, 1841, p. 90. XX L°nx\\, the existence of this is contested. EFFECTS ON THE ECONOMY. The Cortex hippocastanihas long been advised as an astringent, but without receiving much attention. t In modern times, it has been proposed by Zannichelli, Hufeland, Voigtel, and others, as the best substitute for the cinchona. These recommendations have caused the bark to be more frequently administered of late,in Europe, by which means it has been discovered to accord almost * Riecke, Op. cit. S. 256. t Merat and De Lens, Art. JEsculus Hippocastanum. HIPPOCASTANUM. 339 entirely in its effects with willow bark : the latter, however, appears to be more effective, and to agree better with the diges- tive organs. In the wars of Napoleon, when bark was very- scarce, it was much employed. Hufeland and Voigtel recommend it especially in intermit- tents. Sinogowitz* advises, that it should be given after the removal of intermittents by quinia, to prevent a relapse ; and, also, in combination with diuretic agents, in the cases of dropsy which often succeed to that disease. Krugelstein found it al- ways extremely efficacious in atonic gout, and in removing the weakness of the digestive apparatus that remains after attacks of gout. The Austrian, Brunswick, Danish, Russian, and Saxon PharmacopcEiast have an aqueous extract of the bark, which Voigtel administered with good results in intermittent fever, and which he often found serviceable in chronic discharges from the mucous membranes. It agrees better with the stomach than the powder or the decoction. Externally, the decoction has been advised as a good astringent. MODE OF ADMINISTERING. Pulvis corticis hippocastani compositus. Compound powder of horse-chestnut bark. Pulvis Chinae Factitius. Factitious Powder of Bark. R. Hippocast. cort. Salic, cort. Gentian, rubr. cort. Calam. Caryophyll. aa. Jij. Misce et fiat pulvis. Hufeland J affirms, that this powder is an adequate substitute for cinchona in three cases out of four. Hufeland, and Prussian Pharmacopoeia. * Rust'3 Majjazin, B. xxix. II. i. p. 84. f Pharmacopde Universale, ii. 14. Paris, 1828. % Armenpharmacopoe. 4te Ausgab. Berl. 1825. 340 HIPPOCASTANTJM. Decoctum corticis Iiippo cast ani. Decoction of horse chestnut bark. R. Cort. hippocastan. giss. Coque cum aquse f.^xviij. ad reman, colat. f.5ix. ; cui refrigerat. adde Spir. aether, sulph. f>3J. — ij. Syr. cort. aurant. f.5J. M. To be used during the apyrexia. Voigtel. Decoctum chinse factitiee. Decoction of factitious bark. R. Salic, cort. pulv. crass. Hippocast. cort. aa. ^ss. Calam. Caryophyll. aa. ^ij- Coque cum aq. fontan. qXv'i. ad reman, colat. 3 viij. Prussian Pharmacopoeia. Decoctum hippocastani acidiim. Acid decoction of horse chestnut. R. Hippocast. cort. pulv. ^vj. Coque cum Acid, sulphur, dilut. f.Jj. et Aquae, f.^x Ad colat. f-3vj. Used in the after-treatment of intermittens. Electuarium corticis hippocastani. Electuary of horse chestnut bark. R. Hippocast. cort. pulv. 3SS. Calam. 3ss. Roob. juniperi, 3 iij. M. ut fiat electuarium. A teaspoonful to be taken every hour, or every two hours, in drojjsies supervening on intermittent fever. Sinogoivitz. HYDRARGYRI BROMIDTTM. 341 HYDRAR'GYRI PRJEPARA'TA. Synonymes. Preparations of Mercury. French. Les Preparations de Mercure. German. Quecksilberpraparate. LXXXVI. HYDRARGYRI BRO'MIDUM. Synonymes. Hydrargyrum Bromatuni, Bromide of Mercury. German. Bromquecksilber. Mercury unites with bromine in more than one proportion. A solution of hydrobromate ofpotassa produces with a solution of nitrate of protoxide of mercury a white precipitate, which re- sembles calomel ; and appears to be a bromide of quicksilver, answering to the protoxide {Hydrargyrum Bromatum, Hy- drargyri Protobromidum ; German, Quecksilberbromur). On the other hand, the bromide, which is formed by the direct union of bromine with mercury, corresponds probably to the peroxide. A white substance results, which can be sublimed by heat, is soluble in water, alcohol, and especially in ether ; is coloured red or yellow by the alkalies, and exhibits considerable resem- blance to corrosive sublimate [Hydrargyrum perbromatum, H. perbromidum, H. deutobromidum ; German, Quecksilber- bromid). EFFECTS ON THE ECONOMY. The effects of these preparations on the sound and diseased organism are not yet well known. They have, however, been employed by some physicians. The protobromide strongly re- sembles calomel in its properties. In the dose of one or two grains, it produces no effect in health, even when taken fasting. In a higher dose — four or five grains, and upwards — it purges moderately, augmenting, at the same time, the secretion of urine. When used in recent syphilitic affections, in the way of friction on the gums, or internally in pill, it removes them like calomel ; but il does not seem to affect the mouth as speedily or as severely as it.* The deutobromide resembles bichloride of mercury in its action, — producing, in too strong a dose, vomiting and purging, ♦ Bulletin General do Thcrapcutique, No. 14, Juilkst 30, 1837. 29* 342 HYDRARGTRI PR^PARATA. with colic and cramp of the stomach ; affecting the mouth, and exciting violent salivation.* Werneck, of Austria, has adminis- tered it frequently in syphilis. In recent cases he prescribes it in the form of pill, beginning with the one-twentieth of a grain. This dose he increases by one-twelfth every two days ; the chancres being covered at the same time with compresses, wetted with a solution formed of six grains of the same substance to a pint of distilled water, After a few days' treatment, he re- marked, that the sores assumed a better appearance ; and from twenty to thirty days were sufficient to effect their entire cica- trisation ; the total quantity of the bromide administered was about five grains. It was rarely necessary to carry it as high as ten or twelve grains. It has been believed that deutobromide of mercury is less liable to act on the salivary glands than the corrosive chloride, and to affect less severely the stomach and chest.f Desorgues has recommended the second (?) preparation as a prophylactic and curative agent in syphilis. It was doubtless, also — Riecke suggests — the second preparation, which was ad- ministered with excellent effects, by Prieger, in porri 'go favosa of an obstinate character. He terms the preparation bromas mer- curii, but the true bromate is probably insoluble in ether. ± the first of the following formulas is recommended by Prieger. Guttrc hydrargyri deutobromidi. Drops of deutobromide of mercury. R. Bromatis mercurii, (vel potius hydrargyri perbromidi,) gr. vj. Solve in jEther. sulphuric. 3iij. M. Dose. — Ten to twenty drops, according to the age of the pa- tient, daily, in water. K. Hydrargyr. deutobromid.gr. j. .9. t Riecke, Die neuern Arzneimittel, u. s. w. S. 261. Stuttgart, 1837, & 2te Auflaoe, S. 376. Stuttgart, 1840. | Iiufeland und Osann's Journal, lv. 66. 346 HYDRARGYRI PRJEPARATA. and Brera uses it in solution, as a gargle, in syphilitic ulcera- tion of the fauces. Such is the chief testimony recorded in favour of the medical action of the cyanuret of mercury. Dr. Christison* thinks, that " the few trials hitherto made of its effects in diseases scarcely justify its introduction as a remedy." Although, however, it has been but little used in Great Britain, many trials have been made with it on the continent of Europe more especially. MODE OP ADMINISTERING. Cyanuret of mercury may be given in pills or in solution; Horn prescribed it in powder, but this form is less appropriate. The dose is from one-sixteenth of a grain to a grain, several times a day. As a gargle, half a grain to a grain may be dissolved in 5}. of water; as an ointment, from one and a half to two grains to 3j- of lard. Chaussier used it in friction on the soles of the feet, in the same way as the corrosive chloride. Liquor liy drargyri eyanureti. Solution of cyanuret of mercury. (Liqueur Antisyphilitique de Chaussier.) R. Hydrargyri cyanur. gr. viij. Aquae destillat. Oj. Each ounce contains half a grain of the cyanuret. Chaussier^ and Parent. R. Hydrarg. cyanuret. ^ss. Solve in Aq. destillat. Oj. Aide Tincturae opii, 3j. M. Dose. — Morning and evening, a spoonful, in a decoction of sarsaparilla or barley. Mendoza and Parent. * Ibid. f Rattier, Formulaire Pratique des Hopitaux Civils de Paris, 3eme edit. Paris, 1827. HYDRARGYRI CYANURETUM. 347 Pilulae hydr argyri cyannreti. Pills of cyanurel of mercury. EL Hydrarg. cyanuret. gr. v. Opii,9ss. Micse panis, Jj- Mellis, q. s. ut fiant pilulae xcvj. Dose. — One to four, three times a day. Parent. Gargarisma hydrargyri cyannreti, Gargle of cyanuret of mercury. EL Hydrarg. cyanur. ^ss. Decoct, ten. sem. lini, (vel rad. althsese,) Oj. M. et fiat gargarisma. R. Hydrarg. cyanur. J^ss. Decoct, hordei, Oj. Mellis rosas, §j. M. et fiat gargarisma. Parent. Brera. Brcra. Unguentnm hydrargyri cyanureti. Ointment of cyanuret of mercury. BL Hydrarg. cyanur. gr. xij. Adipis, §j. M. ut fiat unguentum. EL Hydrarg. cyanur. gr. xvj. Adipis, gj. 01. limonis, gtt. xv. M. From half a dram to a dram, to be rubbed in, in cases of tetter. Biett. An ointment of this strength is used by Dr. Strohl, of Strasburg, as a dressing for chancres." * Gaz. M6d. de Strasburg, No. 15. and 17 ; and Encycl. des Sciences Med. Sept. 1841, p. 525. 348 HYDRARGYRI PR^PARATA. LXXXVIII. HYDRAR'GYRI IO'DIDUM. Synonymes. Hydrargyri Proto-iodidum, H. Proto-ioduretum, Hydrargyrum Iodatum flavum. H. Iodidum, H. Iodidulatum H. Iodatnm, (in contradistinc- tion to the Periodatum,) Iodidum Hydrargyrosum, Hydrargyri Proto-iodi- dum, Protiodide, Proto-iodide or Proto-ioduret of Mercury. French. Proto-iodure de Mercure. German. Gelbes Iodquecksilber, Gelbes Quecksilberiodid, Protoiodiir des Quecksilbers, Quecksilberiodidul, Iodquecksilber im minimum des Iods. METHOD OF PREPARING. According to Tunnermarm, the best method of preparing the iodide is the following : — Take of Nitrate of protoxide of mer- cury (not tinged yellow by the admixture of nitrate of peroxide), 28.25 parts, and of Iodide of potassium, 16.5 parts; rub them together for some minutes in the dry state, and afterwards with a little Distilled water, gradually adding the water so as to dis- solve the saltpetre formed. The mixture is then passed through the filter, and the yellowish-green precipitate of iodide of mer- cury is well washed, and dried by a gentle heat. The objection to this process is the difficulty of obtaining the mercurial salt at a minimum of oxidation, and the consequent liability of the resulting compound to contain uncertain quan- tities of the red iodide. M. Boutigny,* to avoid these disadvan- tages, recommends the following form : — Take of Mild chloride of mercury, three ounces and five drams ; Iodide of potassium, two ounces and four drams : pulverise the iodide in a glass mor- tar, and add the calomel ; place the mixture in a porcelain cap- sule, and pour over it ten or twelve ounces of boiling distilled water. After cooling, decant the fluid, collect the precipitate on a filter, and wash with distilled water. Dry in the shade, and keep in a well-stopped bottle. The iodide, thus prepared, may, according to M. Boutigny, sometimes contain a minute portion of mercury or the mild chloride, but the quantity of either is so small as to be of no moment. In the London and United States Pharmacopoeias, it is pre- pared by rubbing together an ounce of mercury and five drams of iodine, adding gradually as much alcohol as may be sufficient until globules are no longer visible. The powder is dried imrae- * Bullet. General de Therapeutique, and Amer. Journ. of Pharmacy, 2d vol. 2d series, p. 326. Philad. 1837. HTDRARGTRI IODIDTTM. 349 diately by a gentle heat, access of light being excluded; and it is kept in a well-stopped vessel.* Iodide of mercury, according to Thomson, consists of 250 parts of mercury, and 156 parts of iodine. It has a greenish-yellow colour, and is a preparation holding the same relation to iodine and mercury, that the mild chloride holds to chlorine and mer- cury ; it is more volatile, however, than the mild chloride, but like it is almost insoluble in water. EFFECTS ON THE ECONOMY. This preparation has been less used than the red iodide to be described next. Tiinnermann remarks, as the results of his ex- perience, that its action in respect to the mercury, is analogous to that of the mild chloride, except that it appears to excite more the lymphatic and glandular systems. When given in conjunction with a generous animal diet, he found it very effi- cacious in a case of scrophulosis, where colliquative sweats had appeared ; and in a second case, also, it rendered essential ser- vice. In one of the cases, he gave it internally in the dose of from one-twelfth to half a grain, three times a day ; in the other, of from half a grain to a grain. He directed it also to be rubbed, in the form of ointment, on tumefied glands of the neck. Pelletan likewise found it serviceable in the cure of obsti- nate glandular swellings, when used in the form of ointment in combination with morphia, as well as in cases of obstruction of the liver. Biett recommends an ointment of the iodide in the treatment of chi*onic venereal ulcers, the cicatrisation of which it expedites ; Lugolt advises it in phagedenic scrophulous ulcers, which present a syphilitic aspect ; and PoiretJ recommends it strongly in cases of psoriasis ; the patient using, at the same time, simple alkaline or vapour baths alternately. According to the experience of Ilicord,§ in the syphilitic affections of children, especially of a cutaneous character, it is to be preferred to other forms of mercurial, and is not apt to be followed by the bad effects, which, in adults, often supervene on the use of other preparations.|| * Pharm. of the United States, p. 119. Pliilad. 1842. f Essays oh the Effects of Iodine in Scrophulous Diseases, &c, by Dr. O'Shaughnessy, p. 170. Lund. 1831. % Gazette des Hopitaux, Juillet 20, 1837; see, also, Bulletin General deThe- rapeutique, Juillet, 1837 ; and C. A. Porter, M.D., in American Journal of the Med. Sciences, Nov. 1839, p. G8. § La Lancette Franchise, No. 65, 1834. || Cogswell's Essay on Iodine, p. 158. Edinb. 1837. See, also, Ricord, Practical Treatise on Venereal Diseases, translated by Drummond, Philad. 1843. 30 350 HYDRARGYRI PRiEFARATA. METHOD OF ADMINISTERING. On account of its insolubility, it is given only in the form of powder or pill, to the extent of from a grain, gradually carried to three or four twice or thrice a day. Externally, it is applied, for the same reasons, in the form of ointment only. Pilulae hydrargyri iodidi. Pills of the iodide of mercury. R. Hydrarg. iodidi, Jj. Confect. rosEe caninae, Jiij. Zingiberis pulv. Jj. M. Pharmac. London. Pilnlae hydrargyri iodidi composite. Compound pills of iodide of mercury. R. Hydrarg. iodid. gr. vj. Extract, opii, gr. iv. Lactucarii, gr. xxiv. Ext. guaiac. gr. xlviij. M. Fiant pilulae xlviij. Dose. — For a child, half a year old, one pill ; for older chil- dren, two, three, or four. In the syphilis of children. Ricord. R. Hydrarg. iodid. gr.j. Ext. junip. gr. xij. Pulv. glycyrrhiz. q. s. Divide in pulv. viij. Dose. — At first, two, morning and evening ; afterwards, three or four. Magendie and Biett. R. Hydrargyri iodid. ^ij. Guaiac. pulv. Jj. Thridac. gss. M. et divide in pil. xlviij. Dose. — One a day in scrophula, and syphilis, &c. Biett* * A. Duhamel, Amer. Journ. of Pharm. July, 1841, p. 105. HYDRAKGTRI IODIDTTM. 351 Pulveres hydrargyri iodidi. Powders of the iodide of mercury. R. Hydrarg. iodid. gr. i. (iv., vj., vel viij.) Magnes. Jj. M. et divide in part. xij. Dose. — A powder, three times a day. Ungnentum hydrargyri iodidi. Ointment of iodide of mercury. R. Hydrarg. iodid. gr. vj. Morphiae acetat. gr. viij. Adipis, ^j. M. In obstinate glandular swellings. Pelletan. R. Hydrarg. iodid. 9j. Adipis, ^iss.* M. In old venereal ulcers. Magendie and Beitt. R. Hydrarg. iodid. ^ij. (vel iij., vel iv.) Adipis, sij. M. As a dressing to phagedenic and scrophulous ulcers. Lugol. When this salve is first prepared, it is of a canary-yellow, sometimes of a greenish colour. By time, it becomes of an orange hue, when it must be thrown aside, as, owing to the formation of the red iodide, it has become as corrosive as the ointment of the corrosive chloride. R. Hydrarg. iodid. Jj- Adipis, 3j. M. To be rubbed morning and evening on the parts affected. Poiret. * Tunnermann uses only 58s. 352 HYDRARGYRI PR.EPARATA. Unguent um hy drargyri iodidi. Ointment of iodide of mercury. R. Hydrargyr. iodid. §j. Cerae albae, §ij. Adipis, 3vj. M. Lond. Pharm. LXXXIX. HYDRARGYRI IO'DIDUM RUBRUM. Synonymes. Hydrargyri Deuto-iodidum, H. Deuto-Ioduretum, H. Per- iodidum, Hydrargyrum Iodatum Rubrum, H. Biniodidum, H. Periodatum, Iodidum Hydrargyricum, Red Iodide, Deutiodide, Biniodide or Periodide of Mercury. French. Deuto-Iodide de Mercure, Periodure de Mercure. German. Rothes Iodquecksilber, lodquecksilber im Maximum, Quecksilber- iodid, Deuto-Iodiir des Quecksilbers. METHOD OF PREPARING. The process of the Pharmacopoeia of the United States consists in dissolving an ounce of corrosive chloride of mer- cury in a pint and a half of distilled ivater ; and ten drams of iodide of potassium, in half a pint of distilled water. The solu- tions are then mixed, and the precipitate is collected on a filter, washed with distilled water, dried with a moderate heat, and kept in a well-stopped bottle. The following is the process recommended in the London Pharmacopoeia : — An ounce of mercury and ten drams of iodine are to be rubbed together, alcohol being gradually added until the globules are no longer visible. The powder is to be dried with a gentle heat, and kept in a well-stopped vessel. The Edinburgh Pharmacopoeia triturates two ounces of mer- cury with two ounces and a half of iodine, adding occasionally a little alcohol till a uniform red powder is obtained. The pro- duct is reduced to fine powder, and dissolved in a concentrated solution — a gallon by measure — of chloride of sodium, with the aid of brisk ebullition. It is then filtered, if necessary, through calico, keeping the funnel hot. The crystals, which form on cooling, are then washed and dried. Red iodide of mercury is a beautiful vermilion-coloured pow- der, which, when moderately heated, becomes yellow, but, when HYDRARGYRI IODIDUM RUBRUM. 353 exposed to the air, is gradually restored to red, and is volatilised. When volatilised, it crystallises in beautiful rhornboidal leaves, which, at a higher temperature, are of a golden- yellow hue ; but at the ordinary temperature of a shining red. The red iodide is insoluble in water; but soluble in alcohol and ether; and in solutions of iodide of potassium, and of chloride of sodium. It contains 250 parts of mercury, and 312 of iodine. EFFECTS ON THE ECONOMY. This preparation, which was introduced into practice by the French physicians, has been particularly recommended msyphilis complicated with scrophula. Biett found it very efficacious in scro- phulo-venereal ulcers, in syphilitic swellings of the lymphatic glands, and in inveterate itch. He administered it also internally, dissolved in alcohol or ether,in scrophulous affections complicated with syphilis, and with advantage. In its effects, it resembles the corrosive chloride, whilst the iodide resembles the mild chloride. Rayer,* indeed, considers the red iodide more active than the corrosive chloride. Paillard found it very efficacious in chronic cutaneous eruptions. He dipped a camel's hair pencil in a weak solution of the red iodide in ether, and penciled the parts with it three or four times a day. In this way, he cured several squa- mous, tuberculous, and other eruptions, exciting scarcely any pain. As, however, this mode of applying it often failed, he em- ployed 3j- mixed with^j. of oil of almonds in the same manner. If the corrosive action was considerable, a sense of heat soon arose in the part, which gradually terminated in burning pain. The neighbouring parts were also hot, painful, and tumefied ; and, in the course of an hour, an effusion of serum took place ; but, in four or five hours, the pain always disappeared. If ap- plied on the cheeks or lips, salivation at times ensued suddenly. Scabs formed, which fell off in a few days, and exposed a red surface much disposed to cicatrise. When frequently applied, symptoms occurred, which were probably the consequences of its being absorbed, — namely, fever, colic, diarrhoea, and dysentery. Breschetf applied it, in the form of ointment, with great success in a case of obstinate ulceration, presumed to be carcinomatous, at the angle of the eye. Blasius advises it internally and externally in lupus, and it has been recommended highly by Dr. J. W. Schmidt, Junr., of New York,J in cases of the same affection, * Treatise on Skin Diseases, by Dr. Willis, p. 79. See, also, Puche, Jour- nal des Connaissances Medicales, Oct. et Nov. 1838, and Janvier, 1839. ■j- Lugol's Essays on Iodine, by O'Shauglinessy, p. 204. \ American Journal of the Medical Sciences, Feb. 1840, p. 301. 30* 354 HYDRARGYRI PRJEPARATA. and especially in the dartre venerienne. Both the iodide and the red iodide were given internally. These cases, as well as syphilitic sore throat of long standing, which had been previ- ously treated by mercury without success, Dr. Schmidt found to yield invariably to a pill of a quarter of a grain of the protoio- dide, and a grain of Extractuni Conii, given night and morning, and afterwards three times daily. After using these pills for from four to eight weeks, he substitutes the solution of iodide of potassium, — changing, in the first place, the action of the parts by cauterizing the throat with the solid argenti nitras. Dr. Schmidt has not found it necessary to carry the iodide so far as to touch the mouth, but should it accidentally do so, he stops the mercury, and goes on with the iodide of potassium. Tunnermann used it with advantage, in the form of ointment, for the removal of fu- runcular inflammation of the glands of the neck. Riecke,* like- wise, employed it, with great success, as a discutient, (gr. xvj. to 3}. of lard,) in a case of ganglion in the region of 'the knee, from which violent pain proceeded along the nerves when it was pressed upon — and in two cases of goitre. Whenever it has to be applied over an extensive surface, as in the disease last men- tioned, it has generally to be discontinued soon, in consequence of the supervention of inflammation of the cutaneous surface. In the form of a weak ointment — composed of red iodide gr. ij., cerate 9ij., almond oil 9j. — it has been used in opacity of the corneaA Kopp has published some favourable cases of the therapeuti- cal application of the red iodide. The ointment, given below, he found very efficacious in luxuriant, chronic, scrophulous, and syphilitic sores, as well as in condylomata, and venereal blotches. Not less useful did he find it in many other skin diseases, and particularly in herpes. In one case, in which he administered it in the last affection, he found a coexistent goitre, which had been there for several years, almost wholly disappear ; and he, consequently, afterwards prescribed it frequently for the latter affection. He also used it, with excellent effect, in ophthalmia tarsi, and, where there was a disposition to the formation ofhor-* deolum,a.\\n\e of the second ointment, the form for which is given hereafter, was applied at bed-time to the edges of the eye- lids. Lastly, he advises friction with the first ointment in chronic rheumatic pains, and in cases of induration of the glands, especially of the liver. After the friction has been con- tinued for some time, an eruption occasionally appears. The Author has frequently administered the red iodide in pub- * Die neuern Arzneimittel, u. s. w. S. 270. t Grafe und Waltlier's Journ. fur Chirurg. Bd. xiii., cited by Pereira, Ele- ments of Materia Medica, 2d edit. i. 762. Lond. 1842. HYDRARGYRI IODIDUM RTJRUM. 355 lie and in private practice, in cases where an active modifier of the system of nutrition appeared to be needed, and where a com- bination of remedies so potent as mercury and iodine suggested itself. In chronic glandular enlargements, especially of the liver and spleen, and in habits where the use of mercury was not contraindicated, both the red iodide and the iodide have, in his hands, proved extremely serviceable. Perhaps there are no preparations, which, under the circumstances in question, merit more attention. MODE OF ADMINISTERING. Red iodide of mercury is given internally in the form of pow- der or pill, or dissolved in alcohol or ether, in the dose of one- sixteenth to one-fourth of a grain, gradually increased daily. Externally, it is applied in the form of ointment. Pilulse hydrargyri iodidi rubri. Pills of red iodide of mercury. R. Hydrarg. iodid. rubr. in syrup, commun. pauxill. terendo bene distribuend. gr. v. Micse panis alb. Sacch. pulv. aa. q. s. ut riant pilulae lx. Dose. — Two, morning and evening, drinking afterwards a cupful of oatmeal gruel. The dose to be raised gradually. Blasius. Tinctnra hydrargyri iodidi rubri. Tincture of red iodide of mercury. R. Hydrarg. iodid. rubr. 9j. Alcohol, 36° (.837) f.giss. M. Dose. — Ten to twenty drops, in a glass of distilled water. Magendie and Biett. Syrnpus hydrargyri iodidi rubri compositns. Compound syrup of red iodide of mercury. \\. llydrargyr. iodid. rubr. gram. i. (gr. 15,44 Troy.) Potass, iodid. gram. 50. Aquae, gram. 50. Dissolve, filter through paper, and add Syrup. (30° when cold), gram. 2400. 356 HYDRARGYRI PRjEPARATA. A tablespoonful of this syrup is a dose. It represents, pro- vided it holds 25 grammes of the syrup, a centigramme of red iodide of mercury, and 50 centigrammes of iodide of potassium. Gibert* jEther sulphuricus com hydrargyri iodido rubro. Sulphuric ether with red iodide of mercury. R. Hydrarg. iodid. rubr. £)j. iEther. sulphur, f.jiss. M. Administered like the last. Magendie and Biett. Ungnentum hydrargyri iodidi rubri. Ointment of red iodide of mercury. R. Hydrarg. iodid. rubr. in pulv. subtiliss. gr. vj. Adipis, Jvj. M. Kopp. R. Hydrargyr. iodid. rubr. in pulv. subtilissim. gr. \ to \. Adipis, ^ij. Cera albas, gr. ij. M. fiat unguentum. For an eye salve. Kopp. R. Hydrargyri iodid. rubr. gr. xv. Adipis, 3ss. M. exactissime. Fiat ung. As a dressing in lupus. Blasius. R. Hydrarg. iodid. rubr. gr. xv. Adipis, |ij. 01. berganiot. gtt. x. M. To be rubbed on the parts in chronic cutaneous affections. Biett. R. Hydrarg. iodid. rubr. 9j. Adipis, ^iss. M. Biett. To be spread thin on lint in old venereal ulcerations. The Unguentum Hydrargyri Biniodidi, of the London Col- lege, is prepared like the Ung. Hydrarg. Iodidi (p. 352). * Journal de Pharmacie, Oct. 1841, p. 634. HYDRARGYRI ET ARSENICI IODIDUM. 357 XC. HYDRARGYRI ET ARSEN'ICI IO'DIDTJM. Synonymes. Arsenici et Hydrargyri lodidum, Hydriodas Arsenici et Hy- drargyri; Iodide or Hydriodate of Mercury and Arsenic, Double Iodide of Arsenic and Mercury, lodo-arsenite of Mercury. Mr. Donovan* has proposed this new compound, which he regards as more efficacious than either the Iodide of Mercury or the Iodide of Arsenic. METHOD OF PREPARING. Triturate 6.08 grains of finely levigated arsenious acid ; 15.3S grains of mercury, and 50 of iodine, with one dram, by mea- sure, of alcohol, until the mass has become dry, and, from being deep brown, has become pale red. Pour on eight ounces of distilled water; and after trituration for a few moments, transfer the whole to a flask ; add half a dram of hydriodic acid, prepared by the acidification of two grains of iodine, and boil for a few moments. When the solution is cold, if there be any deficiency of the original eight ounces, make it up exactly to that measure with distilled water. Finally filter. By the long continued trituration of arsenic, mercury, iodine, and alcohol, the metals are converted into iodides, which combine. The mass, by solution in water, is converted into a hydriodate of arsenic and mercury. The quantities of the two metals are so adjusted, that, when converted into protoxides by decomposition of a portion of the water in which they are dissolved, there will be eight grains of protoxide of arsenic, and sixteen of protoxide of mercury. The quantity of water is such, that each dram by measure of the solution will contain exactly one-eighth of a grain of protoxide of arsenic, and one-fourth of a grain of protoxide of mercury. Mr. Donovan conceives, that the quantity of mercury ought to be double that of the arsenic, in order to insure a slow, and moderate, yet adequate mercurial action, along with the proper effect of the arsenic. Of the preparation, above described, and which Mr. Donovan calls Liquor Hydriodatis .Irsenici et Hydrargyria each dram by measure consists of water, one dram ; protoxide of arsenic, one- eighth of a grain ; protoxide of mercury, one-fourth of a grain ; * Dublin Journal of Medical Science, Nov. 1839, p. 281. See, also, M. Soubeiran, December, 1841, p. 744 ; and Mr. Donovan, Dublin Journal, Nov. 1842, p. 171. 35S HTDRARGYRI PRJEPARATA. iodine, converted into hydriodic acid, four-fifths of a grain. The colour of the solution is yellow, with a pale tinge of green ; its taste is slightly styptic. It is incompatible with tincture of opium, or with sulphate, muriate, or acetate of morphia. The test of the perfection of the preparation, according to Mr. Donovan,* is, that the whole of the iodine, arsenic and mercury shall disappear, and be dissolved during the process of preparing it. This cannot happen unless the three elements employed have been chemically pure, and unless the trituration has been suffi- ciently long continued. The colour, a short time after the liquor has been prepared, should be golden-yellow, and the specific gravity, 1.02. EFFECTS ON THE ECONOMY. Numerous trials have been recently made with this preparation in cutaneous diseases, especially in psoriasis, lepra and lupus ; and the testimony of some of the most eminent of Mr. Donovan's countrymen has been brought forward in its favour. Mr. Car- michael has given it in five or six cases of lupus, and in one of psoriasis, with decided benefit.! Mr. Colles administered it in two extreme cases of scrophulous ulceration in the adult with some benefit : Dr. Croker gave it internally and applied it exter- nally with complete success in a case of psoriasis guttata : Dr. Graves treated a very inveterate case of psoriasis with decided advantage ; Dr. Irvine completely cured a most virulent case of the same affection by the internal use of it ; Mr. Cusack found, that venereal eruptions yielded rapidly to half dram doses, three times a day ; and Sir Henry Marsh had a case of impetigo Jigurata, of strumous origin, covering the face, chest, arms, and thighs, but particularly well marked at the flexures of all the joints, which was cured by the administration of fifteen minims, twice a day, gradually increased to one scruple, and finally to half a dram. The treatment was cautiously pursued, for some- what less than a month, with a gradual amendment of the dis- ease, which subsequently disappeared entirely. Since those cases were published, Mr. Donovan has given numerous others from the practice of Dr. Charles O'Reilly, Sir Henry Marsh, Dr. Robert J. Hickson, Dr. J. D. White, Mr. Richard Jones, Dr. Bigger, Mr. O'Ferrall, Dr. Ferguson, Dr. Os- brey, Dr. W. T. Hamilton, Dr. Graves, Dr. Kirby, Mr. Gabriel Stokes, and Dr. C. P. Croker, which lead him to infer, that the diseases, in which the preparation has been found of most ser- * Ibid. Sept. 1840, p. 106. f Dublin Medical Press, Jan. 18, 1840. HYDRARGYRI ET ARSENICI IODIDUM. 359 vice, are the various forms of psoriasis, impetigo, porrigo, lepra, venereal eruptions — both papular and scaly — pityriasis, sycosis, ephelis, lupus, sibbens, and some uterine diseases.*' In several of the cases, slight ptyalism was induced. MODE OF ADMINISTERING. The dose of the Liquor Hydriodatis Arsenici et Hydrargyri is from fifteen minims to half a fluidram, two or three times a day. Mr. Donovan! recommends the following form : — Hanstns liquoris hydriodatis arsenici et hydrargyri. Draught of the solution ofhydriodate of arsenic and mercury. R. Liq. Hydriodat. Arsenic, et Hydrarg. 3ij« Aquae destillat. giiiss. Syrup, zingib. §ss. M. Divide in haustus iv. Dose. — A draught, night and morning. The division into draughts, Mr. Donovan considers neces- sary, — first, to insure accuracy of the dose ; and next to pre- vent injury to the ingredients by the use of a metallic spoon, as a measure ; — the general way in which doses of medicines are administered. When applied externally in cutaneous affections it may be di- luted with an equal portion of water, or farther — should a weaker lotion be indicated. Mr. Donovan states, that the employment of this preparation is rapidly extending, as shown by the fact, that within two years and a half, about three hundred pints of it have been sent out of his establishment alone, which — as he properly remarks — is a vast quantity of an article prescribed in minim doses.j * Dublin Journal of Medical Science, Nov. 1842, p. 199. f Ibid. Nov. 1839, p. 282. X Ibid. Nov. 1812, p. 199. 350 INDIGUM. XCI. INDIGUM. Stnonymes. Indicum, Indicus Color, Pigmentum Indicum, Indigo. German. Indig. This well-known colouring material is obtained from several species of the genus Indigofera (I. tinctoria, I. anil, I. disper- ma, I. argentea,a.nd I. hirsuta), belonging to the Natural Fa- mily Leguminosae, and, in the Linnaean System, to Diadelphia Decandria. As we receive it, it is in small, solid, brittle masses, of a deep azure colour, without smell or taste, and assuming a coppery lustre on being rubbed. It is entirely soluble in sul- phuric acid, and is wholly consumed on burning coals. Accord- ing to the analysis of Chevreul, 100 parts of Guatemala indigo of commerce contain only 45 parts of pure indigo, or indigo-blue — with which no therapeutical experiments have as yet been made : the greater part of the residue consists of a green matter soluble in spirit of wine {indigo-green); and a red resin {indigo- red) ; the rest is extractive matter, gum, and some carbonate of lime, oxide of iron, argillaceous and siliceous earth. With hy- drogen, pure indigo forms isatic acid, which has considerable resemblance to the hydrocyanic. EFFECTS ON THE ECONOMY. The natives of the countries, where the different kinds of indigo grow, employ it occasionally as a therapeutical agent, especially in diarrhoea and intermittent fever. It is only within the last few years that attention has been paid to it in Europe. Professor Von Stahly,* of Ofen, appears to have first employed it with success in various spasmodic diseases, especially in epilepsy. To these cases Lenhossek alludes, in detailing certain trials which he himself had made with it. In 1833, Grossheimtmade known a case, in which he found it extremely useful. A lady, twenty- eight years of age, had suffered for eleven years with violent hysterical convulsive attacks, for which she had employed almost every remedial agent. The attacks began with a feeling of hea- viness over the whole body, with slight convulsive twitchings of the limbs, which extended to the trunk, and were followed by total, or almost total, loss of consciousness : this, after an un- * Hecker's neue Annalen, B. i. H. 1. Berlin, 1835. | Mediscinische Zeitung, No. 51, 1833. INDIGUM. 361 certain period, terminated in a comatose state, from which she was gradually restored — but in a languid condition — to perfect con- sciousness. Under the use of indigo for half a year, with pedi- luvia — which had been previously employed without advan- tage — she completely recovered. These results gave occasion to the institution of experiments, touching the remedial properties of indigo,in the Charite at Berlin, the results of which have been given by Roth.* In most of the cases, the indigo excited nausea, and even vomiting, preceded by a metallic taste on the tongue. At times, the vomiting was so violent and prolonged, that it was necessary to discontinue. it ; but generally on continuing its use, the vomiting ceased in three or four days, and diarrhoea took its place. All the pa- tients did not vomit, and many escaped the diarrhoea. When once diarrhoea occurred, however, it commonly persisted as long as the indigo was used. The evacuations were seldom entirely fluid, but usually semifluid, and of a dark bluish-black colour. While the vomiting and purging continued, more or less uneasi- ness was experienced in the digestive apparatus. The vomiting and diarrhoea were frequently accompanied by pains in the sto- mach and bowels, which were commonly slight, but occasionally so violent that the indigo had to be discontinued. In every pa- tient at the Charite, the urine was of a dark violet hue. Stanly affirmed, that the perspiration was coloured blue, but this Roth never observed. He remarked, moreover, that after the use of indigo for several weeks, certain patients were easily thrown into slight convulsions, similar to those caused by the use of nitrate of strychnia, and that they were affected with slight subsultus tendinum. Almost all the patients, indeed, who took indigo, were at first more frequently attacked with spasms than prior to the use of the remedy. In the beginning, the attacks of the dis- ease were, in all cases, stronger, but of less duration, than previ- ous to its employment. These changes continued for one, two, three, and even as long as eight weeks, whether the patients took small or large doses. At the expiration of this time, all the epilep- tic symptoms were diminished in intensity and duration, until the last attacks were mere premonitions. The number of epileptic cases, treated by indigo, which Roth had an opportunity of observing in the Charite, was twenty-six ; of these nine were cured, eleven improved, and six remained. Dr. Idcler,t who instituted the experiments at the Charite, has also given publicity to the results ; and his testimony accords with that of Roth. It is proper to observe, however, that, of the nine cases cured, three experienced relapses in from eight to • Hecker's ncue Annalen, B. i. Heft. 1. Berlin, 1835. f Medicinische Zeitung, No. vi. and Lancet, June 6, 1835. 31 362 INDIGUM. twelve months ; but from causes, according to Riecke,* which of themselves might have induced epilepsy. Dr. Strahl,t of Berlin, likewise experimented with indigo, but his results were by no means favourable. In ten cases of old. standing epilepsy, it was not of the slightest service, and the same may be said of two cases of St. Vitus' s dance. In four cases of hysteria, it excited violent nephralgia, and in one of the cases only, after the affection of the kidney was removed, was the pa- tient cured. It acted, however, signally on the uterus ; in two cases of spasmodic affections, complicated with a?nenon , hcea, the latter derangement was removed, whilst the spasms still con- tinued, even after the recurrence of the catamenia. In the Cha- rite of Berlin, the purest Guatemala indigo of commerce was used, and it has been a question, whether Strahl did not employ one of feebler powers. It is worthy of remark, that he observed a dark green colour of the urine during its use, whilst in the cases in the Charite a dark violet hue was constantly noticed. Favourable cases are also detailed by Drs. Mankiewicz, of Nackel4 and Hohnhorst, of Frankfort. § Dr. Noble, of Versailles,|| administered it in three cases, in which the disease had continued for four, twelve, and twenty years respectively. At the time of making known the results, a month had elapsed in the first case, and two months in the second, since an attack had been experienced, and the last case he con- sidered entirely cured. In the first patient, who was eighteen years old, four drams occasioned vertigo, slight depravation of vision, and convulsions similar to those produced by strychnia; and in both the other cases, diarrhoea was induced, which ceased, however, as soon as the indigo was discontinued or the dose re- duced one-half. He gave it in the dose of one dram gradually increased to four drams daily. The observations of Rech,of Montpellier, were not as favour- able to it. In none of the epileptics to whom he gave it was there any thing more than a slight amelioration. In the Hospice d'Hommes Incurables du Faubourg St. Martin, trials were also made with it by Dr. Blanche. Of ten cases, five were either cured or improved. One of these had existed for three years, and the paroxysms recurred every five or six days ; but after the administration of the indigo, he had no return at the expiration of five months ; in a second case, a youth fifteen years old — * Op. cit. S. 276, and 2te Auflage, S. 389. Stuttgart, 1840. f Hecker's Neue wissenschaftliche Annalen, 1836; and Edinb. Med. and Surg. Journal, 1837. X Medicin. Zeitung. Mai 31, 1837, S. 109. § Ibid. S. 110, and Medicin. Zeitung des Vereins fur Heilkunde in Preus- sen, 1837, No. 22. || Bulletin General deTherapeutique, 1836. INDIGUM. 363 who had been epileptic from birth, and had regularly one or two paroxysms a day, from the 19th of July, when the exhibition of the indigo was begun with, until the middle of August, when the results were published — had only two insignificant attacks. The improvement in the other three cases was not as marked, yet it was unquestionable. The other five children experienced no improvement, yet no inconvenience was sustained, although the indigo was given in doses of four, six, and eight drams in the day. It was administered in water or in a tisane ; and in one or two cases it excited vomiting, but after having been discontinued, it was borne subsequently. In all it induced tormina, and acted upon the bowels, but did not interfere with the appetite or any of the other functions. Dr. Benjamin F. Hardy,* one of the senior resident physicians at the Philadelphia Hospital, published the results of some trials made with indigo, which, so far as they go, confirm its anti- paroxysmal power. Two of the seven cases reported were ap- parently cured, two ameliorated, and three without any decisive results — the medicine not having been continued perhaps for a sufficient length of time. In these cases, it was commenced in the dose of 3j., which was usually doubled daily until the pa- tient took gij^ daily, which quantity was persevered in for some weeks. In some of the cases, the faeces, urine, and perspiration were all coloured blue. In other trials, instituted in the same excellent charity, with the indigo, the results were not as favourable.t It is obvious, indeed, that a wide difference must exist amongst cases of epi- lepsy, and that where the organic modifications are considerable, as indicated by concomitant mania or idiocy, little can be expect- ed from any remedy ; but even in such hopeless cases, the num- ber of paroxysms appears to have diminished under its use. Where the cerebral affection is slight and more functional than organic, indigo, like artemisia and other remedies extolled in epilepsy, may be useful. Its main efficacy, perhaps — as has been said of the Ferri Subcarbonas (p. 308) — consists in the new impression which it makes, in adequate doses, upon the nerves of the stomach, and through them upon those of the whole system ; but to effect the revulsion to the proper extent, it is necessary, that the dose should be augmented day by day, and the remedy be continued in large doses for a sufficient length of time. Dr. Pereira^ Btates, that he has tried it in a considerable num- Dunirlison's American Medical Intelligencer, for July 15, 1839, p. 122. + f)r. William II. McKee, in Dunglison's Airier. Mod. Intelligencer, Sept. 16, 1839, p. 177. % Elements of Materia Mcdica, &c, 2d edit. p. 1C20, Lond. 1812 ; or Amer. edit, by Dr. Carson, Pliilad. 1843. 364 INJECTIONS INTO THE EUSTACHIAN TUBE. ber of epileptic cases at the London Hospital, but without deriv- ing the least benefit from it. MODE OF ADMINISTERING. As indigo is extremely light, the powder is too bulky for admi- nistration ; it is taken with disgust, and is apt to excite vomiting. On this account, the form of electuary was selected in the Charite. It was generally combined with the Pulvis aromaticus, or the Pulvis ipecacuanha? et opii. As to the dose, Roth advises, that it should be commenced in grains but be elevated to drams, — nay even to one or more ounces in the day. In the Charite, the fol- lowing formulae were generally employed : — Pulvis i n di g i. Powder of indigo. R. Indig. in pulv. subtilissim. ^ss. Pulv. aromat. gr. v. M. et fiat pulvis. A powder to be given four times a day. Electuarium indigi. Electuary of indigo. R. Indig. pulv. aquae guttis nonnullis subact. 3ij. — gss. Pulv. aromat. Jss. Syr. simpl. f.Jj. M. et fiat electuarium. To be used in the course of the day. Ideler. XCII. INJECTIONS OF AIR, VAPOUR OF ETHER, ETC., INTO THE EUSTACHIAN TUBE. An important improvement in the understanding and treat- ment of diseases of the ear has resulted from the attention that has been paid, of late, to the pathological condition of the Eusta- chian tube, and the means through it of rectifying certain morbid states of the organ of hearing. A mystery has been thrown, or INJECTIONS INTO THE EUSTACHIAN TUBE. 365 attempted to be thrown, over the diseases of the ear, and as a consequence, they have furnished largely to empiricism ; so that an exclusive aurist has been, too often, perhaps, esteemed synony- mous with an exclusive empiric. Now, that the physiology of the outer and middle ear is better understood, their pathological relations are no longer environed with the same difficulties. The attention of the surgeon has to be first directed to the meatus externus, and if he discovers any obstacle, — as hardened ceru- men, — which prevents the vibrations of a sonorous body from reaching the membrana tympani, such obstacle must be re- moved. Should no defect exist there, he inquires into the state of the Eustachian tube, to detect, whether it be pervious so as to permit a free passage for the air from the throat to the middle ear — any impediment to which is a common cause of deafness; and, lastly, if the tube be found in a state of integrity, his atten- tion is turned to the condition of the nerve, to discover whether the defect — organic or functional — be seated there. Such are the main subjects of investigation in cases of deafness; although the condition of the membrana tympani, of the ossicles, and the mastoid cells become interesting incidental objects of inquiry. Chronic inflammation of the Eustachian tube occasionally gives rise to stricture or narrowness of the tube ; at others, to obstruction of the tube by means of mucus, or to accumulation of mucus in the tympanic cavities. In the former case, catheterism is demanded ; in the latter, injections of air, in addition. For the purpose of catheterism, various instruments have been employed. The catheter of Itard is a conical silver tube, curved at the extremity, with a slight enlargement to prevent laceration of the membrane. Kramer's instrument is a modification of that of Itard ; the curve is more gradual, and the enlarged or button point is omitted. It is made of silver, six inches long, and is of a calibre varying from the size of a small crow-quill to that of a large goose-quill. The extremity is well rounded, and it is curved only to the distance of five lines from the point, exactly at an angle of 144°, so as to correspond to the lateral (Reduced one-half.) situation of the mouth of the Eustachian tube. It is of the same calibre throughout its whole length, and provided with a funnel- 31 366 INJECTIONS INTO THE EUSTACHIAN TUBE. shaped dilatation at the outer extremity, half an inch in length, to admit the pipe of the injecting syringe, &c. To this part is attached a ring, on the same level with the beak of the catheter, by means of which the situation of the beak can be ascertained, when the instrument is introduced. The catheter is farther graduated in inches, which is conve- nient in repeated introductions.* When it is requisite to sound the Eustachian tube, a piece of catgut may be passed through the instrument. The catheter recommended by Mr. Pilchert admits of being passed farther into the tube, and has a more gradual curve. DeleauJ employs a flexible elastic gum catheter, which the patient learns readily to pass into the Eustachian tube, and by turning down the outer extremity, is able to inflate the tube with his own breath. This the author has seen repeatedly done. The silver instrument, slightly warmed and oiled, is intro- duced, with its convexity upwards, along the floor of the nos- trils until the point reaches the pharynx ; it is then gently turned, so that the point shall be outwards and a little upwards, the aperture of the Eustachian tube being above the level of the floor of the nose : in this way, the tube enters, and is readily felt by the operator to have done so. The instrument, is then carried onwards, until its farther progress is prevented by the narrowness of the tube. Mr. Pilcher's instrument is of such dimensions as to frequently occupy three-quarters of an inch of the tube ; but if it be pushed beyond the fibrocartilaginous por- tion — or that part of the tube which readily admits it — the mucous membrane may be lacerated, and pain will certainly be produced.§ When Mr. Pilcher's catheter is fairly introduced, it will re- main without support, an advantage it possesses— in the opinion of its proposer — over those of Itard and Kramer, which require a frontal bandage to retain them in situ. Itard's bandage is re- presented in the accompanying figure. It consists of a middle piece made of metal, bent so as to fit the arch of the forehead, * Kramer, on Diseases of the Ear, chap. 2, Amer. Med. Library Edit. Philad. 1838. t A Treatise on the Structure, Economy and Diseases of the Ear, p. 304. Lond. 1838. t Op. cit. p. 305. § Op. cit. p. 305. INJECTIONS INTO THE EUSTACHIAN TUBE. 367 and slightly padded within ; to this are attached two straps, which fasten with a buckle. To the centre of the middle piece, a pair of forceps are attached, which move in a ball and socket joint, and the blades of which are brought together by a screw. The bandage is applied before the catheterism is commenced ; and when the instrument is introduced, the forceps are brought down, and screwed tight on the catheter, so as to retain it in position. Through the catheter, thus introduced, aurists were in the habit of sending lukewarm water through the Eustachian tube into the cavity of the tympanum ;* but owing to certain objections that apply to the employment of fluids, Deleaut suggested the air-douche or injections of air for the purpose of clearing the cavity ; and this is regarded by Kramer \ as a great improve- ment. With the view of increasing and regulating the force with which the air is sent into the. cavity, both these gentlemen invented air-presses or condensers. The marginal figure repre- sents that of Kramer. c b is a cylinder, 10J inches high, made of molten brass; the diameter of its calibre is \\ inches, and it is fastened at b with strong screws, on a strong oaken stand of the height of an ordinary stool. Within the cylinder c b is a pump barrel of wrought brass screwed into it, which measures 10^ inches in height, and 2£ inches in diame- ter, rising at d a 3 inches out of the cylinder, so that the whole machine a 4 is about 13 inches high. In the piston of the pump barrel, there is a valve for the passage of the air, which besides passes in at the opening situate at d. There is a second valve in the bottom of the pump barrel, through which the air is forced into the interior of the cylinder. When air is injected into the tympanum, it may be heard to strike against the membrane, and to rush through the cavity into the mastoid cells, and thus may become a means of exploring the condition of the middle ear. * Sec some cases of deafness relieved in this way, by Dr. John H. Dix, in Boston Medical and Surgical Journal, Sept. 25, 1839, p. 105. f Sur le Cath.terisrno de la trompe d'Kustache, &c. Paris, 1828 ; Itard in M£m. de l'Acadi'm. Koyale de Medccine, Tom. v. Fasc. 4, Paris, 1836 ; and translation in Medical and Surgical Monographs, vol. i. p. 75, of Dunglison's Amer. Med. Library, p. SO, Philad. 1838. X Op. citat. p. 164. 36S INJECTIONS INTO THE EUSTACHIAN TUBE. Mr. Pilcher* observes, that — from his daily experience of the great facility with which air and fluids may be introduced into the tympanum, and regulated, both as to quantity and force, by means of a common syringe accurately fitted to the catheter — he does not hesitate to declare his conviction, that the ceremony and inconvenience of the air-press may be dispensed with. He recommends that the operator should merely steady the instru- ment with his left hand, whilst he uses the syringe with his right. By this means, any fluid or gas injected through the catheter, may be brought into contact with the mucous membrane, and thus stimulate the nerves of the cavity. Nor is the air-press en- tirely devoid of danger. Inflammation and even suppuration is sometimes caused by the air douche. This occurred, in seven cases, to M. Itard; and Mr. Henry Savaget refers to five cases, which came under his cognizance, where perfect deliquium was caused, which continued for several hours. A case, too, has been detailed in which, after "pumping air" four times through the nostrils into the Eustachian tube, immediately on removing the instrument from the nostril, the patient fell back in the chair and never spoke afterwaids.J The sudden shock to the nervous system was probably the cause of death ; and it has been sug- gested, that to avoid too great a degree of pressure, the nozzle of the tube of the air-press should be held, during the operation, so loosely in the dilated end of the catheter, that there may be room for air to regurgitate ;§ and likewise, that instead of sending in the air by douches or charges — it should be transmitted in a gentle and continued stream. Another circumstance, which shows the importance of care, is the fact, that the mucous membrane may be ruptured, and seri- ous emphysematous tumefaction be occasioned. It is proper to observe, that the results of 258 cases, treated by Itard, || are far from encouraging. Of these, but two of cure are said to have been effected, and in this result, according to Itard, other causes occurred ; whence he infers, first, that as a means of exploring obstructions of the tympanum by the crepitation, which often accompanies them, douches of air can afford no cer- tain index ; and secondly, that as a mechanical agent for deter- ging or evacuating obstructing matters, they can only dislodge and force them together ; and, consequently, that both in the second ♦Op.cit P 307. t Lond. Med. G.iz , for Jul v 20, 1839, p. C16. Dr. M. Lynch, in Lancet, Aug.3, 1839, p. 683, and Ibid. p. 690 ; and Dr. Joseph Williams, Treatise on the Ear; including its Anatomy. Physinloory and Pathology, &c. p. 242. Lond. 1840. I London Med. GuzpMp. July (i, 1839, p. 538, and Dunglison's American Medical Intelligencer, Aug. 15, 1839, p. 150. \ British and Foreign Medical Review, July, 1839, p. 95. i Op. chat. INJECTIONS INTO THE EUSTACHIAN TUBE. 369 and first point of view, douches of air do not deserve the con- fidence of the profession.* The vapour of acetous ether has recently been injected into the middle ear, in cases of nervous deafness, of which Kramerf makes two varieties ; noise in the ear constituting the essential point of difference between them. This noise belongs, without exception, to the erethitic form ; whilst it is foreign to the torpid. Incases of nervous deafness, Itard proposed to introduce ethereous vapour through the catheter, and to generate this vapour in an apparatus, in which the ether is dropped on a saucer of red hot iron, by the heat of which it is vaporised. The ether is, how- ever, decomposed in this manner, so that it is not etherous vapour which enters the tympanum,. but an acrid very irritating kind of gas, which, according to Kramer, is well suited to the torpid form of nervous deafness, but is positively injurious in the erethitic variety. He considers the attempt to vaporise acetous ether in a flask, placed in warm water, and connected by means of a tube with the cavity of the tympanum, to belong to the same class of methods, which act in too irritating and injurious a manner, owing to the vapour being given off far too rapidly. This inconvenience he proposes to remedy in the erethitic form of nervous deafness, in the following way: — A large glass flask — represented in the accompanying figure — holding about ten quarts, is firmly and closely -stopped with a cork through which are passed two brass tubes, each provided with a cock ; one of these tubes is connect- ed above with a funnel for dropping in the fluid, and the other with an air-tight tube to conduct the vapour, gene- rated and enclosed within (he flask, into the cavity of the tympanum. When the apparatus is to be used, the cork is to bo firmly fixed into the neck of the llask, with the two tubes attached, and the cocks closed ; the proper quantity of ether is then to be poured into the * See, on this subject, Mr. T. Wharton Jones, in Lond. Med. Gaz., Auff. 3 10, 17, and 24 : 1839. 6 f Op. citat. 211. 370 INJECTIONS INTO THE EUSTACHIAN TUBE. funnel, and forced into the flask by a gentle expiration, where it is converted into thin vapour at the ordinary temperature of the room. This vapour fills the interior of the flask equably, and is, indeed, in a state of slight condensation, so that when the me- tallic tip of the tube is connected with the catheter, and the cock is opened, the vapour issues with a whizzing sound. Having previously introduced the catheter, through the nose, into the mouth of the Eustachian tube, and placed it in con- nexion with the tube of the vapour apparatus, the patient is to sit near a table, leaning his arm upon it, and with the correspond- ing hand he is to hold the tube of the apparatus, in such manner that it may remain in close connexion with the catheter. Each sitting occupies a quarter of an hour, and is repeated daily, apply- ing the vapour alternately to the right and to the left ear. It is unnecessary to make use of warm water to pour into the flask, as the ordinary temperature of the room is sufficient to vapo- rise the ether. In the torpid form of nervous deafness, this method of proce- dure does not answer, owing to the necessity for greater excita- tion than it is capable of effecting. In such case, a modification of the apparatus of Itard has been proposed by Kramer. Owing to the metallic saucer in Itard's becoming cool more than once during a single sitting, and requiring to be exchanged for a hot one, as a necessary consequence the temperature of the vapour generated never remains, for a moment, the same, but varies ex- tremely ; immediately after the insertion of the red-hot saucer, the vapour issues burning hot into the ear, and in a few minutes sinks to a very low temperature. These evils Kramer proposes to rectify in the following manner : — For the floor on which the bell-glass of the apparatus rests a thin metal plate is substituted, IODINUM. 371 which is warmed, at pleasure, by an oil lamp placed beneath, so that, the ethereous fluid falling on it is thus conducted through the catheter into the middle ear. Through the cover of the appa- ratus, a thermometer, with a metallic scale, passes down almost to the bottom, and indicates the temperature at which the ethe- reous vapour passes into the ear. After a sitting or two — if the individual is to be benefited by the plan — in either form of deafness, an improvement ought to be perceptible. This course of treatment, aided, occasionally, by attention to the state of the system, has, in Kramer's hands, been attended with satisfactory results, and has been adopted with advantage by others with a more or less modified apparatus.* A case, of the successful application of the acetous ether in ere- thitic deafness, has been published by Dr. Bolton, of Richmond, Virginia.! The hearing distance was amazingly improved by it, and the success far exceeded the operator's most sanguine expectations. The vapour proves, however, at times too irritating, or occa- sions results by no means to be desired. The Author was applied to in one case in consequence of inflammation having supervened in the mucous membrane, which subsequently extended, in the erysipelatous form, over the cutaneous surface. It yielded to appropriate treatment. XCIII. IO'DINUM. Synonvmes. Iodinium, Iodium, Iodum, Iodina, Iodine. French, lode. German. Iod. Iodine was accidentally discovered, in the year 1S12, by Cour- tois, a manufacturer of saltpetre at Paris, but it was chiefly through the labours of Gay-Lussac and Sir Humphry Davy,J that the chemical relations of this elementary body were appre- ciated. The discoverer first detected it in the mother waters of soda obtained from sea-weed ; and as it was found to exist chiefly in several of the sea-weeds, and especially in the sponges, it * Pilcher, Op. cit. |>. .TIB. See some observations on this subject, with two by no mean9 satisfactory cases, by Mr. T. Wharton Jones, in London Med. Gazette, for Aug. 31, and Sep. 7, 1839. f Dunglison's American Medical Intelligencer, April 1, 1839, p. 1. X Annales de Chimie, lxxxviii. xc. and torn, xci., and Philos. Transact. 1814 and 1815. 372 I0DINUM. struck Coindet,* that experiments might be made with it in goitre : from these he obtained such striking results that its reputation soon spread abroad, and it was employed in various other diseases, — often with the most marked advantage. By experience, too, the injurious effects which it is by many con- sidered capable of inducing were appreciated, so that it could be administered more satisfactorily than at an earlier period. By the continued investigations of the chemist, iodine was found to be more largely distributed than was at first imagined. It was discovered in many of the marine mollusca, in sea-water, and in several mineral waters. METHOD OF PREPARING. Iodine is obtained from the mother waters of the soda derived from sea-plants, in which it exists — it is believed — in the form of iodide of sodium. The waters are procured by burning differ- ent kinds of weeds which grow on the sea-shore, lixiviating the ashes, and concentrating the liquor. To obtain iodine from this liquor, an excess of concentrated sulphuric acid is added to it, and the whole is boiled gently in a glass retort furnished with a re- ceiver. The sulphuric acid lays hold of the basis of the hydri- odic salt, and of the hydrogen of the hydriodic acid ; whence result sulphate of soda, water, sulphurous acid and iodine ; the last passing over into the receiver in violet fumes with a little acid, and there becoming condensed. To purify the iodine, it may be washed with water, containing a little potassa, and be redistilled.f It is manufactured in large quantity in Scotland, from the kelp of the Hebrides and Orkney Islands.:): According to Dr. Traill, the greatest quantity is produced by kelp, made from driftweed, which is in a great measure composed of Fucus digi- tatus, andF. Lorcus ; — cat weed, which consists of F. vesiculosas and F. serratus, yielding much less of it. One hundred tons of Caithness kelp afford, according to the experience of a manu- facturer, one thousand pounds of iodine, or about a 224th part.§ It is always prepared on the large scale, and hence is placed in the Materia Medica list of the Pharmacopoeia of the United States. Iodine is solid at the ordinary temperature, of a foliated ap- * Bibliotheque Universelle, Tuillet, 1820, p. 190. f For the method employed by Soubeiran, see Journal de Pharmacie, Jan- vier, 1837 ; and for that by Barruel, see Bussy, Ibid. X Christison, Dispensatory, p. 552, Edinb. 1842 ; and the Author's General Therapeutics and Mat. Med. ii. 312, Philad. 1843. § Christison, loc. cit. IODINUM. 373 pearance, metallic lustre ; of a grayish or bluish-black colour similar to that of plumbago, and friable. It is soluble in 7000 parts of water, and the solution has an orange-yellow colour. Its specific gravity is 4.946 at 62° of Fahrenheit. Its smell is simi- lar to that of chlorine, with which it accords in its property of destroying vegetable colours. It possesses, in a high degree, electro-negative properties. It colours the skin yellow, which colour gradually disappears. It fuses at 220° Fahrenheit. The vapour is of a beautiful violet colour, whence its name («a Solve in To be rubbed on the neighbourhood of the eye, as an anodyne, in cases of cancerous and other painful affections of the eye. A. Poll} CI. MOR'PHIJE ACETAS. Svnonvmes. Morphince Acetas, Morphium Aceticum, Acetas Morphii, Acetas Morphicus, Acetate of Morphia. French. Acetate de Morphine. German. Essigsaures Morphin, Morphiumacetat. METHOD OF PREPARING. Acetate of morphia may be obtained by mixing morphia, acetic acid and distilled water in an appropriate vessel, and gradually evaporating to dryness, at a temperature of about 90° Fahi'4 This mode of preparation is required, owing to the * Ricettario Clinico. Padova, 1825. t C. G. Lincke, VollsUindiges Recept-Taschenbuch, u. s. w. ii. 288. Leipz. 1841. % Pharmacop. of the United States, p. 144, Phil. 1842. 430 MORPHIiE ACETAS. difficulty of obtaining the acetate crystallised, in consequence of its extreme deliquescence. Crystallised acetate of morphia may, however, be prepared by dissolving morphia in alcohol, saturating with acetic acid, filtering the solution, and evapora- ting gradually in a vessel covered over with thin rag. The acetate crystallises in an arborescent manner on the sides of the vessel. Acetate of morphia is one of the substances, which, in the experiments of Magendie,* were found to promote the coagula- tion of the blood. Oflate, this salt of morphia has been highly recommended in arthritis and nervous affections, by M. V. Cristin,t of the Hospital St. John, Turin, according to a form given below. When the pains are relieved, or sleep is about to commence, the intervals between the doses are increased, or it is suspended altogether. Its good effects in neuralgia have been extolled by many others ; — the effect of the remedy being kept up for days and weeks, if neces- sary. Mr. BraithwaiteJ remarks, that Dr. Cristin prescribes it in the dose of one-tenth of a grain every hour, but that he has generally found it necessary to give much larger doses without any other bad effect than severe sickness, which was easily abated by creasote or excitants — as the spirilus ammonias aro- maticas. He prescribes one-fourth or one-sixth of a grain every hour or two, in severe cases, until the system is completely under its influence, and then keeps up its effects by smaller, and less frequently repeated, doses. It is questionable, however, whether the acetate be superior to opium. Dr. Francis Gerard, of Avignon, has found the acetate so highly useful in Asiatic cholera, that he prefers it to all other remedies. Of ninety-nine patients, treated thereby, eighty-one were cured. He found, when given early, that it especially checked the vomiting, and moderated the subsequent reaction, after which the other symptoms gradually ceased. When, how- ever, the resources of art had been long postponed, the effects of the remedy were less marked ; the vomiting and the other symp- toms persisted longer ; the supervening reaction was much more tardy, and frequently ended in a state of collapse, which, under the most trifling imprudence, produced an unfortunate result. Gerard administered the acetate at first in the dose of one-fourth of a grain every half hour, until the serious symptoms were * Lecons sur le Sang, &c, and translation, in London Lancet, Jan. 26, 1839, p. 636. f Repertorio Medico-chirnrgico del Piemonte, cited in British and Foreign Medical Review, Jan. 1840, p. 252. % Retrospect of Practical Medicine and Surgery, vol. i. Jan. to July, 1840, 3d edit. p. 15. Lond. 1842. M0RPHLE ACETAS. 431 removed, and he omitted it as soon as the spasms and the diar- rhoea and vomiting had ceased, or as soon as reaction ensued. Acetate of morphia has been much used endermically in the diseases mentioned under the head of Morphia. A quarter or half a grain or more is placed on some part of the skin whence the cuticle has been removed ; and it may be repeated, as the case may require. In the severer neuralgic and neurotic cases, the quantity applied in this way is sometimes very large. In a case of hydrophobia, reported by Dr. Burne,* of London, ten grains at a time were sprinkled on a blistered surface with ex- cellent tranquillising effects. At times, when applied to a blis- tered surface for several days in succession, a papular eruption has been observed, which quickly becomes vesicular, proceeding from the edges of the blister, and gradually spreading over the entire surface.t A case of traumatic tetanus has been published, which was cured by the internal and endermic use of the acetate of morphia.J It has been likewise proposed to inoculate with morphia. If the point of a lancet, dipped in an aqueous solution of morphia, be inserted horizontally about one line in depth beneath the epidermis, and be allowed to remain there a few seconds, the fol- lowing effectSj according to M. Lafargue, are observed : — About a minute and a half after the operation, a small pimple appears, with a diffuse rosy areola, and slightly itching : in about twenty minutes, the pimple becomes about four lines in diameter, and one line in thickness, and is flattened : its colour is somewhat deeper than that of the skin ; it is hard ; the areola very red, and about an inch and a half in diameter; its heat is increased, but the sensation of itching remains about the same. During the first hour, the pimple and its areola are at their highest degree of development, after which they gradually disappear. The general effects, which M. Lafargue experienced from thir- teen punctures thus made on the anterior part of his forearm, were, — heaviness of the head, frequent yawnings, clamminess of the mouth, and an invincible desire to sleep ; yet the quantity of muriate of morphia employed could not have exceeded a quarter of a grain. He considers, that the inoculation of mor- phia may supersede the use of blisters and ammoniacal plasters, and that it deserves employment more particularly where the object of the physician is to produce the local effects of morphia. Its influence as a rubefacient are marked, and hence its probable utility in superficial neuralgia and in chronic rheumatism.^ * Lond. Med. Gj&. April 14, 1838. f Dr. A. Thomson, in London Lancet, for Jan. 19, 1839, p. 632. X L. Piquot. .Tourn. des Connais. Med. Chirurg. Dec. 1840. § Q. Gibbon, Dunglison's Amer. Med. Intelligencer, July, 1841, p. 1. 432 MORPHIA. The experiments of Lafargue were repeated by M. Martin- Solon, with nearly the same results.* METHOD OF ADMINISTERING. The dose of this article is from a quarter of a grain and less, to a grain or more. Its strength does not vary materially from that of pure morphia. Liquor m orphiae acetatis. Solution of acetate of morphia. R. Acetat. morphias, gr. xvj. Aquae destillat. f-3vj. Acid, acetic. f-5ij- M. This formula was proposed by the authort as a substitute for the " gouttes calmantes" of Magendie,:); which permit the depo- sition of the morphia when kept for a short time. The dose is from six to twenty-four drops. R. Morphiae acetat. gr. xvj. Aqu33 destillat. f.^j. Acid, acetic, gtt. iij. vel iv. Alcohol. f>5J. Fiat solutio. Magendie. Mistura morphiae acetatis. Mixture of acetate of morphia. R. Acetat. morphiae, gr. i. Aquae destillat. f.^iv. Syrup, acaciaj, f.gi. M. Dose. — A spoonful every hour in arthritis and nervous af- fections, until the pains are removed. Cristin. * Bulletin de l'Academie Royale de Medecine, Nos. 1 & 7, 1836-7. | Formulary, &c, translated from Magendie, by C. T. Haden, Esq. 2d edit, by Robley Dunglison, M.D. p. 14. Lond. 1824. Amer.edit. Philad. 1825. $ Formulaire, &c. MORPHIA ACETAS. 433 Syrnpus morphise acetatis. Syrup of acetate of morphia. R. Morphiee acetatis, gr. iv. Syrupi simplic. Oi. Dissolve the salt in half a dram of water acidulated with a few drops of acetic acid ; filter, and add it to the syrup. This syrup is recommended and used in Paris, in place of the syrupus papaveris. It has the advantage of being always of uniform strength. Magendie. It has been suggested,* that the syrup of the acetate or sulphate of morphia should always be made of the strength of one grain to the ounce ; and it is certainly desirable that uniformity should prevail in this respect. If this exist, it matters but little what the proportion is, within certain limits. The acetate may, also, be applied in the form of ointment ; and it is frequently added to glysters, in chronic diarrhoea. Hildenbrand recommends the following ointment to be rubbed on the pubesin cancer of the uterus: — Unguentum morphirc acetatis. Ointment of acetate of morphia. R. Morphias acetat. gr. iv. Ung. hydrarg. ciner. simpl. aa. 3U» A piece, the size of a pea, to be rubbed on twice daily. A solution of acetate of morphia, which he terms liquor opii, has been proposed by Mr. Houlton.t He prepares it asfollows: — Take two ounces and a half of the best Turkey opium ; thirty-two fluid ounces of Bcaufoy's acid of the strength of pickling vine- gar : macerate with a gentle heat for six days, frequently shaking the vessel ; then filter, and evaporate the fluid to the consistence of the extracts of the pharmacopoeia, finishing the evaporation by the spontaneous method. This Mr. Houlton employs under the name exlractum opii aceticum. To the above extract he * A. Duhamel, Amer. Journ. of Pharmacy, for Oct. 1840, p. 187. ■\ Lond. Med. Gaz. Aug. 12, 1837. See, also, M. Buchner, pere, in Journal de Pharmacie,Fevrier, 1812, p. 48. 37 434 MORPHIA MT7RIAS. adds alcohol, five fluid ounces ; distilled ivater, thirty-five fluid ounces ; macerating for eight days, and filtering. This liquor opii is about the strength of the tinctura opii in sedative property, and Mr. Houlton affirms, from his observa- tions, that it is in no respect inferior to Battley's liquor opii sedativus, — a secret preparation, which has been much used. CII. MOR'PHItE MU'RIAS. Synonymes. Morphinse Murias, M. Hydrochloras, Morphias Hydrochloras, Morphium Muriaticum, Chlorhydras Morphicus, Hydrochloras Morphicus, Murias Morphii, Muriate of Morphia, Hy drochlorate of Morphia or Morphine. French. Hydrochlorate de Morphine. German. Salzsaures Morphin, Hydrochlorsaures Morphin. METHOD OF PREPARING. According to the last Pharmacopoeia of the United States, the muriate of morphia is prepared as follows : — Take of Morphia, in powder, gi. ; Distilled water, Oss. ; Muriatic acid, a sufficient quantity. Mix the morphia with the water, then carefully drop in the acid, constantly stirring till the morphia is saturated and dissolved. Evaporate the solution by means of a water bath, so that it may crystallize on cooling. Dry the crystals on bibu- lous paper. In the London and Edinburgh Pharmacopoeias, morphia is first separated from opium in the form of the muriate.* Muriate of morphia is in snow-white feathery crystals, which are wholly soluble in water. M ODE OF ADMINISTERING. It may be given in the same cases and doses as the other salts of morphia. * For Dr. Wm. Gregory's mode of preparing the muriate, see Edinb. Med. and Surg. Journ. for April, 1831; Amer. Journ. for August, 1831, p. 531; and Philad. Journal of Pharmacy, iii. 124. See, also, Mr. M. Robertson, in Edinb. Med. and Surg. Journ. April, 1832 ; and Dr. A. T. Thomson, Lond. Pharmaceut. Journ. and Transact., and Amer. Journ. of Pharmacy, July, 1842, p. 154. MORPHIA MURIAS. 435 The following preparations are directed in the Edinburgh Pharmacopoeia : — Trochisci morphias. Morphia lozenges. R. Morphise muriat. J^i. Tinct. tolut. fcgss. Sacchar. §xxv. Dissolve the muriate of morphia in a little hot water ; mix it and the tincture of tolu with the sugar ; and with a sufficiency of mucilage form a proper mass for making lozenges ; each of which should weigh about 15 grains.* Each lozenge contains about one-fourth of a grain of muriate of morphia. Dr. Pereirat states, that the morphia lozenges of the shops usually contain 5T th of a grain of the muriate. It is a good mode of employing morphia with the view of allaying cough. Trochisci morphiae et ipecacuanha. Morphia and ipecacuanha lozenges. R. Morphiae muriat. 9i. Ipecac, in pulv. subtil. Ji. Tinct. tolut. f.fss. Sacchar. sxxv. Proceed as for Trochisci Morphia. Each lozenge contains about one-fourth of a grain of muriate of morphia, and one-thirteenth of a grain of ipecacuanha. They are used in the same cases as the last. * Christison, Dispensatory, p. 643. Edinb. 1842. f Elements of Mat. Med. and Therap. ii. 1782. Lond. 1842; or Amer. edit, by Dr. Carson, Philad. 1843. 436 MORPHIJE SULPHAS. CII1. MOR'PHIJE SULPHAS. Synonymes. Morphinse Sulphas, Morphium Sulphuricum, Sulphas Morphii, Sulphas Morphicus, Sulphate of Morphia or of Morphine. French. Sulfate de Morphine. German. Schwefelsaures Morphin, Morphinsulphat. METHOD OF PREPARING. Morphia is dissolved in dilute sulphuric acid. The solution is then evaporated by heat, and suffered to crystallize, which it does in silken tufts, or snow-white feathery crystals, that are wholly soluble in water. EFFECTS ON THE ECONOMY. The general effects on the economy in health and disease re- semble those of acetate of morphia, to which it is perhaps to be preferred on account of its greater uniformity. There is an advantage, however, in retaining both preparations in the materia medica, as when the system becomes accustomed to the one, the other may be substituted. In his experiments on the blood, Magendie* found that the sulphate of morphia — unlike the acetate and the muriate — opposed the coagulation of that fluid. A syrupus morphias sulphatis, a liquor morphias sulphatis, and an unguentum morphias sulphatis may be formed in the same manner as with acetate of morphia. The common form for the solution of sulphate of morphia is the following : — it is that of the Pharmacopoeia of the United States ; and it is to be regretted, that the strength is not the same as that of the Liquor Morphias Acetatis. Liquor morphise sulphatis. Solution of sulphate of morphia. R. Morphise sulph. gr. viii. Aquae destillat. Oss. Fiat solutio. * Legons sur Le Sang, &c. ; or translation in London Lancet, January 1839. MORPHIiE SULPHAS. 437 Dose. — A tea-spoonful (which is considered to be equiva- lent to about twelve or fourteen drops of laudanum), to be repeated as occasion may require. Citrate of morphia is occasionally used ; but it possesses no advantage over the preparations described above. Many years ago, Dr. Porter, of Bristol, recommended a liquor morphise citratis to be prepared in the following manner : — Beat four ounces of the best crude opium in a mortar, with two ounces of crystallised citric acid ; mix well with a pint of boiling water ; filter after twenty four hours' maceration. Dr. Paris speaks well of this preparation.* Magendie recommends the substitution of the following process : R. Morphise pur. gr. xvi. Acid citric, crystalliz. gr. viij. Aquae destillat. f.Jj. Tinct. coccinel. q. s. Fiat solutio. Dose. — Six to twenty-four drops in the twenty-four hours. A tartrate of morphia was suggested by Mr. Hadent as a substitute for the liquor opii sedativus, of Battley. Mr. Haden made it by macerating the dregs, remaining after making the tincture of opium, in a solution of tartaric acid. Forty drops acted in all respects like twenty of the liquor opii sedativus. It neither stimulated nor induced costiveness. Of late, the bimeconate of morphia has been brought before the notice of the profession by Mr. Squire, J but he has not given the formula for its preparation. Impressed with the idea, that the combination of the active principle of opium, as prepared by nature, would prove more beneficial as a therapeutical agent than the artificial salts, he instituted a number of experiments, with the view of procuring the bimeconate as free from the other ingredients of opium as possible ; and he asserts, that at length he obtained a tolerably pure salt, which, from the trials that have been made with it, has fully answered his expectations as to its superior medicinal power over the other preparations of ♦ Pharmacolorria, 4th Amer. from 7th Lond. edit. By Dr. J. B. Beck, p. 439. New York, 1831. I Translation of Magendie's Formulary, 2d edit. By Robley Dunglison, M. D. &0. p. 19. Lond. 1824. \ Lond. Med. Gazette, Mar. y, 1839. 37* 438 moxa. opium. The salt is given in solution made nearly of the same strength as laudanum. Dr. Macleod, who made trial of it, asserts, that it appeared to him to be a very mild and efficient preparation, rarely produc- ing headach or other discomfort ; and that it repeatedly an- swered, in the most satisfactory manner, where opium had disagreed, and succeeded in some cases where other salts of morphia — the acetate and the muriate — had failed to give relief. Equally strong testimony in its favour is afforded by Dr. A. T. Thomson, who details three cases — one of neuralgic pain of the left side of the face ; another of wakefulness, without any apparent cause, and a third of anomalous pain of the hip and thigh, all benefited strikingly by its use. A preparation termed M'Munn's Elixir of Opium has been recently introduced into American practice with many testimo- nials in its favour ; but the formula for its preparation is kept secret ; and, therefore, it merits no farther notice here. CIV. MOXA. Synoxyme. Moxiburium. By the term moxa, the Chinese and Japanese designate a cottony substance, which they prepare by beating the dried leaves of Artemisia Chinensis, a kind of Mugwort. Dr. Lind- ley, however, states, that it is made from A. Moxa.* With this down they form a cone, which is placed upon the part in- tended to be cauterised, and is set fire to at the top. This mode of exciting counter-irritation has been long practised by the Chinese and Japanese, and by the ruder nations of the old world ; but it was not much employed in Great Britain and France until about the commencement of the seventeenth cen- tury, when it was introduced through the agency of a physiciant who had resided in India. It fell again, however, into disuse, until attention was redirected to it, during the last century, by Pouteaui and Dujardin, and, at the commencement of this century, by Percy and Laurent,§ and others. || * Flor. Med. 463. t Ten Rhyne, Medit. de Veteri Medicin. ; Dissert, de Arthritide, Lugd. Bat. 1G72; and Ksmpfer's History of Japan, translated by Scheuchzer, vol. ii. append, sect. iv. Lond. 1728. \ Melanges de Chirurgie, p. 49. ■5 Diclionnaire des Sciences Medicales, Art. Moxibuslion. || See, for a history of the moxa, the author's translation of Baron Larrey's Memoir on the Use of the Moxa. Lond. 1822. 439 MODE OF PREPARING. Various agents have been used by different people, in "moxi- bustion," — for so the mode of cauterisation has been termed, which consists in placing some combustible substance on a part of the body, and suffering it to burn down. From the earliest ages, the Nomades employed the fat wool of their flocks, as well as certain spongy substances growing upon oaks,* or springing from the hazel ;t the Indian, the pith of the reed,J and flax or hemp impregnated with some combustible material ;§ the Persian, the dung of the goat ; the Armenian, the agaric of the oak ; the Chinese and Japanese, the down of the artemisia ; the Thessalian, dried moss ;]| the Egyptians, the Arracanese, and several oriental nations, cotton ;1F the Ostiaks** and the Lap- landers^ the agaric of the birch ; and the aborigines of this continent, rotten and dried wood. Hippocratesjt was in the habit of employing fungi and flax for the same purpose. In modern times, also, various substances have been used for the fabrication of moxas. Whatever article is selected, it ought to be a spongy, light, vegetable matter ; readily combustible, and so prepared as to burn down slowly. In Germany, they use the tinder — amadou — which is known to be an agaric prepared for the purpose ; and it is not uncommonly employed in our hospitals, — a small disc or cylinder being placed on the part, and set fire to. It is now generally used in the French Hospitals.§§ The match used by artillerists was recommended by Percy, |] || after Bontius :f 1F it is composed of hemp steeped in a solution of nitre. He likewise proposed the pith of the sun- flower — helianthns annuus — recommending, that the stalk should be cut into cylinders of the desired length, the bark being left on ; so that, when ignited, it may burn in the centre and be held with the hand.*** This,he called moxa devoltursAW These moxas, called Percy's moxas, prepared by Robinet, are usually * Hippoc. lib. de Affect, cap. xxx. f Paulas JSgineti lit), vi. cap. 49. i Ku.'inpfer, vol. ii. app. sect. iv. p. 36. § Bontius de Medicini Indorum, p. 32. ]| Percy, in Pyrotechnic Chirurgicale pratique, p. 12. % Prosper. Alpin. de Medicina /Egypliorum, lib. iii. cap. 12. ** Voyages de M. Pallas, iv. 68. f j" Acerbi's Travel's through Sweden, Finland, and Lapland, ii. 291 ; and Linna:us, in Laohesis Lappotlica, translated by Sir James Smith, i. 274. XX De Affect, cap. viii. o§ Bulletin General de Tlnirapeutique, Jnillet, 1840. Illl Op. cit. p. 77. Paris, 1811. ff Op. cit. p. 32. Paris. 1645. *** Art. Moxibuslion, in Diet, des Sciences Mcdicales. Iff Merat and De Lens, Diet, de Mat. Med., Art. Moxa. 440 MOXA. found in the London shops. They consist of pith, rolled in cotton and enveloped in muslin.* The moxa, used by Larrey, and very generally employed by many practitioners, is made by taking a quantity of cotton wool, pressing it somewhat closely together, and rolling over it a piece of fine linen, which is fastened at the side by a few stitches. Larrey advises, that it should have the shape of a truncated cone — the form usually adopted — and be about an inch long. Commonly the cylinder is shorter than this; six or eight lines — as, when above six lines high, the combustion is not felt — and about four or five lines broad. The moxas, employed by Dr. Sadler,t of St. Petersburg, are about half an inch in diameter, and three-quarters of an inch in height. They are composed of a nucleus formed of the pith of the sunflower, wrapped in layers of cotton, of various thickness, and surrounded with an external envelope of thin muslin ; both of the latter being previously steeped in a solution of nitre. They are held, while burning, by means of two long hair-pins, the legs of which are slightly bent, in order to accommodate them to the shape of the moxa ; and, when the latter is burned down to the place where it is held by the first hair-pin, it can be held with the other, and retained in its proper position. With this last view, Larrey J has a special portc-moxa, consisting of a ring to receive the cylinder, with a handle attached to it, and three small supports or knobs of ebony, placed beneath the ring, to prevent the heated metal from acting upon the surface. Mr. Leney§ soaks a piece of lint in a strong solution of nitrate of potassa, dries it, and cuts off pieces of the size of the thumb nail, which he fastens with thin adhesive plaster over the seat of pain ; sets fire to the opposite extremity, and then applies the blow-pipe. The pain during the process is very severe, but he affirms, that the Irish prefer it greatly to the application of a blister. Professor Grafe|| employs moxas made of wafers, dipped in a mixture of three parts of oil of turpentine, and one part of sul- phuric ether. Before applying this inflammable matter to the skin, it is necessary to carefully remove the superfluous liquid. These moxas are said to ignite readily, burn promptly and uniformly, and not to crepitate. Of late years, a plan for raising vesication on the surface has * Pereira, Elements of Mat. Med. 2d edit. p. 1352. Lond. 1842 ; or Araer. edit, by Dr. Carson, Philad. 1843. f Zeitschrift fiir die gesammte Medicin. B. iii. H. ii. & iii. and British and Foreign Med. Review, July, 1837, p. 217. X The Author's translation of his Essay on the Moxa, p. 5. \ Lond. Med. Gaz. July 15, 1842. !| La Lancette Francaise, Jan. 26, 1839. MOXA. 441 been adopted, which, as Dr. Granville remarks, must be regarded as a kind of moxa.* This, he admits, is equally successful with the one he proposes, and which we have already described (p. 191), in forming a rapid vesication : " but it is, at the same time, so complicated, and attended by such intense pain," that, in practice, he says, it will not bear comparison with the prepa- rations which he recommends. A piece of linen or paper, being cut of the requisite size, is immersed in spirit of wine, or brandy. It is then laid on the part to be blistered, care being taken, that the moisture from the paper or linen does not wet the surround- ing surface. The flame of a lighted taper is applied quickly over the surface, so as to produce a general ignition, which is exceed- ingly rapid. At the conclusion of this operation, the cuticle is found detached from the true skin beneath. In cases of convul- sions, the region of the spine has been treated in this manner, and with good effects.! Dr. Osborne, of Dublin,J avails himself of the high temperature produced by lime in the act of slaking, for the purpose of a moxa. Some quicklime in powder is placed to the depth of about half an inch within a strip of card, bent and tied so as to form a circle. Some water is then dropped on the lime, and mixed with it. In about two minutes, it swells, and becomes dry ; and, at the same time, a degree of heat is produced, which — according to some experiments — may amount to 500° Fah. Dr. Osborne considers this moxa superior to all others ; — first, from the intensity of the heat, and secondly, from its conveni- ence, — not requiring the assistance of any heated substance, and being unaccompanied by the emission of sparks or smoke, which frighten the patient. When the quantity of lime used is smaller than that mentioned above, or if it be not kept on long, an appearance results, resembling that produced by acetic acid; and a thick crust is formed, which separates as the new skin is perfected beneath. But if the quantity of lime be large, and it be kept on as long as the heat continues, a complete destruction of the skin ensues ; and in this manner issues may be made of greater depth, and in a much shorter time, than by the usual cauterants. Dr. Osborne gives a case of apparent ulceration of the upper- part of the rectum and sigmoid flexure of the colon ; in which all the symptoms of internal ulceration disappeared after the application of a lime moxa, of about the size of a crown, over the region of the sigmoid flexure. In a case of incipient soften- * Counter-irritation, its Principles and Practice, Dunglison's Amer. Med. Library edit., p. 21 and p. 42. Philad. 1838. f Mr. C. J. Edwards, in Provincial Medical and Surgical Journal, January, 1842. \ Dublin Journal of Med. Science, Jan. 1842. 442 moxa. ing of tubercles ; and in another apparently of purulent infil- tration after pneumonia, its effect in arresting the ulcerative pro- cess was most decided. In a case of hip-joint disease, in which there was great pain, and consequent loss of sleep, the patient slept well on the following night, and, in a few days, had gained much power over the limb ; and in another case of the same disease, which had proceeded to destruction of the joint, and extensive enlargement of the parts around it, great relief was obtained. The size of the ulcer formed by it is always much larger than that of the lime applied. When the lime is prepared from cal- careous spar, the heat, produced on the addition of water, is sudden and intense, and the pain is proportionably urgent. For ordinary purposes, however, well selected pieces of lime from a lime-kiln answer well if fresh, but not otherwise. In the application of the various moxas, or of most of them, their agency can be so graduated as to produce either simple rubefaction, vesication or the formation of an eschar. Where it is desirable to produce the first result only, the cylinder of cotton may be removed when the pain becomes somewhat severe ; or the burning material may be held close to the surface, and be moved gradually along it. In this manner, a counter-irritant effect may be exerted along the spine or any extensive surface. Any burning substance — a lighted coal, for example — will answer for this purpose. When vesication is needed, it must be kept on longer ; and if it be desirable to produce an eschar, the moxa may have to remain on until it is wholly consumed. Larrey,|| indeed, advises, that the blowpipe should be occasion- ally employed to hasten the combustion. When the integument has once become disorganized, the slough will be thrown off in due time, leaving an ulcer. Larrey says the sloughing can be prevented by the application of liquid ammoniat to the burnt surface, after the moxa has been removed. This will do when the disorganization is partial ; but we know, from experience, that it often fails. EFFECTS ON TIIE ECONOMY IN DISEASE. Moxa — in its different forms — is doubtless a most valuable agent, where rapid counter-irritation is indicated. It resembles, indeed, in its action, the ammoniated counter-irritants of which we have already treated, and is applicable to the same diseases; — the only difference between them — when cauterisation is * Op. citat. p. 5. t Ibid. p. 9. NARCOTINA. 443 effected — being, that the agent in the case of the ammoniated lotion is a potential, in that of raoxa an actual, cauterant. The moxa must be regarded as one of our most valuable re- vellents. CV. NARCOTINA. Stnonymes. Narcotinum, Narcotin, Narcotine, Opiane, Matter or Salt of Derosne. French. Matiere ou Sel de Derosne, Sel Essentiel d'Opium. German. Narkotin, Opian, Derosne's Opiumsalz. On this substance, which is one of the immediate principles of opium, and which has attracted the attention of many chemists and therapeutists, much uncertainty exists in regard to its pre- cise properties. It seems, that it has not hitherto been found except in opium. METHOD OE PREPARING. It is commonly obtained, either from the aqueous extract of opium, by means of ether, which only dissolves the narcotina, and consequently requires but to be evaporated to obtain it; or from crude opium, which has been exhausted by cold water : it may hence be obtained from the residue after the preparation of the aqueous extract of opium of the shops. With this view, the opium is twice treated with boiling acetic acid at 2° or 3° ; it is precipitated by ammonia, and the washed precipitate is purified by treating it with hot alcohol at 40°, and a little animal charcoal ; the liquid is then filtered, and the pure narcotina is precipitated on cooling. It crystallises in very white needles; is devoid of taste and smell ; fusible in the manner of resins, and very slightly soluble in water ; soluble, with the aid of heat in alcohol, and in the volatile and fixed oils; very soluble in ether, which distinguishes it from morphia ; very soluble also in cold acetic acid, whence it is precipitated on heating the solution — another mode of sepa- rating it from morphia — and soluble in dilute acids. It is coloured of a vivid red by nitric acid ; and is analogous, in some respects, to the crystallisable resins or sub-resins of M. Bonastre.* * Merat and De Lens, Diet, de Mat. Med. Art. Narcotine. 444 NARCOTINA. Narcotina is generally reckoned amongst the vegetable alka- loids ; but by some it is considered to be neuter.* Dr. Christisont states, that " opium contains no fewer than six crystalline active principles;— morphia, codeia, and paramorphia,narcotin,narcein and meconin, of which the first three are alkaline and the others neutral." Dr. O'ShaughnessyJ prepares muriate of narcotinaby taking of Bengal opium, two pounds ; Alcohol, 20 pounds. These are rubbed together in a large mortar, adding the spirit by degrees, until the opium is exhausted of its soluble parts. The solution is then decanted, and the insoluble part pressed. To the alco- holic solution as much ammonia is added as renders the liquid slightly turbid. Fifteen pounds of the alcohol are then distilled from a common alembic ; and the fluid in the still is drawn off, and set aside to cool. On cooling, a mass of coloured crystals is deposited, composed of narcotina, meconate of ammonia, and resin. This is washed with icater, which dissolves the me- conate of ammonia, and afterwards with a quart of water and a dram of muriatic acid, which dissolves the narcotina and leaves the resin. The solution is then filtered, and evaporated to dryness. Muriate of narcotina, thus prepared, is a transparent resi- nous mass, of a rosy colour, and brittle vitreous texture. It is very soluble in distilled water and spirits ; and its salts are in- tensely bitter. EFFECTS ON THE ECONOMY IN HEALTH. These have been so contradictory, that it has been conceived the same preparations cannot have been used by different ob- servers^ According to Magendie,j| morphia is the anodyne principle of opium, and narcotina the exciting. When a grain of narcotina dissolved in oil was given to a dog, it produced a state of stupor, which superficial observers might readily confound with sleep ; but it differed evidently from sleep ; the animal's eyes were open ; the respiration was not deep as in sleep, and it was impossible to arouse it from its sluggish condition. Death generally took place in twenty-four hours. When combined with acetic acid, it pro- duced quite different effects. Animals could bear a dose of even * Christison, Dispensatory, p. 672, Edinb. 1842. t Ibid, p. 671. X Calcutta Quarterly Journal, and Lond. Lancet, July 20, 1839, p. 606. § Ibid, and Diet, des Sciences Medicales, xxxiv. 298. || F^rmulaire pour la Preparation, &c. de plusieurs nouveaux Me"dica- mens. NARCOTINA. 445 twenty-four grains without dying, and whilst under its influence, they were agitated by convulsions like those which camphor in- duces — exhibiting the same signs of fright, the same backward motions, foaming at the mouth, convulsions of the jaws, &c. When morphia and narcotina were both given at the same time, the different effects of each occurred together. A grain of mor- phia, for example, and a grain of narcotina, dissolved in acetic acid, were placed in the pleura of a dog. The animal soon be- came drowsy and fell asleep under the influence of the morphia ; but a singular and remarkable strife appeared to go on for an hour and a half, between the stimulating effects of the narcotina and the anodyne effects of the morphia. At length, however, the animal slept soundly, being probably, Magendie suggests, under the influence of the morphia alone. His opinion is, that narcotina is injurious when not united with an acid, and very exciting when so united. M. Orflla — the celebrated toxicologist — it appears, has en- tertained various views upon the action of narcotina; at one time considering it inert, at another to possess the same action as morphia ; and at another, to concur, when combined with morphia, in the properties of opium, but to a slight degree — since opium, deprived of narcotina, is not less deleterious — and to pos- sess a different modus operandi from opium, without, however, our being able to regard it as the exciting principle.* Owing to all these uncertainties connected with it, narcotina is little if at all employed in medicine. It would seem, however, that the exciting properties of opium do not appertain exclu- sively to it ; for, as has been elsewhere remarked, there are many persons, who are as disagreeably affected by morphia alone as they are by opium which contains both morphia and narcotina. The salts of narcotina have been employed successfully as an antiperiodic, especially in intermit tents J and Dr. O'Shaugh- nessyj has laid before the Medical Society of Calcutta, the results of his experience with them. Sixty cases were treated, of which all but two were successful. Dr. O'Shaughnessy remarks far- ther, that, besides the sixty cases recorded, more than one hun- dred ague patients had been treated by his pupils and acquaint- ances with perfect success by the remedy. * Mcrat and De Lens, Op. cit., and Orfila, Toxicologic Gencrale, ii. 69. f Dr. Roots, London Lancet, Sep. 1832, and T. W. Jeston, Ibid. Oct. G, 1832, p. 41. X India Journal of Medical Science, Sep. and Nov. 1838, and British and Foreign Medical Review, No. xv. for July, 1839, p. 263. 38 446 NUX VOMICA. CVI. NUX VOMICA. Synonymes. Vomic Nut, Poison Nut, Bachelor's Buttons. French. Noix Vomique. German. Krahenaugen. EXTRACTUM NUC1S VOMICiE ALCOHOLICUM. Synonymes. Extractum Nucis Vomicae Resinosum, E. Nucis Vomicae Re- sinosum. Spirituous, Resinous or Alcoholic Extract of Nux Vomica. French. Extrait Alcoolique de Noix Vomique. German. Geistiges Extraktder Krahenaugen. In the year 1809, Magendie discovered, that one entire class of vegetables — the bitter strychnos — has the power of exciting the spinal marrow, without implicating, except indirectly, the functions of the brain.* Since then, many have confirmed the observations of Magendie, and have attended especially to its agency in various diseases. The preparation of the strychnos, most used — if we except the active principle — has been the alcoholic extract of the nux vomica. METHOD OF PREPARING. Take any quantity of rasped nux vomica ; exhaust it by re- peated macerations in alcohol of 40° (.817), and evaporate it slowly to the consistence of an extract. Alcohol of less strength may be used, but, according to Magendie, the product will be proportionably less active. A dried alcoholic extract is made by dissolving in water the alcoholic extract made by means of alco- hol at 36° (.837) ; filtering and evaporating in appropriate dishes, as in making the dry extract of bark. The Extractum Nucis Vomica of the Pharmacopoeia of the United States is directed to be prepared as follows : — Take of Nux vomica, a pound ; Alcohol, a sufficient quantity. Expose the nux vomica to steam till it is softened, then, having sliced and dried it, grind into powder. Introduce it into an apparatus for displacement, and pour alcohol upon it gradually until the liquid passes without bitterness. Distil off the greater part of the alcohol from the filtered liquor, and evaporate the residue to the proper consistence.! * Examen de Paction de quelques vegetauxsur la moelle epioiere. Paris, 1809; and Formulaire, &c. f Pharmacopoeia of the United States, p. 352, Philad. 1842. NUX VOMICA. 447 EFFECTS ON THE ECONOMY. According to Magendie, a grain of this extract, absorbed from any part of the body, or mixed with food, promptly destroys a dog of considerable size, by inducing paroxysms of tetanus, which, by their continuance, arrest respiration sufficiently long to induce complete asphyxia. When the dose is much stronger, the animal appears to die entirely from the action of the nux vomica on the nervous system.* If an animal be touched whilst under the action of the sub- stance, it experiences a commotion similar to that of a strong electric shock, and this takes place each time the contact is re- newed. On dissection, no morbid appearances exist which can account for death. When introduced into the frog's stomach, Dr. Lombard,! of Geneva, found, that it produced tetanic convulsions, which, in a few hours, caused death. The contractions of the heart were sometimes strong and complete, sometimes irregular, tumultuous, and intermitting ; always diminished in frequency. Applied to the heart itself, it slightly stimulated it, rendering the pulsations more energetic and frequent, whence Dr. Lombard concludes, that the nux vomica cannot be used with advantage in any dis- eases of the heart ; for, although it diminishes the frequency of the pulsations, it renders them irregular. The action of the extract on healthy man is the same as that described by Magendie, and if the dose be sufficiently large, death speedily follows with thesame symptoms. J In those that are affected with paralysis, the effect is also the same ; but what is singular, it is particularly manifested on the paralysed parts by tetanic convulsions, and a feeling of creeping, which indicate the operation of the remedy : a local perspiration is also often observ- ed to break out on some parts of the body. When administered in cases of hemiplegia, the contrast between the two sides of the body is rendered striking : whilst the sound side remains at rest, the other may be violently agitated ; tetanic shocks may super- vene and a copious perspiration break out. In a female, Ma- gendie saw the affected side covered by a peculiar eruption, whilst the other side afforded no trace of it. There is a differ- ence even between the two sides of the tongue, a decidedly bit- ter taste being occasionally perceived on the one, whilst the other exhibits nothing similar. * Segalas, in Journal de Physiologic par Magendie, Oct. 1822. | Gazette MCdicale de Paris, Oct. 10, 1835. t See the details of two cases of poisoning by nux vomica, in Lond. Med. Rep. xix. 448 and 45G ; Christison on Poisons, and Brande, Dictionary of Materia Medica, p. 375. Lond. 1839. 448 NUX VOMICA. If a much larger dose be given, both sides of the body parti- cipate, but unequally, in the tetanic spasms, so that the patient is sometimes thrown out of bed by the violence of the contrac- tions. When given in very small doses, it has not any percep- tible effects immediately, and some days elapse before its advan- tageous or noxious properties can be appreciated. According to Magendie,* the extract may be given in all dis- eases that are attended ivith debility, general or local, and in paralysis of all kinds, general or partial. He himself observed excellent effects from it in marked cases of debility of the genital organs, incontinence of urine, &c. He also used it with advantage in several cases of partial atrophy of the upper and lower extremities. As regards its administration in cases of paralysis succeeding to apoplexy, he remarks, that it should not be given until some time after the coup de sang in the brain, which occasioned the palsy ; and that even then beneficial re- sults can be expected only when no marked organic mischief exists ; indeed, in the latter case, he considers the disease irre- mediable, and that bad effects might result from pushing the remedy. The efficacy of the alcoholic extract of nux vomica in various forms of paralysis has been confirmed by many observers. Even before Magendie had employed it, Fouquier,t had given it in several cases, with the most satisfactory results. Since then, we have had the testimonies of Chauffart,| Gendron,§ Perrussel, Recamier, Mauricet, Baxter,|| Galli, Haurf, Wenneis, Burkard, Petrequin,1T Gellie,** and numerous others in its favour. The Author's own experience with it in cases of hemiplegia has not been limited ; yet although he has succeeded in inducing tetanic movements in the limb, he has not been satisfied that much advantage was derived from it ;tt and, in some cases, it appeared to induce serious encephalic excitement. After effusion has occurred into the encephalon time is required for its absorp- tion, and but little beneficial agency can be expected from any remedy. Nor are the results of the experiments and observa- tions of Jahn by any means in accordance with those of the practitioners above mentioned. He tried it in numerous cases of * Formulaire pour la Preparation, &c. de plusieurs nouveaux Medica- mens, &c. + Bulletin de la Faculte de Medecine, &c. vol. v. 1818. \ Journ. Gener. de Med. Oct. 1824. || Ibid. Nov. 1829. || New York Medical Repos. vol. viii. IF Gazette Medicale de Paris, Oct. 27, and Nov. 3, 1838, and Bulletin General de Therapeutique, Mars. 1840. ** La Lancette Franchise, Aout 29, 1837. ff See the Author's Practice of Medicine, ii. 262. Philad. 1842. Also Chauffart, in Op. cit. NUX VOMICA. 449 paralysis, but affirms, that he did not see any good effect from it ; and, with the exception of two cases, did not notice the slightest action, although the extract was carefully prepared ac- cording to the formula given by Magendie. Yet, he remarks, he was by no means sparing in the dose. In the two cases in which a change seemed to be induced, there was an evident in- crease of the paralysis. This discrepancy, as well as other evidences of the same con- trariety of experience, may doubtless have been partly owing to difference in the strength and quality of the preparation ; and hence, according to some, the value of strychnia — its active principle — which is not liable to as much uncertainty.* Dr. Christison,t however, affirms, that " there seems no particular reason why the powder and extract should have been displaced by the principle strychnia ; for their effects are precisely the same ; and the principle is not only troublesome to prepare, but likewise, being seldom pure, is liable to the objection of irregular strength, which is brought against the galenical preparations of the drug." In cases of partial paralysis, as in colica pictonum, amauro- sis^ palsy of the rectum, &c, both the alcoholic extract of mix vomica and its active principle have been used and with good effect. (See Strychnia.) Dr. Cerchiari§ treated two cases of incontinence of urine suc- cessfully with the extract. The first was that of a girl nineteen years of age — who, from her infancy, had passed her urine in- voluntarily every night in her sleep. She was ordered the third of a grain of the extract in pill, three times a day ; and in eight days the cure was complete. The second case was that of a young married female, whose urine flowed involuntarily, day and night, after her first delivery. As there was no fistulous opening to account for the involuntary discharge, and it appeared to arise from weakness of the neck of the bladder, in consequence of contusion by the head of the child, the extract was adminis- tered in the same doses as in the preceding case, and in fifteen days the cure was complete. Mondiere, in cases of incontinence of urine dependent upon atony, prescribed it advantageously in association with black oxide of iron.|| M. PetrequiuH found, that local anaesthesia or loss of sensibi- * Richter's Specielle Therapie, u. s. w. B. x. S. 352. Berlin, 1628. f Dispensatory, p. 658, Bdinb. 1842. X Petrequin j. Acaeise, 3ss. Tinct. card, f.^ss. Aquae destillat. f.Jx. M. Dose. — Two dessert-spoonfuls, to children ; to be repeated every three or four hours, if necessary. Trochisci olei tiglii. Lozenges of croton oil. R. Olei tiglii, gtt. ij. Sacchar. ^j. Mucilag. acaciae, q. s. ut fiant Trochisci, non torrendi, No. viij. Dose. — One every two hours, until the desired effect is in- duced. SeilerA * Ellis's Medical Formulary, 6th edit, by Dr. S. G. Morton, p. 36. Philad. 1842. t Hufeland's Journal, B. lix. St. 4. S. 134 ; und Rust's Magazin, B. xviii. St. 2, S. 358. OLEUM TIGLII. 471 Sapo olei tiglii. Soap of croton oil. Sapo crotonis. R. Olei tiglii, partes ij. Liquor, potassse, partem j. Triturate in the cold, and when the mixture has acquired the proper consist- ence, run it into moulds of pasteboard, and, in the course of a few days, remove it by slices. Dose. — Two or three grains in water, or in the form of pill. Caventou. Linimentnm olei tiglii. Liniment of croton oil. Lini?nentum crotonis. R. 01. tiglii, p. i. — olivs, p. v. M. To be rubbed on the skin, night and morning, until pustula- tion is induced. Ungnentum olei tiglii. Ointment of croton oil. R. Olei tiglii, rr\,x. — xxx. Adipis, 3ss. M. A little of this to be rubbed on the part so as to excite the peculiar eruption. 472 PAULLINIA. Emplastrum olei tiglii. Plaster of croton oil. Sparadrap de crolnn. M. Bouchardat melts over a very gentle fire, 4 parts of diachy- lon plaster ; and when it is in a semifluid state, he mixes with it 1 part of croton oil. This he spreads upon linen, so as to form an adhesive and irritating plaster. M. Caventou prefers the following form, as he considers the degree of heat employed in the process of M. Bouchardat may interfere with the powers of the croton oil. R. Adipis, p. iiss. Cerse, p. ss. 01. tiglii, p. i. The wax and lard must be melted, and when nearly cold, the oil be incorporated.* Popet recommends a tinctura granorum tiglii, or a tinc- ture of the seeds, to be made of two ounces of the seeds from which the rinds have been carefully removed, to one ounce of alcohol. This is allowed to digest for six days, and is then filtered. The smallest dose for an adult is twenty drops. This preparation, he says, has the advantage of excluding the more acrid drastic matter contained in the epidermis and husk, whilst the kernel affords cathartic material enough to act powerfully and certainly. CX. PAULLIN'IA. Paullinia is an extract from a plant of the same name, a native of Brazil. It is prepared by the Indians, and seems to possess considerable, excitant powers. M. Gavrelle presented a specimen of it to the Sociele de Medecine, of Paris, as well as a new alkali, which had been separated from it by two chemists of Paris. Both the extract and the alkali are very bitter, and somewhat resemble Cafein. M. Gavrelle states, that Paullinia is obtained from the Paullinia sorbilis ; Family, Sapindaceae. M. de Chas- * Bulletin General de Therapeutique, Mars, 1842, and Journ. de Pharm. Avril, 1842, p. 453. f Medico-Chirurgical Transactions, vol. xiii. p. i. PAULLINIA. 473 tetus found it to be composed of gum, starch, a resinous matter of a reddish-brown colour, a fat oil, tannic acid, and a crystalli- zable substance, possessing the chemical properties of cafein. EFFECTS ON THE ECONOMY IN DISEASE. In Brazil, and the neighbouring countries, it is given in the form of Tisane — the powder being mixed with cocoa — in diar- rhoea and dysentery. As a tonic, M. Gavrelle has employed it successfully in chlorosis, tedious convalescence, paralysis, the colliquative diarrhoea of phthisis, and hemicrania. According to Von Martius, an extract is prepared in Bra- zil from Paullinia sorbilis, which is known there under the name of Guarand, and is administered in similar pathological cases.* MODE OF ADMINISTERING. The hydro-alcoholic extract op paullinia is considered to represent the plant most accurately in its chemical properties. Of this, M. Gavrelle has given formulae for Lozenges, Syrup, Pills, Powder, Tincture, and Ointments Trochisci paulliniBB. Lozenges of paullinia. R. Extract. Jiydro-alcoholic. paulliniae, 3vss. Sacchar. (vanilla odorizat.) Jfoiss. Make into lozenges, each containing 10 grains. Syrupus paullinise. Syrup of paullinia. I£. Extract, hydro-alcohol, paullin. Jiiss. Syrup. Oij. Haifa fluid ounce may be given in the 24 hours. * See art. Guarand, in Diet. Univers. de Mat. M£d. par Mcrat et De Lens, torn, ii., p, 305. liruxelles, 1838 ; Journal de Pharmacia, and Amer. Journ. of Pharmacy, Jan. 1841. p. 310; M. Dechastetus, Journ. de Pharm. Aout, 1840; J. J. Virey, Ibid., and Von Schleehtendal. Encyclopid. Worterb. der Medicin. Wissenschaft. xxvi. 433. Berlin, 1841. f Journal de Chimie MeM., and Kncyclographie des Sciences Mcdicales, Juillet, 1840, p. 230. See, also, American Journal of Pharmacy, Oct. 1840, p. 208. 40* 474 PHLORIDZINA. PilulflE paullinirc. Pills of paullinia. R. Extract, hydro-alcohol, paullin. q. s. To be made into pills, each containing a grain and a half. Pulveres paullinise. Powders of paullinia. For a dose. R. Paullin. in pulv. %i. Sacchar. aromatizat. gss. M. Tiuctura paullinise . Tincture of paullinia. R. Ext. hydro-alcohol, paullin. §i. Alcohol. (22°) Oi. M. IJnguentum paullinia. Ointment of paullinia. R. Ext. hydro-alcohol, paullin. 3U- Adipis. jfij. M. CXI. PHLORIDZINA.* Synonymes. Phloridzinurn, Phloiorrhizinum, Phloiidzia, Phloridzine, Phlo- rizin, Phloridzin. German. Phloridzin, Phloiorrhizin. This bitter principle exists in the bark of both the trunk and the root of the apple, pear, cherry, and plum tree. * From y\tot, inner bark, and §/£a, root. PHLORIDZINA. 475 METHOD OF PREPARING. The following plan is recommended by M. de Koninck, its discoverer (1834 or 1835). — The fresh bark of the root of the apple tree is to be boiled for two hours with sufficient water to cover it : the decoction is to be decanted, and a second one made by the addition of more water. On uniting the two decoc- tions, and permitting them to stand for twenty-four hours, a de- position of phloridzin, in granular crystals, takes place. These are to be treated with distilled ivater and animal charcoal to purify them. An additional quantity is obtained by evaporating the mother waters to one-fifth. At this degree of concentration, all the phloridzin is deposited. This method affords about one part in three hundred. Another plan yields five per cent. It consists in digesting the fresh root in weak alcohol, at a tempera- ture of 120°, for about eight or ten hours, distilling off the greater part of the alcohol, and crystallising the residue.* Phloridzin crystallises in silky spicula of a dead-white colour when in masses, or in long slender prisms or tables when crys- tallised with care. One thousand parts of water, at a tempera- ture from 32° to 71°, only dissolve about one part ; but at from 71° to 212°, water dissolves it in all proportions. It is also very soluble in pure alcohol at ordinary temperatures, although but slightly so in ether, even when boiling. It has no action on test papers. S. g. 1.429.t EFFECTS ON THE ECONOMY IN DISEASE. M. de Koninck found, that from ten to fourteen grains given for a dose, with a dram of sugar, produced the most marked ef- fect in intermittent fever, where sulphate of quinia had failed. In four cases, reported by Dr. Van Mons^of Bruxelles, the dis- ease was arrested by the first sixteen grains : other cases required sixteen grains, a few hours before the first paroxysm; twelve grains before the second ; six before the third ; and four before the fourth. Five successful cases are likewise given by M. Ma- thysen,§ elcve interne at the Hospital St. Pierre, Bruxelles ; and * Journal do Plmrmacie, xxii. 78, and Arner. Journ. of Pharmae. vol. ii. new series, p.. 240. See, also, M. Boullier, in Gazelle Medieale de Paris, 17 Juin, 1837, and M. Marchand, Journ. deChim. Med. Avril, 1841. f For Borne elaborate chemical researches on l'liloiidzine, M. J. S. Stass Annates de Chimie et de Physique, Deo. 1838. X Bulletin Medical Bulge,. Mai, 183G. § Ibid. Oct. 1835. 476 PIPERINA. M. Lebaudy* affirms, that its efficacy is so decided, that we cannot hesitate to class it with the most powerful febrifuges; and that it has this advantage over quinia, that it never induces gas- tralgia ; yet M. Leonhardt is satisfied from his various trials, that phloridzin does not possess any febrifuge virtue ! METHOD OF PRESCRIBING. It may be given in the form of pill or of powder, like the sul- phate of quinia. It was administered at the hospital at Brux- elles, in one case, in the way of lavement ; — twenty-four grains being given in three lavements. The paroxysm returned, but was less violent. In two days afterwards, the same quantity was administered in the same manner, and the fever did not recur. CXII. PIPERI'NA. Synonymes. Piperinum, Piperium, Piperine, Piperin. German. Piperin, PfefTerstorT. This substance was discovered by M. Oerstiidt, in the year 1S19, in black pepper, Piper nigrum. \ It is found, also, in Piper longum, and it has been presumed to be the same, or an analogous principle with the cubebin of Piper cubeba. It has been affirmed, that it exists only in black, and not in white pepper ; but this is an error. Dr. Christison§ invariably obtained it from the latter in larger quantity than from the former, and more easily, because it is combined with less resin. M. Oer- stiidt at first regarded it as a vegetable alkali, but M. Pelletier subsequently analysed it, and proved it not to be such, but to bear a considerable analogy to resins, and not to be of a peculiar nature. || Piperin has not been much used, except in Italy. * Journal des Connaiss. Med. Chirurg. cited in Braithwaite's Retrospect of Medicine and Surgery No. 5, p. 1*29, Lond. 1842, where it is termed erro- neously Phloridrine ; and whence it is copied into the Amer. Journ. of the Medical Sciences, and into the American Journal of Pharmacy, for Jan. 1843, under the name Ptihridinn. t Encyclojraphie des Sciences Medicales, Mai, 1838. | Journal de Physique, No. 2. 18-20, and Gazette de Sante, Mai 25, 1820. § Dispensatory, p. 698. Edinb. 1842. || Examen chimique du Poivre, par J. Pelletier. 8vo. Paris. 477 METHOD OF PREPARING. Let two pounds of black pepper, bruised, be digested, at a gen- tle heat, in three pounds of alcohol, at 36° (.837). This mixture must afterwards be raised to ebullition, then suffered to remain at rest, and grow cold ; when it must be decanted, and the ope- ration be repeated with fresh alcohol. The two solutions must then be mixed together, and two pounds of distilled water and three ounces of muriatic acid be added. The liquor becomes turbid, and a precipitate, of a deep gray colour, is thrown down, which is composed, in a great measure, of fatty matter. The deposite being separated, crystals may be collected on the filter and sides of the vessel. These are piperin. On adding water until the liquid is no longer rendered turbid, a fresh quantity is obtained. The above process, which is that of Meli, is the same as one described by M. Pelletier. He has likewise procured it by the following method : — After having exhausted pepper by alcohol, and evaporated the alcoholic tinctures, a fatty or resinous matter is obtained : this must be subjected to the action oi boiling ivater, which must be added again and again, until it passes off colour- less. By dissolving this fatty matter — thus purified by washing — in alcohol, by the aid of heat, and leaving the solution to itself for some days, a multitude of crystals are obtained, which may be purified by solution in alcohol and ether, and by repeated crys- tallisation. The alcoholic mother waters, left to themselves, will furnish fresh crystals. This crystalline matter is piperin. Piperin presents itself in the form of four-sided prisms, two of which — parallel to each other — are evidently broader than the others. In the pure state, it is of a white colour, and translucent : it is frequently, however, coloured yellow by portions of resin being combined with it. It has been affirmed, that when Piperin is quite pure it is bland ;* but Dr. Christisonf states, that the very whitest crystals he was able to obtain, were as acrid as those which are brownish, and they emitted an intensely irritating vapour when thrown on a heated iron plate. It is inodorous, and of a feeble taste of pepper ; fuses readily by heat ; is not volatile, and is scarcely soluble in cold water, but somewhat more so in hot. In respect to its solubility in alcohol, testimony is discordant. According to Magendie, it dissolves very readily therein ; according to C. G. Gmelin, it is soluble only in small * Dispensatory of the United States of America, 4th edit. p. 512. Philad. 1839. t Op. cit. p. 097. 478 PIPERITA. quantity in cold, but in tolerable proportion in hot alcohol, as well as in ether and in the volatile oils. The solutions taste acrid and peppery, and do not react on vegetable colours ; — which shows that it is not an alkaloid, as the discoverer conceived. With acids, it forms no intimate chemical combinations ; acetic acid, indeed, dissolves it in considerable quantity ; it is, however, in great part, precipitated by water, and by evaporation the whole of the acid escapes. It is related to the resins. EFFECTS ON THE ECONOMY. Piperin has been exhibited chiefly by the Italian physicians for the cure of intermittent fever. Its employment \vas,doubtless, suggested by the use of pepper-corns as a popular remedy in that disease. According to Riecke,* the antiperiodic virtue of pepper is exhibited upon the healthy economy, — a few pepper-corns taken before the expected appearance of the menses, arresting them for several days. Of this, he himself has had no experi- ence ; but he affirms, that the females, in a district of southern Germany, have great confidence in their virtues. Meli,t who treated many cases of intermittent with piperin, considers it as the best of all febrifuges, quinia not excepted. He forms twenty grains into ten pills, and gives these at inter- vals during the apyrexia. He ascribes the efficacy of the oleum acre piperis in the same complaint to the piperin it contains. The febrifuge virtue of piperin has been confirmed by many other Italian physicians ; by Brandolini, Bertini, Gordini, To- relli, and others. According to Brandolini, from forty to fifty grains are generally required to effect a cure. Bertini gave it in three doses during the apyrexia, to the extent of a scruple, made into pills with a bitter extract : after two or three doses, the fever was generally arrested. Gordini affirms, that relapses occurred less frequently after the use of piperin than after that of the sulphate of quinia. On the other hand, in the hospital at Turin, Christin was disappointed in it, and such seems to have been the result of the trials made by Chiappa.J In the year 1S23, he administered it in ten or twelve cases, but was unable to detect any great antiperiodic property ; not more than a fourth part of the sick experienced benefit, whilst, on the others, cin- * Die neuern Arzneimittel, S. 361 ; und 2te Auflage, S. 522. Stuttgart, 1840. | Nuove Esperienze, &c. Milan, 1823, 8vo. ; and Annali Universali di Medicina, xxvii. 161, and xxviii. 22. * Riecke, Op. cit. S. 361; und 2te Auflage, S. 553. Stuttgart, 1840. PIPERINA. 479 chona acted like a charm. In general, a burning sensation was experienced in the stomach after taking it, as well as in the throat, with the same kind of feeling occasionally in the rectum, and in the whole abdomen ; and in two young individuals, the eyes were made red, and the eyelids, nose, and lips were swollen. Piperin has, likewise, been employed by others beside the Ita- lian physicians. Dr. Blom, of Utrecht, has given it in intermit- tents, but not with as much success as the quinia. According to him, the remedy, soon after it is taken, particularly in very im- pressible persons, occasions a sense of internal heat, especially in the epigastric region, and not unfrequently it causes perspira- tion, especially on the upper lip. Blom is, however, doubtful, whether these effects be ascribable to the piperin, or to a portion of the resin of the pepper remaining united with it. He is of opinion, that both in general debility, and in debility of the diges- tive apparatus, piperin merits a preference over sulphate of qui- nia, both because it can be better borne by the stomach, and be- cause it acts more tonically upon it. It has been given in intermittent fever, with great success, by Dr. Hartte,* Port of Spain, West Indies. He prescribed it as soon as the sweating stage was established, until IS grains had been taken, and on the following day, when the intermission was complete, he directed the same quantity every three hours. It succeeded, in every case, in checking the paroxysm, and as soon as this was accomplished he gave, for some days, pills composed of Pilula Hydrargyri, Piperin, and Sulphate of Quinia, the for- mula for which is given below. In inflammatory intermittent^ as well as in those with gastric complications, piperin is to be avoided. Magendie suggests that it should be given in blomorrhcea, in place of cubebs. METHOD OF ADMINISTERING. Pilulsc piperinse. Pills of piperin. R. Piperin. gr. xij. Extract, gentian. <\.s. ut fiant pilulae xij. Dose. — One every hour during the apyrexia of fever. * Edinb. Med. and Surg. Journ. Jan, 1841, p. 98. 480 PLATINI PR-EPARATA. Pilulfe piperinrc composite. Compound pills ofpiperin. R. Pil. hydrarg. gr. i. Piperin. gr. ij. Quinize sulphat. gr. ij. Syrup, q. s. ut fiat pilula. One to be taken morning, noon, and night. Hartte. CXIII. PLAT'INI PRiEPARA'TA. Synonyme. Preparations of Platinum or Platina. EFFECTS ON THE ECONOMY. The preparations of platinum have not been much used in medicine. Recently, experimental researches have been under- taken by M. F. Holer,* in regard to their employment as physio- logical and therapeutical agents ; and the following are the main results. Experiments were made on rabbits, dogs, and on him- self, with the view of discovering the physiological action of the perchloride of platinum or chloroplalinic acid, of the chloro- platinate of sodium or the double chloride of platinum and sodium; of the chloroplatinate of potassium, and the chloro- jilatinate of ammonium. He found — First. That the chlorides of platinum are poisonous. — the perchloride in the dose of 15 grains; the chloroplatinate of sodium in that of 3ss. Secondly. The chlorides of platinum are less poisonous than the chloride of gold, and corrosive sublimate. Thirdly. The perchloride of platinum, in concentrated solution, produces violent itching or irritation of the skin, followed by a slight eruption on the part to which the solution has been applied. Taken internally, it first of all irritates the mucous membrane of the stomach, oc- casions headache, reacts on the nervous centre, and through it exerts a special alterative action on the fluids of the economy. Fourthly. The chloroplatinate of sodium produces no local * Gazette Medicale de Paris, No. 48, 1840; and Journal de Pharmacie, Avril, 1841, p. 213. PLATINI BICHLORIDUM. 481 irritation on the skin. Taken internally, it does not react on the nervous centres in as manifest a manner as the simple perchlo- ride. It more especially increases the urinary secretion. Fifthly. The perchloride of platinum is a very efficacious remedy in the treatment of syphilitic diseases, and especially in those that have been of long duration, and are inveterate. Sixthly. The chloro- platinate of sodium is more proper for the treatment of recent syphilitic diseases. It is also very efficacious in the treatment of rheumatic affections. Seventhly. Platinum ought to be ranked in the class of alterative remedies, by the side of gold, iodine and arsenic. It differs from mercury in previously inducing excite ment ; whilst its administration is not followed by any of the disagreeable consequences induced by mercury. Eighthly, and lastly. Platinum is preferable, as an alterative, to mercury and gold. PLAT'INI BICHLO'RIDUM. Synonymes. Platini Perchloric! um, Bichloride or Perchloride of Platinum. French. Bichlorure ou Perchlorure de Platine* This preparation is made by dissolving platinum in aqua regia, and evaporating the solution to dryness. A very gentle heat ought to be used ; otherwise the bichloride maybe decomposed ; and the protochloride, or even reduced platinum, be the result. Bichloride of platinum in concentrated solution or in the solid state is of a deep red colour. It is very deliquescent ; very solu- ble in water, and soluble also in alcohol. Mistura platini perchloridi. Mixture of chloride of platinum. (Potion platinique.) R. Platin. perchlorid. sice. gr. iss, Mucilacr. acac. Aquae, aa. f-o'ij- To be taken by table-spoonfuls in the course of the 24 hours. 41 4S2 SODII CHLOROPLATINAS. Pilule platini perchloridi. Pills of perchlorlde of platinum. (Pilules platiniques.) R. Platin. perchlorid. gr. viij. Guaiac. resin, gi. Glycyrrhiz. pulv. q. s. ut fiant pil. xx. Dose. — One, two, three, or four, morning and evening. Unguentum platini perchloridi. Ointment of per chloride of platinum. (Pomrnade platinique.) R. Platin. perchlorid. gr. xv. Extract, belladon. 3ss. Adipis, §i. To be applied to indolent ulcers. SO'DII CHLOROPLATINAS. Synonymes. Chloroplatinate of Sodium, Double Chloride of Platinum and Sodium. French. Chloroplatinate de Sodium, Chlorure Double de Platine et de Sodium. The chloroplatinate of sodium is prepared by dissolving bichlo- ride of platinum and very pure chloride of sodium in proper proportions in water, evaporating and crystallizing. It is soluble in water and in alcohol, and crystallizes in beautiful transparent prisms of an intensely yellow colour. PLUMBI IODIDUM. 483 Mistura sodii chloroplatinatis. Mixture of chloroplatinate of sodium. {Potion de chloroplatinate de sodium.) R. Platin. perchlorid. gr. v. Sodii chlorid. pur. gr. viij. Mucilag. acac. Aquae, aa. f.^iij. To be taken by spoonfuls in the 24 hours. Injectio sodii chloroplatinatis. Injection of chloroplatinate of sodium. {Injection de chloroplatinate de sodium.') R. Sodii chloroplatinat. crystalliz. gss. Decoct, papaveris, Oss. The experiments of M. Hofer with the salts of platinum have not been numerous ; but they confirm the assertion of Magendie, that they possess properties analogous to those of the salts of gold. CXIV. PLUMBI IODIDUM. Synontmes. Plumbi Ioduretum seu Iodetum, P. Hydriodas, P. Iodhy- dras, Plumbum Iodatum, P. Hydroiodicum, Iodide or Ioduret of Lead. French. Iodure de Plomb. German. Bleiiodid, Iodblei, Bleiiodiire, Einfach Iodblei, Hydriodsaures oder Iodwasserstoffsaures Blei. MODE OF PREPARING. This preparation may be made by adding a solution of one hundred parts of iodide of potassium to a solution of seventy-five parts of acetate of lead. 4S4 PLTJMBI I0DIDUM. The London Pharmacopoeia of 1836, gives the following form : — Take of Acetate of lead, nine ounces ; Iodide of potassium, seven ounces ; Distilled water, a gallon (imperial measure) : dis- solve the acetate of lead in six pints of the water, and filter; and to these add the iodide of potassium, previously dissolved in two pints of the water: wash the precipitate and dry it. In the Edinburgh Pharmacopoeia, it is directed to be prepared by the double decomposition of nitrate of lead and iodide of potassium. Dr. Christison* considers, that the nitrate is t prefer- able to the acetate of lead, as being more uniform in composition, and free from any excess of oxide of lead, which interferes with the purity of the product. Iodide of lead is in the form of a bright yellow colour, and, ac- cording to Soubeiran,t is soluble in 1235 parts of cold water ; and is somewhat more soluble in boiling water, which, on cooling, deposits the iodide in minute, shining, yellow, crystalline scales. Riecke % says it is soluble in 1200 parts of cold water, and in 200 of hot. When heated, it melts, and is dissipated in vapours, which are at first yellow, and afterwards violet. EFFECTS ON THE ECONOMY. Iodide of lead is not an irritant, when applied even to a de- nuded surface. § M. Paton|| administered twelve grains of it to a cat of moderate size. In four hours the animal did not appear to experience any inconvenience; twelve more grains were then given ; in twelve hours, the animal became uneasy, and con- stantly refused every kind of food. It appeared to suffer in the kidneys ; subsequently, it was attacked with violent colic, which caused it to jump to great heights. Three days after taking the iodide, it died, suffering dreadfully. The dissection was made twelve hours afterwards, when no traces of irritation were per- ceptible. M. Paton examined the exterior of the stomach chemi- cally, but was unable to detect any of the iodide, nor could any portion of it be discovered in the fasces. He then boiled the intestines and their contained matters in distilled water ; the liquid was filtered and decolourised by charcoal, but no effect was induced by the tests for lead. The matter remaining on * Dispensatory, p. 711. Edinburgh, 1842. f Traite de Pharmaeie ; and Dr. Wood, in Dispensatory of the United States of America, by Drs. Wood and Bache, 4th edit. p. 998. Philad. 1839. % Die neuern Arzneirnittel, u. s. w. 2te Auflage, S. 563. Stuttgart, 1840. § Eager, in Dublin Journal for 1834. || British Annals of Medicine, Mar. 3, 1837 ; and Journal de Chimie Medi- cal, Jan. 1837. PLUMBI IODIDUM. 485 the filter was digested in dilate nitric acid : the solution was filtered, and a precipitate obtained on pouring in a solution of chromate of potassa. The liquid was evaporated; the residue calcined along with what was left by the evaporation of the water, and the whole brought in contact with dilute nitric acid. Nitrous gas was disengaged, and the solution responded to re- agents like the solutions of the salts of lead. M. Paton infers, that iodide of lead introduced into the stomach is partly absorbed, and that it is this portion which causes death, — the remainder passing into the intestines, and admitting of detection by the method described. When given internally, in the dose of a. quarter or half a grain, Velpeau thought, that it occasioned, in one instance, irritation in the alimentary canal ; but Dr. O'Shaughnessy thinks that this result must have been owing to idiosyncrasy, as ten-grain doses can be borne with perfect impunity. The experiments of Dr. Cogswell* show, that it is by no means an active agent, and that its physiological operations do not correspond with its thera- peutical effects ; as, in continued doses, it produced the constitu- tional action of lead, and not at all that of iodine. Owing to its not exciting cutaneous irritation — like iodine, and iodide of potassium — iodide of lead has been applied exter- nally. Velpeaut treated three cases of enlarged glands with very gratifying success, although the patients had used frictions with other preparations of iodine ineffectually. Similar good effects were observed by Guersent, Roots, and others. Dr. Christisoni. has seen it repeatedly useful to appearance in obstinate ulcers, especially when " consecutive to mercurio-syphilitic eruptions in strumous habits." P i lula; plumbi iodidi. Pills of iodide of lead. R. Plumbi iodid. gr. iv. Confect. rostE, 9j. M. et divide in pilulas xij. Dose. — One night and morning, in scrophulous affections of the glands, joints, &c. The dose may be gradually increased to three or four pills, or more. J°y-h • Essay on Iodine, p. 142. Edinb. 1837. f Logpl, Essays on Jodine, &c, by O'Shaughnessy, p. 20C % Dispensatory, p. 712. Edinb. 1813. § Tweedie's Library of Medicine, v. 320. Loud. 1840; or 2d Aincr. Edit, vol. iii. Fbilad. 1842. 41* 4S6 PLUMBI TANNAS. Unguent um plumbi iodidi. Ointment of iodide of lead. R. Plumbi iodid. 3j. Adipis, sviij. M. Applied to scrophulous and other indolent swellings in the form of friction. Lond. Pharm. CXV. PLUMBI TANNAS. Synonymes. Tannate of Lead. French. Tannate de Plomb. German. Gerbsloff blei. Autenrieth* has strongly recommended tannate of lead in cases of paratrimma ad decubitum, that is, of sores produced by lying, and its advantages have been confirmed by others. METHOD OF PREPARING. Tannate of lead is formed by precipitating an infusion of oak bark by acetate of lead, according to the following formula : " Take of oak bark, in coarse powder, an ounce ; boil in eight ounces of water, until, when strained, four ounces remain : add acetate of lead as long as any precipitate falls ; filter the liquor through bibulous paper, and dry the precipitate remaining on the paper to the consistence of a thin ointment." Dr. Tott has recommended it in cases of decubitus gangrse- nosus, or sloughing sores produced by lyingA In one case, in which it appeared to be inefficacious, he took two drams of the dried precipitate, mixed it with an ounce of unguentum rosatum, and used this unguentum plumbico-tannicum with success. * British Annals of Medicine, June 2, 1837 ; and Journ. de Chimie Medi- cale, Mars, 1837. f Grafe und Walther's Journal der Chirurgie, B. xxiv. S. 676, Berlin, 1836; and Gazette Medicale, Jan. 1837. POTASS^ CHLORAS. 48 7 CXVI. POTAS'SJE CHLORAS. Synonymes. Kali Chlorieum, K. Chlorinicum, Chloras Kalicus Depuratus, Chloras Potassicus, Alcali Vegetabile Salito-dephlogisticatum, Chloruretum Potassa? Oxidatum, Haloidum Oxygenatum, Marias Potassa? Hyperoxygena- tum seu Oxygenatum, Oxygeno-chloruretum Potassii, Kali Oxymuriaticum, Kali iMuriatic urn Hyperoxygenatum,Potassa3 Euchloras, Chlorate of Potassa, Chlorate of Protoxide of Potassium, Oxymuriate of Potassa, Hyperoxymu- riate of Potassa. French. Chlorate de Potasse. German. Chlorsaures Kali, Oxydirt Salzsaures oder Hyperoxygenirt Salzsaures Kali. METHOD OF PREPARING. la the chemical manufactories, chlorate of potassa is prepared by passing chlorine gas into a solution of carbonate of potassa. In this way, chlorate of potassa is obtained mixed with more or less chloride of potassium. The salt prepared in the laboratories, before it is adapted to medical use, should be purified by recrys- tallisation. It is to be observed, that when the adequate quan- tity of chlorine gas is not employed in the preparation, the re- sulting compound is analogous to chlorinated soda and chlori- nated lime, and in action it agrees rather with those preparations than with the true chlorate of potassa. This may tend to ex- plain the discrepancy in the experience of different physicians. Chlorate of potassa crystallises in white leaves, having the splendour of mother-of-pearl, or in four or six-sided tables, hav- ing a specific gravity of 1.989. It is permanent in the air, and has a cool, saline, disagreeable taste, similar to that of saltpetre. Six parts are soluble, at the ordinary temperature, in 100 parts of water. When exposed to heat, oxygen escapes, and chloride of sodium remains. When beaten forcibly in a mortar, it crackles, and emits light, and sparks. When rubbed lightly with inflam- mable substances, or when struck, it inflames readily, and hence its well known employment in the formation of matches. EFFECTS ON THE ECONOMY. These have not been completely tested, in the opinion of some at least.* L. W. S.uhs, who has frequently administered it, is of opinion, thai in this salt the direct effect of the alkali is rendered milder by the chloric acid, whilst the alkali modifies that of the * Riecke, Die ncuern Arzneimittel, S. 300, und 2te Auflage, S. 451. Stuttgart, 1810. 48S POTASS.E CHLORAS. acid ; in this manner, the caustic property of the alkali is de- stroyed ; whilst the liquifying or resolvent (jluidisirende) pro- perty is moderated, but not removed. On the other hand, by the union of the chloric acid with the alkali, the powerful excitant action on the nerves, which the former exerts, is at the same time markedly moderated, although certainly not destroyed ; the mode in which it is exerted, he thinks, is probably changed. By such a union, a medicine has been supposed to be formed, which acts chiefly on the nervous system, and which is capable of mitigat- ing and probably of removing any morbid erethism therein, with the hypersesthesia thereby induced. Such is the opinion of certain therapeutists. Others imagine, that it is capable of purifying the mass of blood in consequence of the chlorine it contains; but a salt of chloric acid is not possessed of the same properties as chlorine ; and, accordingly, when the author has found occasion to administer it, he has never wit- nessed any of the effects ascribed to it ; nor has he seen any evi- dence of the ??iodus operandi on the nervous system mentioned above, or of its imparting oxygen to the blood as supposed by some.* The saline powder given below, which was considered by Dr. Stevens to be so useful in many febrile affections, is af- firmed by Mr. Braithwaitef to have been very beneficial in typhous cases, marked by dry, parched, brown or black tongue ; dark sordes on the teeth and gums, &c, &c. In almost every case, he found the dark appearances in the mouth to be altered in an incredibly short time. From its excitant properties, and under the notion that it may act upon the blood, and through the blood on the functions of nu- trition as an excellent alterative, chlorate of potassa has been recommended in chronic cutaneous diseases in general, as well as in hepatic and syphilitic affections. It has also been occasion- ally administered in cases of chronic asthenia. KohlerJ employed it in several cases of tubercular phthisis, and notwithstanding the general results of his experiments were unfavourable, he thinks it ought to be admitted into the number of those remedies that are useful in phthisis, although its stimu- lating action on the circulating and pulmonary systems cannot be denied. Its use is contraindicated where the fever runs high, and where there is any sign of inflammation of the lungs, or ten- dency to haemoptysis. Dr. Christison§ states, that he has tried the effects of seven-grain doses three times a day in phthisis, * See Stevens on the Blood, p. 296. London, 1832 ; and Pereira, Elements of Mat. Med. and Therap. 2d. edit. i. 514, Lond. 1842; or Amer. edit, by Dr. Carson, Philad. 1843. f Retrospect of Practical Medicine and Surgery, July to December, 1840, p. 275. X Rust's Magazin, B. xlvi. § Dispensatory, p. 73'J. Edinb. 1842. POTASS^ CHLORAS. 4S9 but could not observe any physiological or therapeutical action whatever. Sachs, in accordance with the views before mentioned, in re- gard to its antineuropathic properties, has advised it in cases of prosopalgia. He affirms, that, in a great many instances, it afford- ed essential relief. Chisholm appears to have been one of the earliest to prescribe it in neuralgia faciei ; and, after him, Her- ber, and subsequently, B. Schaffer, Jos. Frank, Meyer, and others, employed it both as a curative and palliative agent in that disease. It has likewise been advised in obstinate rheumatism of the nervous kind, by Knod von Helmenstreit ; and Eyr has extolled it in ulceration of the mouth after violent salivation. MODE OF ADMINISTERING. Sachs prescribed it in the dose of from three to six grains, three or four times a day, but some give it in much larger quantity. It may be administered either in the form of powder or of solution. It would appear, as Dr. Pereira has properly remarked,* that most of the uses of this salt have been founded on certain views of chemical pathology, some of which are now considered un- tenable. It passes through the kidneys unchanged, and conse- quently the notion, that it furnishes oxygen to the system must be discarded. From the results of the author's numerous trials with it, he is disposed to accord with Dr. Christison,t that no evidence has yet been published of such a nature as to entitle it to admission into the Pharmacopoeias : yet it is officinal in the London Pharmacopoeia. Palves p o t as sac c 111 or at i s compositns. Compound powder of chlorate ofpotassa. (S/evens's Saline Powder.) R. Potassm chlorat. gr. viij. Sodii chlorici. gx. xx. Soda bicarbonat. gr. xxx. M. One of these to be given every two or three hours in low febrile cases. Stevens. * [bid, p. 514. | Ibid. p. 738, Edinb. 1842. 490 potass^: CHLORAS. Liquor potasss chloratis. Solution of chlorate qfpotassa. Solutio Murialis Potassz Oxygenali, Liquor ad Ulcera Monica. R. Potassse chlorat. Jj. Aqusedestillat. f.5xij. M. To be applied to indolent ulcers, by means of lint dipped in it, or of a camel's hair pencil, to excite the tissues. Swed'iaur.* P otus pot assffi chloratis. Drink of chlorate ofpotassa. (Polus oxygenatus. — French. Tisane oxyg^nee.) R. Liquor, potass, chlorat. Oij. Aquae, Oiv. M. Given internally, in cases of general asthenia. Dose. — One or two pints a day. Swed'iaur. Mistura potassisc chloratis. Mixture of chlorate ofpotassa. R. Potassse chlorat. 5iss. Aqua? destill. f.5iv. Solve. Dose. — A spoonful, every two hours. Von Helmenstreit. Eyr dissolves twenty-five grains of the chlorate in four fluid ounces of distilled ivater, and administers a spoonful three times a day. R. Potass, chlorat. 3j. Aquae destillat. f-.^iv. Syrup althg?ffi, f.gj. M. Dose. — A table-spoonful, four times a day. Kohler. * Pharm. Med. Pract., Bruxelles, 1817, 2d edit. POTASSII BROMIDTTM. 491 CXVII. POTAS'SII BRO'MIDUM. Synonymes. Kalinm Bromatum, Bromuretum Potassicum, B. sen Brometum Kalii, B. Potassii, Bromide of Potassium. In Solution, Hydrobromate of Potassa, Potasss Hydrobromas, Kali Hydrobromicum, Bromhydras Po- French. Bromure de Potasse. German. Bromkalium, Kaliumbromid, Kaliumbromiire, Bromwasserstoffsau- res oder Hydrobromsaures Kali. METHOD OF PREPARING. According to Liebig, this preparation can be readily made by- dissolving bromine in alcohol, and adding caustic alkali until the spirit begins to change colour, then evaporating and heating to redness. In the London Pharmacopoeia, it is directed to be made by adding first an ounce of iron filings, and afterwards two ounces of bromine to a pint and a half of distilled water. The mixture is set aside for half an hour, and frequently stirred with a spatula: a gentle heat is then applied, and when a greenish colour is produced, two ounces and a dram of carbonate of potassa, dissolved in a pint and a half of water, are poured in : what remains is filtered and washed with two pints of boil- ing distilled water, and again filtered. The mixed solutions are then evaporated, that crystals may form. Liebig says it crystallises in four-sided shining tables : accord- ing to Balard,* commonly in tubes, and at times in long rectan- gular parallelopipedons. It has a pungent taste like that of com- mon salt but more acrid ; and is devoid of odour. By heat, it crepitates, and melts into a red hot flux, without experiencing change. It is more soluble in hot than in cold water ; producing, during its solution, evident cold, and becoming converted into hydrobromate of potassa. It is also soluble in alcohol, although in small quantity. The solution of bromide of potassium dissolves no more bromine than pure water. EFFECTS ON TIIE ECONOMY. Bromide of potassium excites the same phenomena as bromine, but with less intensity. From a dram and a half to two drams is needed to kill a dog. The animal appears to suffer j is restless, * Annales de Chimie, torn, xxxii. 492 POTASSII BROMIDUM. and gradually falls into a state of prostration. In smaller doses, it appears to act powerfully on the human stomach. The bro- mide, like bromine, seems first to have been applied to therapeu- tical purposes by Pourche.* Two cases of scrophulous tumours are reported by him to have been removed by friction with an ointment composed thereof, and a cataplasm sprinkled with an aqueous solution. In a third patient, chronic otorrhcea and scro- phulous tumefaction of the testicle yielded to the same agency, combined with the internal use of bromine. A very large goitre was reduced two-thirds by it. Pourche prescribed the bromide internally in the form of pill, in the dose of four to eight grains in the day. Magendiet employed the preparations of bromine ins crop hula, in amenorrhoea, and in hypertrophy of the ventricles of t he heart. Prieger recommended an ointment of" Kali bi^omicum" in inve- terate porrigo favosa as well as in obstinate and malignant tet- ter, and with good success ; and Dr. Williams! in cases of en- larged spleen. The last gentleman suggests, that it possesses " unusual, if not specific (?) powers in the cure of diseases of the spleen." It was owing to these results that the bromide was in- troduced into the London Pharmacopoeia, of 1836. § Dr. Williams also gave it with success in a case of ascites. MODE OF ADMINISTERING. Liquor pot assii bromidi. Solution of bromide of potassium. B. Potassii bromidi, gr. vi. — viij. — x. Aquae lactucae, f.^iij. Syrup altheea?, f.^i- M. To be given in the course of the twenty-four hours, in table- spoonfuls. Magendie. * Journ. de Chimie Medicale, iv. 594 ; see, also, Bulletin General de The- rapeutique, No. 14, Juillet 30, 1837. f Formulaire, Ed. cit. % Elements of Medicine, i. 338. § Pereira, Elements of Materia Medica and Therap. 2d edit. i. p. 499, Philad. 1842; or Amer. edit, by Dr. Carson, Philad. 1843; and Brande's Diet, of Mat. Med. p. 126. Lond. 1839. POTASSII CYANURETTJM. 493 Ungnentum potassii bromidi. Ointment of bromide of potassium. R. Adipis, 3j. Potass, bromid. gr. xxxiv. M. From half a dram to a dram to be rubbed on scrophulous swellings. Magendie. M. Pourche employs 3j. of the bromide to the ounce of lard. R. Axung. gj. Potassii bromid. gr. xxiv. Bromini liquid, gr. vi. ad xij. M. Magendie. CXVIII. POTAS'SII CYANURETUM. Svnonymes. Potassii Cyanidam, Kali Hydrocyanicum, Kalium Cyanogena- tum, Cyanuretum Potassicum seu Kalii, Cyanidum Kalii, Cyanetum Kalii, Hydrocyanas sea Cyanhydras Potassee seu Kalicus, Cyanide or Cyanuret of Potassium. French. Cyanure de Potassium. German. Cyankalium, Blaustoffkalium, Kaliumcyanure, Hydrocyansaures Kali. This preparation was proposed by MM. Robiquet and Viller- me,* as a substitute for hydrocyanic acid. It is, in their opinion, far more certain in its effects than that preparation. METHOD OF PREPARING. Cyanuret of potassium is formed whenever potassa is calcined with an animal matter, as in the preparation of the Prussian blue. It is commonly prepared, after the process of Robiquet, by exposing to long continued heat the ferruginous prussiate of potassa. The cyanuret of iron is completely decomposed, and that of the potassium remains. The residuum, after this strong calcination, constitutes a solid, blackish mass, which consists wholly of cyanuret of potassium, soiled by the iron and the char- coal belonging to the cyanuret of iron. The mass is dissolved in water, when the iron and charcoal are deposited ; whilst the * Bulletin de la Socfctt Medicale d'Kmulation, Juillet, 1823. See, also, Dr. James Hamilton and Mr. Thos. G. Mackenzie, in the Maryland Medical and Surgical Journal, Apl. 1810, p. 201. 42 494 POTASSII CYANURETUM. cyanuret of potassium dissolves, and is transformed into hydro- cyanate of potassa. When the process has been well conducted, the solution is perfectly colourless, and retains no portion of iron. M. Chevallier* considers this process to be impracticable, as the cyanuret decomposes water on coming in contact with it. The result, therefore, must be hydrocyanate of potassa; and, on heating this, all the hydrocyanic acid escapes, and the residue is merely potassa. He prepares the salt by calcining ferro- cyanuret of potassium, and then separating the cyanuret from the quadricarburet of iron by pure alcohol: on distilling this, the cyanuret is obtained very pure. Dr. Hamilton and Mr. Mackenzie, of Baltimore,! recommend the following process as most convenient and simple : — Expose, — say four ounces of the dried ferrocyanuret of potassium in a common Hessian crucible to a red heat, until nitrogen ceases to pass over ; (this generally takes from one and a half to two hours ;) then, breaking the crucible, powder the black mass quickly, and add — say sixteen fluid ounces of alcohol, stirring the mixture repeatedly, until it acquires the temperature of about 150° Fahr. ; then filter, and evaporate by a sand or water bath regulated so as to be below the boiling point of alcohol ; for if heated above this temperature, oil of wine is formed, which is gradually decomposed during the process, and carbon is de- posited, which blackens the mixture. The evaporation should be carried on so as to have as great an extent of surface exposed as possible. The ferrocyanuret will be found to have yielded six or seven drams of the cyanuret, which is dry, inodorous and perfectly white. The following process is directed in the last edition of the Pharmacopoeia of the United States (1842): — Take si ferrocya- nuret of potassium, in powder, 3viij.; Distilled water, f.^vj. Expose the ferrocyanuret to a moderate heat until it becomes nearly white, and is wholly deprived of its water of crystalliza- tion. Put the residue in an earthern retort, with the beak loosely stopped, and expose it to a red heat for two hours, or till gas ceases to be disengaged. Withdraw the retort from the fire, close the orifice with lute, and then let the whole remain until quite cold. Break the retort, remove the black mass, reduce it to coarse powder, introduce into a bottle of the capacity of twelve fluid ounces, and then add the distilled water. Agitate the mixture occasionally for half an hour, throw it on a filter, evapo- rate the filtered solution rapidly to dryness, and keep the dry mass in a closely stopped bottle. * Journ. de Chimie Medicale, and Journal of Phila. College of Pharmacy, 1832. } Op. cit. p. 203. POTASSII CYANURETTJM. 495 Pure cyanuret of potassium is white and transparent : it may- be fused in the fire without being decomposed, and keeps for an indefinite period, provided it be preserved dry. It is very soluble in water, but sparingly so in alcohol. All acids decom- pose it, even the carbonic : hence the solution, when exposed to the air, emits the smell of hydrocyanic acid ; and carbonate of potassa is formed, in the place of the hydrocyanate of potassa. It has a sharp, somewhat alkaline, and bitter almond taste, and an alkaline reaction. Its solution, when exposed to the air, ex- hales the odour of cyanohydric acid. EFFECTS ON THE ECONOMY, MM. Robiquet and Villerme performed some experiments on animals in the presence of Magendie.* A tenth of a grain de- stroyed a male linnet in a minute; less than a grain killed a guinea-pig in two or three minutes : a small drop of the hydro- cyanate of potassa, containing only the hundredth part of a grain of the cyanuret in solution, caused a linnet to drop down dead in half a minute. Half a dram containing five grains of the cya- nuret, killed a dog of large size in a quarter of an hour. Magendie proposes, that the cyanuret of potassium should be dissolved in eight times its weight of distilled water, when it be- comes transformed into hydrocyanate of potassa. To this solution, he gives the name medicinal hydrocyanate of potassa, and ad- vises that it should be given under the same circumstances, and in the same doses, as the medicinal hydrocyanic acid (see page 19 and 29). He farther suggests, that to render it wholly inde- pendent of the action of the small portion of alkali contained in the cyanuret, a few drops of some vegetable acid may be added, or it may be prescribed with an acid syrup. The dose of the cyanuret is a quarter of a grain at first, gra- dually increased to a grain and more. M. Bally gave it to fifty- two individuals labouring under different diseases ; it produced no effect on thirty-five ; and, on the others, the result was neither constant nor salutary, so that he is not inclined to place more reliance upon the cyanuret than upon the hydrocyanic acid. By Dr. Lombard,! of Geneva, it has been applied externally, with success, in some cases of facial neuralgia. He uses it by friction, in the form of watery solution, or of ointment, according to circumstances. The watery solution is in the strength of from one to four grains to the ounce of water; and the ointment is composed of from two to four grains of the cyanuret to an ounce * Formulaire pour la Preparation, &c. de plusieurs Nouveaux Mcdica- mens, &c. | Gazette des Hopitaux, and Lond. Med. Gaz. Sept. 1831. 4.96 POTASSII CYANTJRETUM. of lavd. The aqueous solution, however, is considered by Dr. Lombard to be the most prompt in its effects. He regards the cyanuret to be contraindicated, where the nervous affec- tion is complicated with inflammatory action. He has found it a useful remedy, also, in chronic rheumatism. In sciatic neuralgia, it was not successful. In white swelling, attended with acute pains, poultices moistened with the solution, gave great relief, Dr. Lombard, indeed, affirms, that the soothing properties of the cyanuret are superior to those of any remedy known. Lotions of hydrocyanic acid are not to be compared with it, — the acid being decomposed with facility, and not devoid of danger. In a case of acute rheumatism, attacking the articulations of a chlorotic young female, M. Malherbe,* after leeching, applied compresses over the joints affected, moistened with a solution of the cyanuret — ten grains to the ounce of distilled water. In forty-eight hours, the pains ceased. It is probable, however, that much of the good effect was owing to the compression. MM. Trousseau and Rulliert also recommend the cyanuret, in the proportion of four grains to an ounce of water, as a local application in various forms of neuralgia. M. AndralJ employed it with complete success in a case of intense cephalalgia, which, for ten months, had resisted the most powerful remedies, as bleeding, a seton in the neck, hlisters and sinapisms. It was used in solution, in the proportion of from six to eight grains to the ounce of distilled water ; and com- presses, wet with the solution, were applied, for eight days, to the forehead and temples. MODE OF ADMINISTERING. Mistura potassii cyanureti. Mixture of cyanuret of potassium. Mixture of hydrocyanate of potassa. Pectoral Mixture, of Magendie. R. Potass, hydrocyan. med. i.Q. Aquas destillat. Oj. Sacchar. siss. M. Dose. — About five drams(a table-spoonful), night and morning. * Journal des Connaissances Medico-Chirurgicales. f Lond. Med. and Surg. Journ, Dec. 15, 1832 ; and Amer. Journ. of the Med. Sciences, May, 1833, p. 238. \ Gazette Medicale, Jan. 1832. POTASSII CYANURETUM. 497 {Pectoral potion.) R. Potass, hydrocyan. med. gtt. xv. Infus. heder. terrestr. f.gij. Syrup, althaea, f.gj. M. Dose. — Five grammes (a tea-spoonful) every three hours. Magendie. R. Potassi cyanur. gr. \. Aquas lactucae, f§ij. Syrup, althffias, f.gj. M. Dose. — Five drams (a table-spoonful) every two hours. Magendie. R, Tinct. castor. Moschi, Potassse nitrat. aa. gr. iv.. Potassii cyanuret. gr. ij. Aquae flor. tiliae, sea Aquae cinnamom. f.jfviij. To be taken in the course of the twenty-four hours, in chorea. Fauquier. Syrnpns potassii cyanureti. Syrup of cyanuret of potassium. R. Potass, hydrocyanat. medic. f-5J. Syrupi, Oi. This syrup may be added to pectoral draughts, and may be substituted for other syrups. PilolaB potassii cyanureti. Pills of cyanuret of potassium.. R. Potassii cyanur. Amyli, aa. gr. iv. Syrup, q. s. ut fiat massa in pilulas viij. dividenda.. Dose. — A pill, night and morning, in convulsions, dys- pncea, &c. Hospital of La Pitie.* * Ryan's Formulary, 3d edit. p. 392. Lond. 1839. 42* 498 POTASSII IODIDUM. Lotio potassi cyanureti. Lotion of cyanuret of potassium. R. Potass, cyranuret. gr. xij. Mist, amygdal. f.3yj. M. To be used in lichen, and other chronic eruptions, attended with much itching. Louis. R. Potass, cyanur. gr. vj. Solve in Aquas destillat. £53. M. Compresses to be wetted with this and applied in cases of neuralgia faciei, hemicrania, &c. Recamier, Trousseau, Blouquier* Unguentum potassii cyanureti. Ointment of cyanuret of potassium. R. Potass, cyanur. gr. ij. — iv. Adipis, jfi. M. The size of a hazelnut to be rubbed in, in cases of neuralgia. Lombard. CXIX. POTASSII IO'DIDUM. Synonymes. Kalium Iodatum, Iodidum Kalii, Kali Hydroiodinicum, K. Hy- droiodicum,Hydroiodas Kalicus. H. Lixivise, Ioduretum Potassicum,Iodhydras Kalicus seu Potassee, Potassii loduretum, Iodide or Ioduret of Potassium. In solution — Potassae Hydriodas, Potassii Proto-hydriodas, Potassii Protoxidi Hydriodas, Hydroiodas Kalicus, H. Lixiviee, Iodhydras Kalicus seu Potassas, Hydriodate of Potassa. French. Hydriodate de Potasse, Iodure de Potasse. German. Iodkalium, Iodwasserstoffsaures Kali, Kaliumiodlire, Iodinwas serstorTKali, Hydriodsaures oder Hydriodinsaures Kali, Kalihydroiodat. METHOD OF PREPARING. According to TUnnermann, iodide of potassium is best pre- pared in the following manner: One part of pure iron filings, with four parts of iodine, is put * Lincke, Vollstandiges Recept-Taschenbuch,ii. i;l. Leipz. 1841. POTASSII IODIDUM. 499 into a glass vessel — by many, into a glass retort — and six or eight parts of water are poured thereon ; gentle warmth is then applied, and the mixture is frequently shaken until the liquid appears clear and almost colourless. In this way, hydriodate of protoxide of iron is formed, which is dissolved in the water. It is now filtered ; the residuum washed several times on the filter with distilled water, and under the application of a moderate heat, a concentrated solution oipotassa is added, by small portions at a time, until a precipitate is no longer thrown down. In this process, the potassium separates the iodine from the hydriodic acid ; the oxygen of the former unites with the hydrogen of the latter 5 protoxide of iron is precipitated, and carbonic acid given off, — heat being required for its entire disengagement, to pre- vent the formation of a carbonate of protoxide of iron with ex- cess of acid, which would be soluble in the water. It is then fil- tered, the residue washed on the filter with distilled water, and the liquid evaporated so as to form crystals. Those chemists or pharmaciens, who are not very accurate in their preparations, evaporate the mother waters to dryness, satisfying themselves, that although the saline residuum contains carbonated alkali, it may answer for external use; which is de- cidedly objectionable. To prevent the loss of the iodide, owing to its admixture with any carbonate of potassa, in the mother waters, Tunnermann finds it most advantageous to neutralise it with the hydriodic acid, which may be prepared in the following manner : Dissolve about one dram of iodine in not very strong alcohol, and pass a stream of sulphuretted hydrogen into the solution, until it is wholly deprived of colour. The hydrogen unites with the iodine, — the hydriodic acid, thus formed, remain- ing dissolved, whilst the sulphur is precipitated. The liquor is then filtered, the sulphur washed with a little tvater, and the spirit and superfluous sulphuretted hydrogen gas are driven off by heating in a glass vessel placed in a sand bath. The remaining fluid is diluted with water, filtered, and a warm alkaline ley added until litmus paper is only feebly reddened. By evaporation iodide of potassium is obtained, which, by repeated solution in water, evaporation of the solution, and filtration, is obtained entirely pure.* The process of Turner is, to take any quantity of the solution of caustic potassa, and to add to it gradually, at a gentle heat, iodine sufficient to neutralise the alkali ; then evaporating to dryness, calcining strongly, dissolving in water, and crystallising.! * Rienke, Die neuern Arzneimittel, S. 305. Stuttgart, 1837. j- Bache, in Wood and Bache'd Dispensatory of the United States, 4th edit. p. 1018, Philad. 1839. 500 POTASSII IODIDUM. Dr. William Gregory* suggested an improvement on the pro- cess of Turner, which has been regarded as one of the simplest.t It consists in adding iodine to a hot solution of potassa until the fluid assumes a yellowish-brown colour, then evaporating, and heating the residuum to low redness, in a platinum crucible. The mass, which at first consists of iodide of potassium and iodate of potassa, thus loses all its oxygen, and becomes convert- ed into iodide of potassium. The formula of CaillotandBaup is — to take ten parts of iodine and fifty of distilled water ; put them into a matrass, and add, in small successive portions, of pure iron filings, five parts, — sha- king the vessel each time. The liquor is then heated until it loses its colour, filtered, and the substance on the filter washed with boiling water, until the liquid is tasteless ; the liquor, and the vari- ous liquids used in the washings, are united, and the whole is heated in a sand bath. When the temperature approaches that of ebullition, enough of a solution of carbonate of potassa is added, to precipitate all the oxide of iron; it is then filtered, and the substance on the filter washed until it is completely exhaust- ed. All the liquors are then united, tested by reddened litmus paper, and if there be any excess of base, a little hydriodic acid is added. It is then evaporated in a sand bath, until a slight pel- licle forms ; the fire is now discontinued, and the salt is suffered to crystallise. Lastly, the crystals are washed with a little water, and dried. £ Iodide of potassium is in white or transparent crystals. These are readily fused, and are volatilised at a red heat. They do not decompose, even when heated with access of air. They are readily soluble in water, and in alcohol, and the addition of the iodide facilitates greatly the solution of the iodine. It would seem, that a slight contamination of iodide of potas- sium with carbonate of potassa is exceedingly common, as it can with difficulty be avoided in the manufacture of the salt ; but Dr. Christison§ affirms, that he has examined specimens, where the carbonate, with its accompanying water, amounted to 90 parts in the 100. "Can we wonder, then," he asks, "that practitioners should complain of the iodide of potassium, that they have given it for months, nay, even for years, without observing any effect * Edinb. Med. and Surg. Journ., xxxvi. 369, for Oct. 1831. \ Cogswell, on Iodine, p. 85. % Jourdan's Pharmacopee Universelle, i. 662. Paris, 1828; also the Lond. Pharmacopoeia, and Brande's Dictionary of Materia Medica, p. 317. Lond. 1839. This is essentially the process of the Pharmacopoeia of the United States (1842). § Edinb. Med. and Surg. Journal, April, 1838 ; and Dispensatory, p. 753, Edinb. 1842 ; also, Pereira, Elem. Mat. Med. and Therap. 2d. edit. i. 491, Lond. 1842 ; or Amer. edit, by Dr. Carson, Philad. 1842. POTASSII IODIDUM. 501 either on the constitution, or on the disease for which it was administered ?" EFFECTS ON THE ECONOMY. As respects the action of iodide of potassium, and its adminis- tration in disease, it is scarcely necessary to do more than refer to what has been said under the head of iodine. On the whole, its effects appear to accord with those of iodine ; at least, no dif- ference is perceptible on the organism. It has been supposed, that it is better than pure iodine, where the object is to act especially on the urinary organs.* For external use, iodide of potassium is usually preferred to iodine. It is constantly given internally, and often in combination with the latter ; the solu- bility of which, as was before remarked, is aided by it. Many of the subjoined formulae contain both one and the other. As re- marked under Iodine, it is now administered in very large doses in a multitude of diseases of different nature, and often, doubt- less, where it can render little or no service. Dr. Buchanan asserts, that he has given it in doses of gss.,and the only precaution he observed was to make the patient drink freely of diluents. It was chiefly to determine some physiologi- cal questions that he administered it in such large doses. Two drams of it were taken by a young man affected with gonorrhoea, and as soon as the medicine made its appearance in the urine, blood was drawn from the arm. On examining the blood, both the serum and crassamentum were found deeply impregnated with iodine.-j- On the other hand, Dr. Lawrie, of Glasgow,;}; considers it very uncertain and at times dangerous, although he esteems it by far the best of the recent remedies, and prescribes it more frequently than any other medicine ; and Mr. Mayo§ affirms, that no medicine, where it does good, produces amend- ment, in constitutional syphilis, so speedily as it. Lugol and others appear to have used it mainly as a solvent to iodine, and he considers it inferior to the latter as a therapeutical agent •, but no chemical or other prepossession can set aside the testimony just cited ; or that of such observers as Ricord,|| C. J. B. Wil- liams,1F Joy, and a host of others. In the Author's hands, it has * Riecke, Die neuern Arzneimittel, u. s. w. S. 306. See, also, Cogswell on Iodine, p. 96. t London Med. Gaz. July 2, 1836. j: Lond. Med. Gaz. July 3, 1810, p. 591. § A Treatise on Syphilis, by Herbert Mayo, F.R.S. Lond. 1840. || Practical Treatise on Venereal Diseases, translated by Druinmond, Amer. Edit. Philad. 1843. Parker, Modern Treatment of Syphilitic Diseases, Dunglison's Amer. Med. Lib. Edit. p. 77, Philad. 1810 ; and Bulletin General de Th<;rap. Juillet, 1840. If Lectures on the Physiology and Diseases of the Chest, Bell's Med. Library Edit. p. 246. Philadelphia, 1839. 502 POTASSII IODIDUM. appeared to afford as much benefit as any of the preparations of iodine. For the testimony in regard to its beneficial and in- jurious effects, see Iodine, page 37L Cases of salivation from its use has been published by Sir Francis W. Smith.* According to recent experiments of Magendie.t iodide of potassium is one of the substances that promote the coagulation of the blood. METHOD OF ADMINISTERING. liquor pot assii iodidi. Solution of iodide of potassium. Potio resolvens ex lodio, Solution de Coindet, Coindefs Solution. R. Potassii iodidi, gr. xxxvj. Aqua destillat, f.3j. Solve. Dose. — Same as that of the tincture of iodine. Coindet and Magendie. R. Potassii iodidi, 3j. Aquas destillat. f.Jj. Solve. Dose. — Fifteen drops three times a day, gradually increased to forty-five: in cases of ovarian dropsy, — frictions with iodine ointment being used at the same time. Elliotson. Liquor potassii iodidi compositus. Compound solution of iodide of potassium. (LugoPs Solution.) R. Iodin. 9j. Potassii iodid. ^ij. Aq. destillat. f-3 vij. Solve. Dr. BacheJ remarks, that "in the original it is seven ounces, but from the context of the author, this is evidently a misprint for seven * Dublin Journal of Medical Science, July, 1840, and Jan. 1841. | Lemons sur le Sang ; and Translation in Lancet, for Jan. 26, 1839, p. 636. % Dispensatory of the United States, 4th edit. p. 374, Philad. 1839. POTASSII IODIDUM. 503 drachms." It is proper, however, to observe, that many of the successful cases were treated by the weaker solution. Dose. — Six drops early in the morning, and in the middle of the day, in a glass of sugared water. In tetter, scirrhus, &c. Lugol. Lugol has a solution of three strengths for internal use : I. II. III. Iodin. gr. f gr- i- gr. U. Potass, iodid. gr. iss. gr. ii. gr. iiss. Aq. destillat. f.^viij. f.^viij. f.gviij. Dose. — Two-thirds, daily, at first ; afterwards, the whole. Lugol recommends this threefold solution in the same cases as his threefold solution of iodine ; the first being continued from fourteen days to three weeks ; the second, from the fourth or fifth week of the treatment to its termination ; the third, the strongest, he did not often use. As Riecke has observed, it would be better to have in the hospitals but one solution, which might be pre- scribed in varied doses. R. Iodin. gr. v. Potass, iodid. gr. x. Aquas destillat. f.^xx. M. Dose. — f.^ij. to f.5vj. London Pharmacopoeia. liquor iodini compositus. Compound solution of iodine. (LtigoPs Solution.) R. Iodin. 3vj. Potass, iodid. giss. Aqua: destillat. Oj. Dissolve the iodine and iodide of potassium in the wate Dose. — Ten to twenty drops, three times a day. Pharm. United States. 504 POTASSII IODIDUM. Tinctura iodini composita. Compound tincture of iodine. R. Iodin. gj. Potass, iodid. §ij. Alcohol. Oij. M. Dose. — Ten minims. Lond. and United States Pharmacopoeia. Mistttra potassii iodidi compositus. Compound mixture of iodide of potassium. R. Iodin. gr. ss. Potass, iodid. 3ss. Syrup, papav. f.sjss. Aq. destillat. Oss. Dose. — Two table-spoonfuls, three times a day ; in cases of complication of syphilis with scrophida. Tyrrel. R. Iodin. gr. iss. Potassii iodid. gr. iij. Solve in Aquae menth. pip. f.§iv. Dose. — A spoonful two or three times a day. To children, a tea-spoonful. In cases of cancrum oris ; also, in dropsy, gleet, and leucorrhoea. On renewing the prescription, the dose of the iodine may be increased one-half, and of the iodide one grain, each time. Coster and Friedrich. R. Potass, iodid. Jiv. Aquae lactucee, f.3 viij. menth. pip. f.3ij- Syrup, althaeee, f.§j. Dose. — A spoonful, morning and evening, in a little water, in- creasing the dose to two spoonfuls. In cases of hypertrophy of the ventricles of the heart. Magendie. POTASSII IODIDUM. 505 R. Potass, iodid. $iv. Aq. lactuc. f.Iviij. flor. naph. f.Jij. Tinct. digit, figj. ad f.Jij. Syr. althaea, f.giss. M. Dose. — Morning and evening, a spoonful, in a little water. In hypertrophy of the ventricles of the heart, with quickening of the heart's action. Magendie. R. Quassiae, Gentian, aa. Jj. Aquae bullient. f.^xvj. Macera per horam et cola. Liquor colat. add. Potass, iodid. gr. xxxvj. carbonat. Jij. M. Dose. — A table-spoonful, three times a day, in a glass of water. dimming. Pilnlae potassii iodidi. Pills of iodide of potassium. R. Potass, iodid. gr. xv. Aq. destillat. q. s. Spong. ust. Ext. dulcamar. aa. Jij. Glycyrr. rad. pulv. q. s. Fiant pilulae clxxx. Dose. — Six, two or three times a day, in scrophula, goitre, &c. Vogt. I ii •: ii i' n t ii 111 iodini compositum. Compound ointment of iodine. — loduretted ointment. R. Iodin. 588. Potass, iodid. 5J- Alcohol. f,5CJ. Adipis. 3 i j . Rub the iodine and iodide with the alcohol, and mix with the lard. Pharm. Lond. and United States. 43 506 POTASSII IODIDUM. Unguentum potassii iodidi, Ointment of iodide of potassium. R. Potass, iodid. ^ss. Adipis, §iss. M. Haifa dram at first, and subsequently, a whole dram to be rubbed in. In goitre, scrophnlous glandular affections, &c. This ointment is generally too weak, unless combined with the internal use of iodine in some form. Magendie. R. Potass, iodid. 9j. Adipis, 3ss. M. The wounded parts to be smeared with it two or three times a day: in moist tetter — serpigo. Between the applications, to be dressed with dry lint. Tunnermann. In dry tetter, the ointment applied is formed of 5j- to 3iss. of iodide to Jj. of lard. Unguentum potassii iodidi. Ointment ofhydriodic kali. — Ointment of iodide of potassium. (Unguentum kali hydroiodici. Pharmacop. Borussic.) R. Potass, iodid. 3j. Magnes. carb. gr. vj. Aq. destillat. guttas nonnullas, M. terendo cum, Ung. rosat. 3J. M. Or, R. Potass, iodid. Sodae carbon, depur. sice. aa. %$$. Ung. rosat. 5iv. ad ^v]. M. A piece, of the size of a small bean, to be rubbed in, morning and evening. In chronic enlargement of the testis. Walt her. Messrs. T. and H. Smith,* of Edinburgh, having found it im- practicable to make a neat ointment of iodide of potassium by * Lond. and Edinb. Monthly Journ. of Med. Science, Oct. 1841. POTASSII IODIDUM. 507 the ordinary method, have recommended the following : Dissolve the requisite quantity of iodide in its own weight of distilled or some perfumed water, and then mix thoroughly in a mortar with the proper quantity of lard. The two will incorporate per- fectly with a very little heating, and form a smooth ointment. R. Potass, iodid. Jss. Ext. opii. 9ss. Cerat. gji M. As a dressing to malignant cancerous ulcers. Unguentnm potassii iodidi compositum. Compound ointment of iodide of potassium. R. Iodin. gr. xij. Potass, iodid. £)iv. Adipis, gij. M. In scrophulous ophthalmia, ulcers, &c. Lugol. R. Iodin. gr. xv. Potass, iodid. 3j. Tinct. opii, f.^ij. Adipis, §ij. M. In painful scrophulous ulcers, white swellings, &c. Lugol. R. Potassii iodid. gr. xij. — xv. Ung. hydrarg. ciner. ^ss. M. In herpes exedens. Blasius. Emplastrum potassii iodidi compositum. Compound plaster of iodide of potassium. R. Iodin. Potass, iodid. aa. ^ss. ad 9j. Emplastr. hydrarg. seu saponis. ^'j* Applied in syphilitic and gouty swelli?igs of the bones. Ebers. 508 POTASSII IODIDTJM. Linimentum potassi iodidi. Liniment of iodide of potassium. (Baume hydriodate.) R. Potassii iodid. §j. Alcohol. (20°) f.giv. M. R. Sapon. ex oleo animal, confect. 3*iss. Alcohol. (20°) f.giv. M. Mix these two solutions together; aromatise with a small quantity of oil of lavender, and before the mixture congeals, pour it into wide-mouthed vials.* This liniment has been much used at Lausanne under the name Gelee pour le goitre. Lotio potassii iodidi composita. Compound lotion of iodide of potassium. Solve in R. lodin. gr. i. ad ij. Potassii iodid. gr. ij. ad iv. Aquse destillat. f.5viij. This solution was commonly used by Lugol externally, to be injected under the eyelids in strumous ophthalmia, fistulse, &c. Lugol. R. Iodin. §ss. Potassii iodidi, 3j. Solve in Aq. destillat. f-o^j. This "rubefacient solution of iodine" may be used two or three times a week, when the last prescription loses its effect, or when it is desirable to stimulate more actively. It is also added, to baths — three or four ounces to any ordinary bath — as well as to poultices, being mixed with an ordinary cataplasm. Lugol. * F. Boudet, Journal de Pharmacie, Avril, 1842, p. 335 ; and A. Duhamel, in Araer. Journal of Pharmacy, July, 1842, p. 102. Solve in POTASSII HYDRARGYRO-IODIDUM. 509 R. Iodin. gj. Potass, iodid. gij. Aquae destillat. f.gij. This "caustic iodine solution" may be used when the last .oses its efficacy. It occasions a crust on the parts. Lugol em- ploys it chiefly when the skin on the edges of the ulcers is greatly hypertrophied, red, and fungous, as well as in phagede- nic or spreading tetters. It may be applied two or three times a week, or daily, should the case require it. Lugol. Collyrinm pot as si i iodidi compositum. Compound colly 'Hum of iodide of potassium. Solve in R. Iodin. gr. ss. ad i. Potassi iodid. £)ss. Aq. rosse, f^iij. M. To be applied four times a day, in cases of scrophulous oph- thalmia, with ulceration of the conjunctiva and cornea. Magendie. CXX. POTAS'SII HYDRAR'GYRO-IO'DIDUM. Synonvmes. Potassii Iodo-Hydrargyras, Kali Iodatum Hydrargyratum,Iodo- Hydrargyrate of Potassium, Iodhydrargyrate of Ioduret of Potassium, Hy- drargyro-iodide of potassium, Hydrargyro-biniodide of Potassium, Di- hydrargyro-biniodide of Potassium. Dr. A. Channing,* who has highly extolled this preparation in various diseases, affirms, that this, with other new salts, was dis- covered by Bonsdorff, of the University of Finland, in 1S26; and it is a fact well known to the chemist, that iodine, chlorine, &c, enter into combinations so as to form both acids and By experiment, Dr. Channing ascertained, that a solution of eight grains of pure iodide of potassium in ten or fifteen minims of water, would combine with a fraction less than eleven Grains * American Journal of the Medical Sciences, Feb. 1834, p. 388. 43* 510 POTASSII HYDRARGYR0-I0DIDTJM. of red iodide of mercury , and maintain the combination in solu- tion, when diluted with water or alcohol to any extent. If more than eleven grains of the red iodide be added, although a small excess may be dissolved in the concentrated solution, on diluting with water, it is promptly precipitated. It would appear, therefore, as Dr. Charming has remarked, that in preparing this salt for ad- ministration, the labour of crystallising it, in order to obtain a solution of a definite strength, is wholly unnecessary ; inasmuch as a solution, combining a fraction more than eight grains of the iodide of potassium with eleven grains of the iodide of mercury, may be used as containing twenty grains of the hydrargyro- iodide of potassium. If it be desirable to obtain the preparation in a crystallised form, it is important, that the definite proportions of the two iodides should be observed, and particularly, that there be no excess of iodide of mercury ; for the saturated solution of eight grains of iodide of potassium will dissolve, and enter into com- bination with, more than thirteen grains of iodide of mercury, forming similar crystals soluble in alcohol, but in water precipi- tating more than two grains of iodide of mercury. This double salt may, also, be formed by dissolving one equiva- lent of bichloride or of per 'nitrate of mercury in a solution of four equivalents of iodide of potassium , evaporating to dryness, and dissolving the double iodide from the chlorohydrate or nitrate of potassa by means of alcohol. When made from the pernitrate of mercury, it is liable, however, to contain nitre, which may be detected by its insolubility in strong alcohol* EFFECTS ON THE ECONOMY. These are similar to those of the iodides of mercury, but, ac- cording to Dr. Channing, in a less degree. The hydrargyro- iodide is not, however much employed, experience seeming to have shown, that it possesses no essential, if, indeed, any advan- tages over those preparations. It has been highly extolled by Dr. Charles C. Hildreth,* of Zanesville, Ohio, in several diseases, in which a combi- nation of iodine and mercury might be expected to be benefi- cial. In ordinary dyspepsia, his faith in its remedial powers is so strong that he had prescribed but little else for the previous four or five years. He speaks highly of it, also, in enlargement of the spleen, amenorrhcea, dysfnenorrhcea, leucorrhoea, dropsy, and glandular enlargements of a scrophulous character. In these * Ambrose Smith, Amer. Journ. of Pharm. Jan. 1841, p. 271. | American Journal of the Medical Sciences, Aug. 1840, p. 314. POTASSII HYDRARGYRO-IODIDUM. 511 last cases, he combines the internal use with the external, accord- ing to the form of ointment given below. Puche* has recommended it as not being so subject to produce salivation, or pains in the bones, as the other combinations of mercury and iodine. METHOD OP ADMINISTERING. Mistura pot assii kydrargyro-iodidi. Mixture of hydrar gyro-iodide of potassium. R. Hydrarg. iodid. rubr. gr. iv. Potassii iodid. £)j. Aquse destillat. f.^j. M. Dose. — Five drops, three times a day . Channing. R. Hydrargyri iodid. rubr. Potassii iodid. aa. gr. iv. Aquae, f.Ji. Solve. The dose of this is from two to six drops, equivalent to from about the thirteenth to the twelfth of a grain of the double salt.t Tinctura potassii hydrargyro-iodidi. Tincture of hydrargyro-iodide of potassium. R. Potass, hydrargyro-iodid. gr. j. Alcohol, dilut. f.3j. M. Dose. — Ten drops, three times a day. Channing. Pilulac potassii hydrargyro-iodidi. Pills of hydrargyro-iodide of potassium. R. Hydrarg. iodid. rubr. gr. viij. Potassii iodid. gr. viij. JSacchar. lact. gr. lxiv. Mucil. acac. q, s. ut fiant piluloe xxxij. Dose. — One to eight, daily. Puche. ♦Journal des Connaissances Mcdicales, Oct. et Nov. 1838, and Janvier, 1839 ; and Annales de Chimie, Oct. 1838. f Ambrose Smith, Amer. Journ. of Pharmacy, Jan. 1841, p. 270. 512 QUINIA. Liqno'r potassii hy drargyro -iodidi. Solution of hydrargyro-iodide ofpotassi inn. R. Hydrarg. iodid. rubr. gr. viij. Potassii iodid. gr. viij. AquEe destillat. f.3viij. M. Dose. — f.3ij. to f.gij. in twenty-four hours. Puche. Unguentum potassii liydrargyro-iodidi. Ointment of hydrargyro-iodide of potassium. R. Hydrarg. iodid. rubr. gr. vij. Potass, iodid. ^ij. Adipis ^j. M. To be applied to tumours, two or three times a day. Should it prove too irritating, the proportion of lard must be increased. Hildreth. QUINIA ET EJUS SALES. Synonyme. Quinia and its salts. CXXI. QUINIA. Synonymes Quinina, Quina, Quininum, Qninium, Chininum, Chininium, Chinium, Kininum, Sal Essentiale Corticis Peruvian!. French. Quinine, Kinine. German. Chinin, Quinin, Chinastoff. Quinia is a most important gift from modern analytical chemis- try to medicine. Not many years have elapsed since the dis- covery of this substance, and yet, by general consent, it is now regarded as one of the most valuable remedies in the catalogues of the materia medica. The honour of the discovery — which had been facilitated by the investigations of other chemists, as to the composition of the cinchona barks — belongs to Pelletier and Caventou, (1820,*) and so rapidly and extensively was its efficacy * Annales de Chimie et de Physique, xv. 289 and 337. QUINIA. 513 promulgated, that in the year 1826, in two laboratories in Paris for the preparation of quinia, fifty-nine thousand ounces of the sulphate — the form best known, and most frequently prescribed — were prepared. For this discovery, the Royal Academy of Sciences of Paris awarded MM. Pelletier and Caventou the Mon- thyon prize of ten thousand francs. It would appear from the observations of Henry and Plisson, that cinchonia and quinia exist in cinchona bark in combination with kinic acid and also with red cinchonic, which is an insoluble red colouring matter.* Quinia is obtained from yellow bark by a similar process to the one described for the separation of cinchonia.t In the pure state, it is of a white colour, and appears commonly in the form of powder ; it crystallises, however, in silky, shining, tufted needles. In both cases, it contains from three to four per cent. of water. By a gentle heat, this escapes, and the quinia melts into a transparent fluid, which, on cooling, is translucent, and similar to a resin. When melted in vacuo, it has a crystalline appearance. In a strong heat, it is decomposed. It has a very bitter taste, and is soluble in 200 parts of boiling water ; a por- tion being precipitated on cooling. It requires a much larger proportion of cold water to dissolve it. In alcohol, it is far more soluble than in water. It is, likewise, soluble in ether, and some- what so in oils. It exhibits an alkaline reaction, — restoring the colour of reddened litmus paper, and neutralising the acids. The observations of Piorry and LavolleeJ and of Quevenne,§ show, that quinia, as well as its sulphate, passes into the urine of patients who use it in any considerable quantity. EFFECTS ON THE ECONOMY. Of the effects of quinia we shall speak at some length, under the head of sulphate of quinia with which it seems to accord entirely in medicinal agency. Several physicians, who have ex- perimented in regard to the efficacy of pure quinia and its salts, have found the first in no respect inferior to the last. Such was the experience of Niewenhuis and Elliotson, the latter of whom exhibited quinia in large doses — as much as five grains every four hours. A French physician, Blegnie,|| even gives the pre- * Journ. de Pharmacie, xiii. 2G9 and 3G9, and Pereira, Elem. Mat. Med. and Therap. ii. 1397, Lond. 1842; or Amer. edit, by Dr. Carson, Philad. 1843. f See page 167. % Gazette Mcdicale, 1836, p. 73. § L'Experience, Juillet, 1838. || Riecke, Die neuern Arzneirnittel, S. 118. See, also, Bally, in Magendie's Journal de Physiologie, ii. 23G. 514 QUINI-E ACETAS. ference to pure quinia — because it possesses, he thinks, equal efficacy, is cheaper, easier taken, and better borne than the sul- phate. He advises, that after each dose an acidulous drink should be taken, to render its solution in the stomach more rapid. Wntzer* and Harlest have also recommended the more frequent use of pure quinia. It may be given either in the form of powder or pill, or in alcoholic solut.on. Tine t lira quinia?. Tincture of quinia. R. Quinia?, 3j. Solve in Alcohol. f.Sss. Dose. — Twenty to forty drops every two hours. Wutzer. CXXII. QUI'NLE ACE'TAS. Synonymes. Quinina? acetas, Chinium Aceticum, Chininum Aceticum, Acetas Chinii, Acetas Chinini, Acetas Chinicus seu Quinicus, A. Quinia?., A. Quiixe, A. Quinini, A. Quinii, A. Kinini, Quina Acetica, Acetate of Quinia or Quinine. French. Acetate de Quinine. German. Essigsaures Chinin. This preparation is not much employed. It is prepared by saturating quinia with concentrated acetic acid diluted with water, and evaporating the neutral solution, by gentle heat, to crystallisation. It appears in the form of very delicate, needle-shaped, snow- white, satiny, and shining crystals ; tastes very bitter ; and is with difficulty soluble in cold water, but readily so in hot. Wutzer and SundelinJ assert, that it acts like the other of quinia, but merits no preference. * Isis,p. 441, 1829. t Heidelberg klinisch. Annalen, B. v. H. 4, S. 573. t Isis, p. 441, 1829 ; also, Heidelb. klinisch. Annal. B. v. H. 4. 575. QUINIiE CITRAS. 515 CXXIII. QUI'NI^ CITRAS. Synonymes. Quininae Citras, Quinini Citras, Quinize vel Quinaevel Quinii vel Chinini vel Kinini Citras, Citras Chinii seu Chinicus seu Quinicus, Chinium Citricum, Chininum Citricum, Quina Citrica, Citrate of Quinia or Quinine. French. Citrate de Quinine. German. Zitronsaures Chinin, Citronsaures Chinin. MODE OF PREPARING. This preparation is formed, like the acetate, from an aqueous solution of citric acid, and pure quinia ; or by the decomposition of a hot solution of sulphate of quinia, by means of an acid citrate of soda.* It forms needle-shaped prisms, of a white colour, which are by no means readily soluble in water. EFFECTS ON THE ECONOMY. The acetate and the citrate of quinia have been highly esteem- ed ; and are adapted for those excitable persons with whom the sulphate does not seem to agree. The citrate has been prescribed by many Italian- physicians, and found to be very efficacious.! Magendie considers it, when it contains an excess of acid, advisa- ble for those cases, where the union of a tonic with an antiseptic property is indicated. He considers, that the following syrup may be substituted, in certain cases, for the syrupus antiscorbu- ticus, which is directed by the Codex Medicament arius of Paris to be prepared in the following manner: — Take of the fresh leaves of cochlearia, ivater trefoil, cress, horseradish, and bitter oranges, cut, of each one pound; cinnamon, an ounce and a half, white wine, four pints. Macerate for two days in a tin cucurbit, covered with a well luted capital. Distil, in a sand- bath, a pint of fluid ; to which add two pounds of white sugar, and make into a syrup. Pass through a cloth, without straining, what remains in the cucurbit; let the liquor rest; decant and boil to the consistence of syrup, with two pounds of white sugar. When cold, clarify and mix with the other. * Guleani, in Annali Universali di Medicina, Luglrrj, 1832, and Heidelb. Klinish. Annal. B. x. If. i. 8.34. Heidelb. 1831. f Beraudi, in Bulletin General de Therapeutitjue. Nov. 1838. 516 QTJINI.E FERROCYANURETUM. Syrnpus quiniae citratis. Syrup of citrate ofquinia. R. Syrup. Oi. Quiniae acetat. acid. gr. xxxvj. M. Dose. — Two spoonfuls, in the twenty-four hours. CXXIV. QUI'NIiE FERROCYANURETUM. Synonymes. QuininseFerrocyanas, Chinium Ferrocyanogenatum, Ch.Ferro- hydrocyanicum, Ferrocyanas Chinii, &c, Ferrocyanate or Hydrocyanofer- rate of Quinia or Quinine. French. Ferrocyanure de Quinine. German. Eisenblaures Chinin. METHOD OF PREPARING. This is obtained by the decomposition of sulphate of quinia by means of a solution of the ferrocyannret of potassium ; after which the impure salt is treated with warm alcohol, and the clear solution is evaporated.* It forms needle-shaped, confused crystals, of a greenish-yellow colour, and very bitter taste, recalling that of hydrocyanic acid. It dissolves readily in spirit of wine, not so in water ; and is decomposed by hot water. EFFECTS ON THE ECONOMY. In this combination, the antifebrile properties of the quinia are said to be even superior to those of the other preparations ; yet the remedy has not got into much use. It has been employed mainly by a few of the French practitioners. Ceriolit and Zac- charelli, Italian physicians, speak in high terms of its efficacy in periodical diseases, even where the sulphate has failed. Cerioli * See Bertozzi's Method, in Journal de Pharmacie, xix. 45, and Philad. Journ. of Pharmacy, vol. 2, new series, p. 82. Philad. 1837. See, also, Mr. Donovan, in Dublin Journ. of Med. Sciences, July, 1840, p. 440. f Annali Universali di Medicina, Luglio, 1832, and Archives Generales de Medecine, Dec. 1832. QTjINI-E MURIAS. 517 gave it in the dose of from two to eight grains, in the day; and G-ouzee* gives the history of three cases completely cured by the administration of a single grain, half an hour before the paroxysm. MODE OF ADMINISTERING. The following formulae have been recommended : Haustus quiniffi ferrocyanureti. Draught offerrocyanuret of quinia. R. Quinise ferrocyanur. gr. iv. Alcohol. f.Jj. Solve et adde Aquae camphor, f . 5 v i j . M. et fiat haustus. To be taken as occasion may require, first shaking the vial. Donovan.^ PilulflB quiniaB ferrocyanureti. Pills of ferrocyanur et of quinia. R. Quinise ferrocyanur. gr. xxiv. Mucilag. acacis, q. s. flat massa in pilulas xij. dividenda. Two for a dose. Donovan. CXXV. QUI'NIiE MU'RIAS. Synonymks. Quinina; Murias, Chinium Muriaticum, Ch. Salitum seu Hydro- chloricurn, Ilydrochloras seu Murias Chiiiii, H. Chinicus seu Quinicus, (Jhlorhydras Quinicus, Muriate of Quinia or Quinine. French. Muriate de Quinine. German. SalzsaoreB Cliinin, Hydroclilorsaures Chinin. Perhaps, next to sulphate of quinia, this salt has most fre- quently been employed in practice. * Observateur Medical Beige, Jan. 1834. f Op. citat. 44 518 QUINIJE NITRAS. METHOD OF PREPARING. It is obtained by dissolving pure quinia in dilute muriatic acid, or by the decomposition of sulphate of quinia dissolved in ivarm water, by means of a solution of chloride of barium, which is added so long as a white precipitate is thrown down ; the hot mixture is then filtered ; the precipitate is washed, and the clear fluid evaporated, by a gentle heat, to crystallisation, so long as crystals shoot on cooling; these are collected, washed in cold water, and purified by repeated crystallisation. It forms fine, needle-shaped, white silky crystals, of a mother- of-pearl lustre ; does not dissolve readily in water, but more so than the sulphate. EFFECTS ON THE ECONOMY. In this respect, the muriate agrees with the sulphate of quinia, and by those of weak digestive powers is borne better. Spiel- man* asserts, that it is a more speedy and effectual remedy for intermittent fever than the sulphate, and it is more soluble. It is, however, more expensive. The dose is generally considered to be the same as that of the sulphate. It is better given in solu- tion than in powder. Spielman rates the dose at from half a grain to a grain. CXXVI. QUI'NLE NITRAS. Synonymes. Quininae Nitras, Chinium seu Chininum Nitricum, Nitras Chinii, &c. Nitrate of Quinia or Quinine. French. Nitrate de Quinine. German. Saltpetresaures Chinin. METHOD OF PREPARING. This salt is obtained like the muriate, by the addition of nitric acid to quinia ; or by the decomposition of nitrate of baryta by sulphate of quinia. It is, at first, a fluid oil-like mass, which gradually becomes * Allgemein. medicinisch. Zeitung, and Journal des Connais. Medic. Fev- rier, 1836 : see, also, Prof. Dierbach, in Heidelb. klinish. Annal. B. x. H. i. S. 33. Heidelb. 1834. QUINLE SULPHAS. 519 solid. In union with water it forms crystals. It dissolves with difficulty in water, but readily in alcohol. CXXVII. QUI'NIJE PHOSPHAS. Synonymes. Qninins Phosphas, Chinium seu Chininum Phosphoricum, Phosphas Chinii, Ph. Cbinini, Phosphate of Quinia or Quinine. French. Phosphate de Quinine. German. Phosphorsaures Chinin. METHOD OF PREPARING. In mode of preparation, it accords with the preceding forms ; dilute phosphoric acid being added to quinia, or phosphate of baryta to sulphate of quinia .* It appears in the form of needle-shaped prisms, of a mother-of- pearl lustre, which are, like the muriate of quinia, readily solu- ble in water, and spirit of wine. Harles,t however, affirms, that in the neutral condition it dissolves, with difficulty, in water. The phosphate is regarded by some to stand next to the sul- phate in medicinal efficacy. CXXVIII. QUI'NIJE SULPHAS. Synonymes. Quininae Sulphas, Quince Disulphas, Q. Sulphas, Chinium seu Chininum Sulphuricum, Sulphas Chinii, Sulphas Quinicus, Sulphate of Quinia or Quinine. French. Sulfate de Quinine. German. Schwfelsaures Chinin, Chininsulphat. This preparation of quinia is by far the most frequently ad- ministered. It is in fine, silky, flexible needles, and at times in rectangular columns. Its taste is extremely bitter, and resem- bles that of yellow bark. Exposed to a moderate heat, it loses its crystalline form, in consequence of the escape of its water * Winkler, in Biichner's Itepert. and Phila. Journ. of Pharmacy, new series, vol. 2, p. 12. Phila. 1837. f Heidelb. klinisch. Annal. B. x. H.i. S. 36. Heidelb. 1831 ; and Journal de Chimie Medicale, 1837. 520 QUININE SULPHAS. of crystallization. It is only slightly soluble in cold water, requiring 740 parts at the ordinary temperature, and 30 parts of boiling water for its solution. In alcohol, it is very soluble, but only slightly so in ether. With sulphuric acid, it forms a supersulphate, which is much more soluble in water than the neutral salt, and hence we usually add a few drops of dilute sulphuric acid to our mixtures of sulphate of quinia. METHOD OF PREPARING. This salt is generally prepared on a large scale in the chemi- chal laboratories of France; whence we obtain it. A formula was admitted, however, into the Pharmacopoeia of the United States (1830), which was taken from the process of M. Henry, Junr.,* for which he received a prize from the Academic Royale des Sciences, of Paris. It is as follows : — Take of Yellow bark, in powder, a pound ; Lime, in powder, four ounces ; Sulphuric acid, Alcohol, Animal charcoal, Distilled water, each a sufficient quantity. Boil the bark for half an hour with eight pints of the distilled' water, acidulated with a fluid ounce of the sulphuric acid. Strain the decoction through linen : then boil the residue with the same quantity of acidulated water, and filter as before. Mix the filtered liquors, and, gradually add the lime, stirring constantly. Wash the precipitate with distilled water, and hav- ing dried it digest in alcohol with a moderate heat. Pour off the tincture, and repeat the digestion several times, till the alco- hol is no longer rendered bitter. Mix the tincture, and distil over the alcohol, till a brown viscid liquid remains in the retort. Upon this substance, removed from the retort, pour as much sulphuric acid, largely diluted with water, as may be sufficient for its perfect saturation. Then add the animal charcoal, and having evaporated the liquor sufficiently, filter while hot, and set it aside to crystallise. In the last edition (1842), the form has been modified as fol- lows : — Take of Yellow bark, in coarse powder, fhiv. ; Muriatic acid, f.ghj.; Lime, in powder, 5v. ; Water, five gallons; Sul- phuric acid) Alcohol, Animal charcoal, each a sufficient quan- tity. Boil the bark in one-third of the water mixed with one- third of the muriatic acid, and strain through linen. Boil the resi- due twice successively with the same quantity of water and acid as before, and strain. Mix the decoction, and, while the liquor is hot, gradually add the lime, previously mixed with two pints of water, stirring constantly, until the quinia is completely precipitated. Wash the precipitate with distilled water, and, * Journal de Pharraacie, vii. 296. Juillet, 1821. QUINI-E SULPHAS. 521 having pressed and dried it, digest it in boiling alcohol. Pour off the liquor, and repeat the digestion several times, until the al- cohol is no longer rendered bitter. Mix the liquors, and distil off the alcohol, until a brown viscid mass remains. Upon this sub- stance, removed from the vessel, pour about half a gallon of dis- tilled water, and, having heated the mixture to the boiling point, add as much sulphuric acid as maybe necessary to dissolve the impure alkali. Then add an ounce and a half of animal char- coal, boil for two minutes, filter the liquor while hot, and set it aside to crystallize. Should the liquor, before filtration, be en- tirely neutral, acidulate it very slightly with sulphuric acid; should it, on the contrary, change the colour of litmus paper to a bright red, add more animal charcoal. Separate the crystals from the liquor, dissolve them in boiling water slightly acidu- lated with sulphuric acid; add a little animal charcoal, filter and set aside to crystallize; wrap the crystals in a bibulous paper, and dry them with a gentle heat. The mother water may be made to yield an additional quantity of sulphate of quinia by precipitating the quinia with solution of ammonia, and treat- ing the precipitated alkali with water, sulphuric acid, and ani- mal charcoal as before.* It results from the calculations of Pelletier and Caventou, that from a quintal of cinchona, two pounds, one dram and thirty grains of sulphate of quinia may be obtained, which makes two drams, sixty-six grains and a sixth per pound, or thirteen grains and two-sixths per ounce; and as the sulphate is composed of nine parts and nine-tenths of sulphuric acid to ninety and a tenth of quinia, it follows that if the dose of cinchona in substance be two drams, we should administer to the patient three grains and nine thirty secondths of a grain of sulphate of quinia ; not taking into account a small quantity of sulphate of cinchonia, which maybe mixed with it. Four grains of the salt are, consequently, more than an equivalent for the dose of the cinchona often pre- scribed in substance. Those practitioners, therefore, who pre- scribe thirty-:^ix or seventy-two grains of the sulphate, give the representative of about twenty-seven drains of cinchona in the former case, and of fifty-four in the latter.t Sulphate of quinia is liable to be adulterated, — for example, by mannite, which is similar in external appearance, but — as elsewhere shown — destitute of all its properties. The adul- teration can be readily detected by means of pure alcohol, which dissolves the quinia alone, but leaves the mannite untouched, which is freely soluble in water, and is known by its character- istic sweet taste. It is also adulterated with gypsum, the pre- ♦ Pharm. of the United Stains, p. 174, Phila. 1842. | Jourdan, Plr.irmacopee Universelle, ii. 375. Paris, 1828, 44* 522 QUINIA SULPHAS. sence of which may likewise be detected by the alcohol, which does not dissolve it.* The quantity of sulphate of quinia prepared is very great. In this country, it was formerly obtained altogether from France, but the Author has been informed, that from 6000 to S000 ounces are annually made by one firm in the city of Philadelphia.! EFFECTS ON THE ECONOMY. The effects of the preparations of quinia on the healthy organ- ism have not been much investigated. According to Caventou, they produce a general excitement, similar to that caused by coffee, and Wittmann affirms, that the sulphate induces an ex- citement similar to that of a paroxysm of fever. Hirschel.i too, asserts, that in a child, four years of age, to whom the sulphate was given in a case of intermittent, a general chilliness of some minutes' duration supervened immediately on taking the remedy, succeeded, in the course of half an hour, by general heat, and this again by a gentle perspiration, in all respects resembling a mild attack of fever. The excitant action of the salts of quinia formed by the vege- table acids is said to be less striking. Sulphate of quinia, in large doses, appears, in some cases, to possess narcotic properties, yet it can scarcely be classed amongst poisons, as it has been given to healthy individuals in very large doses, without any unpleasant effects. Bally,§ for instance, gave u to the extent of 110 grains in the day without any inconveni- ence. Dr. Thomas Fearn,|| who administered it largely, regards it to be more narcotic than sedative, — usually, he thinks, stimu- lating in small doses, but in large doses the stimulant effects not being obvious, but rather the reverse ; and such appears to be the view of Dr. A. Flint.! When Mr. Scott,** a medical gentleman and a martyr to dys- pepsia, took quinia in very large doses, under the idea that his malady was intermittent neuralgia, he found several singular phenomena induced thereby. He was directed to commence with two grains three times a day, until he arrived at twenty * Vallet and Dubail, Journal de Pharmacie, Janvier, 1840. f See his General Therapeutics and Materia Medica, vol. 2, p. 80, Philad. 1843. X Hufeland's Journal. B. lxi. St. 6. S. 140. § Revue Medicale, v. 244. Juillet, 1821. || Transylvania Journal of Medicine, Oct., Nov., and Dec. 1836, p. 798, and Dunglison's Amer. Med. Intell. June 15, 1837, p. 109. % Amer. Journ. of Medical Sciences, Oct. 1841, p. 277. ** Lond. Med. and Physical Journal, March, 1833. QUINI-E SULPHAS. 523 grains for a dose, that is, a dram a day. Until the doses were increased to fourteen or sixteen grains, he did not experience any peculiar effects, but he now began to feel heat of skin, dry- ness of mouth and fauces, and obstinate constipation. He like- wise lost the power of naming substantives ; was obliged for a long while to consider what familiar things were called, and was unable to cast up a line of six or eight figures correctly. His perceptions of quantity were likewise impaired, so that in prescriptions he wrote ounces for drams, drams for grains, &c, &c. He still, however, persevered with the quinia, until he took 9j. four times a day, but he was unable to continue these exces- sive doses long, the untoward symptoms augmenting, so that he was often unable to stand, and fell several times in the street. Very similar results to those observed by Mr. Scott, and espe- cially as regards the inability of utterance — which, in their cases, was complete — are recorded by M. Menage,* and Mr. G. 0. Heming.t Cases of deafness caused by large doses have been lately de- tailed by Dr. Joseph Williams, of London,t by Mr. C. R. Bree,§ of Stow-market, England ; by M. Fr. Lugeol, of Havana,|| and by Prof. Giacomoni.lT MM. Trousseau and Pidoux** refer to the case of a soldier who took 48 grains of the sulphate for the cure of spasmodic asthma, which returned daily at a certain hour. Four hours after taking it, he experienced buzzing in the ears, diminished sensibility, giddiness, and violent vomiting. Seven hours after taking it, he was blind and deaf, delirious, incapable of walking by reason of the giddiness, and vomited bile copiously. He was, in fact, in a state of intoxication. The symptoms gradually subsided. In impressible individuals, the sulphate and the muriate — even in moderate doses — not unfrequently induce a sense of anxiety, restlessness, vertigo, confusion, depravation of vision, tinnitus aurium, and, in many cases, transient deafness, all which symptoms appear to be of a neuropathic character, and, it has been affirmed, occur more frequently in females, especially in those who are pregnant or suckling — and in persons of slender and delicate conformation.tt In certain cases, quinia and its * Gazette Medicale de Paris, April 25, 1840. f London Lancet, and Philad. IVled. Examiner, July 18, 1840, p. 468. J London Lancet, July 25, 1840, p. 639. § Ibid. Aug. 22, 1810, p. 786. || Bullet. Gen. de Thcrap. Mars, 1842. If Annali di Medicin. Feb. 1841, and Journal de Pharmacie, Sept. 1842, p. 209. * Traitc de Therapeutique, ii. 217. f| Riecke, Die neuern Arzueimittel, S. 120. 524 QUINI.32 SULPHAS. salts seem to have caused ptyalism — the saliva being inodorous, and the teeth firm ; and, when calomel has been given along with it, it has been conceived that ptyalism has ensued sooner than it otherwise might have done. Recently, a question has been raised as to the ultimate inno- cuousness of large doses of the sulphate ; and cases have been referred to in which fatal or serious results supervened in acute and chronic rheumatism, and in amaurosis from 70 or SO grain doses in the practice of some of the physicians of Paris.* The most striking agency of quinia and its salts, is in cases of periodical diseases of all kinds ; and especially in intermittent fever ; they have now, indeed almost wholly taken the place of the cinchona, over which they possess many points of preference. In the first place, their bulk is much less ; they therefore do not oppress the stomach so much, whilst the impression of the cin- chona on*that organ not unfrequently interferes with its anti- pyretic properties. In malignant fevers, too, it is often impos- sible to introduce the requisite quantity of cinchona, into the organism, to prevent the succeeding paroxysm, and the life of the patient is consequently placed in the greatest danger. In this case, sulphate of quinia is invaluable ; possessing as it does, the febrifuge virtues of cinchona in such a concentrated state, that but a small quantity is required to produce equal efficacy with a large quantity of powdered cinchona. In such cases, indeed, the latter is apt to disagree with, or be rejected by the stomach, before its full influence can be exerted. In these per- nicious fevers, that occur especially in Italy and Holland, sul- phate of quinia has supported life in innumerable cases where cinchona, in substance, might have failed, and has thereby best exhibited its sanative agency. t In these cases, quinia is admi- nistered without regard to complications, which, in less urgent cases, might be allowed to interfere with its administration. Another advantage, ascribed to quinia, is, that in cases of parox- ysmal fevers, in which the attacks follow each other so closely, that the second commences before the first has terminated, it may be given during the paroxysm, a time at which cinchona would be apt to occasion oppression of the stomach and vomiting. It has likewise been found advantageous in large doses — twelve to thirty grains and more daily — in engorgement of the spleen^ consequent on intermittent fever ;J and M. Levy§ has seen the * Philad. Med. Examiner, Feb. 4, 1843, p. 24. f Repertorio Medico-Chirurgic. por 1'anno 1822, Torino. No. 22. Med. Chirurg. Zeitung. B. ii. IS. 137, 1823 ; and Richter's Specielle Therapie, B. x. S. 326, Berlin, 1828. % For the opinions of MM. Bally, Nonat, and Piorry, on this subject, see Medico-Chirurg. Rev. July, 1840, from La Lanjette Franjaise. § Op. cit. QUINIA SULPHAS. 525 dropsical effusions, that notunfrequently supervene on neglected cases of the same disease, yield readily to the sulphate in full doses.* Recently its use has been recommended in asthma by Dr. B. R. Hogan.t He gave it in doses of from two to eight grains, repeated in an hour, if relief should not follow. He also affirms, that in the forming stage of croup, in the case of a child, two years old, two grains of sulphate of quinia, and a snuff plaster on the chest warded off the attack. In the typhoid fever of children it was found serviceable by MM. Rilliet and Barthez.J Trials of the remedy have likewise been made at the Hopital Cochin in Paris by M. Blache, in the typhoid fever of adults, the results of which were favourable. The cases, however, were not numerous, and in certain of them other remedies were prescribed either before or in conjunction with the sulphate of quinia. Afterwards, some of the patients of M. Husson, at the same hospital, were subjected to the same mode of treatment, and the results have been published by M. Laurent.§ The dose of the medicine usually prescribed was three-quarters of a grain every hour; at times, the dose was larger, and given less frequent- ly; and, in several instances, two drams and more were given in the twenty-four hours for several days together. in thir- teen cases no other remedy was administered, but although the patients recovered, the results did not show any great superiority over other modes of management. In no instance were the phenomena arrested by the quinia. Of ten patients, who had the disease mildly, all recovered but one, whose death was. attri- buted by M. Laurent to the quinia. Of three patients labouring under the disease in a severe form, one only recovered ; and he was for a time in great danger from intestinal hemorrhage. The report of M. Laurent is not very favourable to the bene- ficial effects of quinia in typhoid fever. Besides their febrifuge property, the salts of quinia possess a tonic virtue, that adapts them for numerous cases in which that class of remedies is indicated. Yet there are many who think that cinchona is better calculated for such cases than quinia, and who administer the latter to prevent the paroxysms of an inter- mittent, but have recourse to cinchona, when they are desirous of fortifying the system to prevent a relapse. There are cases, too, which resist quinia, and its preparations, and which subse- * Bulletin General de Therapeutique, Nov. 30, 1837, and M. Levy, Gazette Med. No. xxii. and Encyclographie dea Sciences Medicales, Juillet, 1840, p. 287. | Dunfrlison's Amcr. Mod. Intelligencer, Feb. 1842, p. 153. £ Archiv. General de Med. Juin, 1841, or Enoyclo Coque cum aquae f.^xij. ad remanent, f.^viij. Colaturas adde Salicin. gr. viij. ad. x. M. Dose. — One or two spoonfuls every two hours. Von dem Busch. CXXXI. SAPO MOLLIS. Synonymes. Sapo Viridis, S. Niger, S. Kalicus, S. Domesticus mollis, Sapo ex Olivae Oleo et Potassa confectus, Kali elainicum. French. Savon Noir, Savon Mou, Savon a base de Potasse. German. Schmierseife, Griine Schmierseife, Kaufliche Kaliseife, Schwarze Seife, Olsaures Kali. Under this name a soap is used, which is formed by a union of oil with potassa. It is the " sapo ex oleo et potassd confectus" of the London Pharmacopoeia, has of late years been brought for- SAPO MOLLIS. 541 ward in Germany as a remedial agent in cases of itch,* and has been employed in many hospitals. MODE OF ADMINISTERING. The treatment of itch by soft soap is directed by PfeufTer to be carried into effect in the following manner. Attention is paid to the general health of the patient for a day before the soap is applied. His whole body, with the exception of the head, face, and genital organs, is then besmeared with it, and the application isrepeated, morning and evening, forsix days. At first, two rubbings, of from four to six ounces, are used : at the third and fourth, from two to three ounces ; and from the fifth to the seventh inclusive, from half an ounce to an ounce ; but after this, the soap is applied only to those parts which are affected with the eruption or itching. On the eighth day the patient takes a bath of tepid soap and water; and the body and bed linen, which have not been shifted during the cure, may now be changed for cleaner. In dry and warm seasons, the patient is able to leave the infirmary on the tenth day, cured ; but in moist and cold, not until the twelfth or fourteenth. The cure of the eruption is gene- rally effected in seven days, that is, by fourteen rubbings. Dur- ing the period of treatment, the patient must remain in bed, avoid exposure to draughts of air, and reside in a chamber, whose temperature is from 73° to 77° of Fahrenheit. On account of the strong smell of the soap, not more than ten patients ought to be allowed to occupy the same room. A full diet may be allowed them. From six to eight hours after the first or second rubbing, a sense of tension and pricking is felt in the skin, which, at times, gradually augments until it amounts to a feeling of burning heat, About the fifth or sixth rubbing, the skin appears of a scarlet hue, without the temperature being materially elevated. In several cases, irritative fever ensues, which disappears in the course of twenty-four hours, with augmented secretion of urine. Miliary vesicles form in groups; sweating takes place freely ; the sleep, which may have been disturbed for a night or two, recurs ; the skin desquamates, and the patient does not find his strength in the least exhausted. Should the inflammation of the skin occur earlier than the sixth rubbing, the friction must be pretermitted. PfeufTer, however, never observed this to he the case. In swophulous and syphilitic dyscrasies, the friction may have * PfeufTer, Beobachtungen liber die Kratze unci ihre Bchandlung durch die Schmier-oder griine Seife. .Bamberg, 1833. 46 542 SAPO MOLLIS. to be repeated once more, and the patient may have to remain from two to four weeks in the institution. It very generally happens, that this plan excites inflammation of the skin and desquamation of the cuticle : when this is not the case, no change whatever is produced in the eruption. In order to mitigate the distressing feeling of burning produced by the rubbing, one part of flowers of sulphur may be added to two parts of the soft soap. In those cases, in which the disease has existed for years, with greater or less intervals, and in those who were strumous in their youth, or were at a subsequent period affected with syphilis; — in all cases, indeed, in which the cutaneous affection has become, as it were, habitual, Pfeuffer directs, that a cathartic should be premised, and that in the course of the cure, a quart of the de- coction of the woods should be taken. This mode of treatment, according to Pfeuffer, is contraindi- cated by febrile conditions, especially of the synochal kind; by acute cutaneous affections ; pulmonary and abdominal catarrhs ; pulmonary and abdominal phthisis ; chronic headach ; and here- ditary or acquired tendency to epilepsy. In such cases he prefers the internal and external use of sulphur : and, after the cure, the establishment of issues. The great recommendation of this plan of treatment, in hospi- tals and infirmaries, is said to be its cheapness, although it strikes us, that there cannot be any marked difference in this respect between it and the treatment by sulphur, which is greatly used, on this very ground, in many of the eleemosynary establish- ments of Germany at this time.* The efficacy of Pfeuffer's plan of treatment has been confirm- ed by numerous observers, — by Graff, Bermann, and Cramer, who is said to have first recommended the soap in scabies; and by Sicherer, Seyffer, Cless, and others, all of whom agree as to its excellence: they regard it as one of the best methods of treat- ment in use. The soft soap forms an ingredient in many of the officinal and other itch ointments.f * H. Vezin, Ueber die Kratze und ihre Behandlung nach der Englischen Methode. Osnabruck, 1836. See, also, Dunglison's American Medical Intel- ligencer, Aug. 15, 1839, p. 158. f Riecke, Die neuern Arzneimittel, u. s. w. 2te Auflage, S. 584. Stuttgart, 1840. SODA CHLORINATA. 543 CXXXII. SODA CHLORINATA. Stnonymes. Sodse Chloridum, S. Chloruretum, S. Hypochloris, Chloruretum Oxidi Sodii, Sodae Oxymurias, Natrum Chloratum, N. Chloricum, N. Oxy- muriaticum, Chlorinated Soda, Chloride of Soda, Hypochlorite of Soda, Chloruret of Soda, Chlorite of Soda, Oxymuriate of Soda. French. Chlorure de Soude, Chlorure d'Oxide de Sodium. German. Chlornatron. This preparation resembles in almost all respects chlorinated lime. Both it and chlorinated potassa were associated by Ber- thollet under the common name Eau de Javelle, or ' bleach- ing liquor' ; and it has of late generally received the name of Liqueur de Labarraque, or Labarraque' 's Soda Disinfecting Liquid. METHOD OF PREPARING. Labarraque* recommended it to be prepared directly by pass- ing a current of chlorine gas into a solution of carbonate of soda. The following is the formula in the last London Pharmacopoeia, for the Liquor Sodfc Chlorinate, Liquor Sodse Chloridi, L. Sodae Oxymuriaticse, L. Chloreti seu Chlorureti Natri sen Sodse, Natrum Chloratum Liquidum, L. seu Jiqua Natri Oxyrnuria- tici, Hypochloris Sodicus Jlqud Solutus ; German, Oxydirt salz- saures Natronwasser, C hlorsodaflussigkeit , or Labarraque 's Disinfecting Liquid. " Take of Carbonate of soda, a pound ; Distilled water, forty-eight fluid ounces ; Chloride of sodium, four ounces; Binoxide of manganese, three ounces; Sulphuric acid, four ounces. Dissolve the carbonate of soda in two pints of the water ; then put the chloride of sodium and binoxide of manganese, rubbed to powder, into a retort, and add to them the sulphuric acid, previously mixed with three fluid ounces of water, and cooled. Heat and transmit the chlorine first through five fluid ounces of water, and afterwards into the solution of carbonate of soda above directed." The following form is given in the last edition of the Pharmacopoeia of the United States (1842): — "Take of Chlorinated lime, fftj. ; Carbonate of soda, ftjij. ; Water, a gal- lon and a half. Dissolve the carbonate of soda in three pints of the water, with the aid of heat. To the remainder of the water add, by small portions at a time, the chlorinated lime, * Gazette de Sante, April 25, 1826. 514 SODA CHLORINATA. previously well triturated, stirring the mixture after each addi- tion. Set the mixture hy for several hours, that the dregs may subside ; then decant the clear liquid, and mix it with the solu- tion of carbonate of soda. Lastly, decant the clear liquor from the precipitated carbonate of?lime, pass it through a linen cloth, and keep it in bottles secluded from the light." When the solution of chlorinated soda is properly prepared, it is devoid of colour ; has a sharp, saline, and astringent taste, and an odour of chlorine. By careful evaporation, it yields crystals, which produce the original liquid when re-dissolved. When the solution is exposed to the air, and allowed to evapo- rate spontaneously, it gives out chlorine, and yields crystals of carbonate of soda.* EFFECTS ON THE ECONOMY. In its general remedial agency, chlorinated soda resembles chlorinated lime, and has been administered both internally and externally in the same cases. It is preferred, however, for inter- nal, whilst chlorinated lime is generally chosen for external use, and this, chiefly perhaps, owing to its being obtained more conveniently, and cheaply. Dr. Pereira states, however, that he has carefully prepared and tried the two chlorides, and gives a decided preference to the chloride of soda. Labarraque, like- wise, preferred it as an antiseptic, on the ground, that by the process of disinfection, it becomes chloride of sodium, which is not a deliquescent salt ; whilst chloride of calcium, formed by chloride of lime, attracts water from the atmosphere, and thereby furnishes one of the conditions — moisture — necessary to the pu- trefractive process. Hence, he thinks, whilst chloride of lime will serve equally well for simple disinfection, chloride of soda is to be preferred where we wish at the same time to prevent a renewal of putrefaction.! By Bouillaud, Chomel and others, chlorinated soda has been given, with advantage, in typhous fevers ; and by Kretschmar,f Lalesque, Colson,and Gouzee§ in intermittents :|| ten cases are reported by the last named gentleman ; in two, the intermittent yielded immediately ; two others were cured after a slight re- turn ; in one, there were four attacks, gradually diminishing ; in * Faraday, Quarterly Journal of Science, N. S, ii. 84, cited by Brande, Dic- tionary of the Materia Medica, p. 508, Lond. 1839. f Pereira, Elements of Materia Medicaid edit. p. 540, Lond. 1842; or Amer.edit. by Dr. Carson, Philad. 1843. X Venus, Grundriss der medicin. Receptirkunst, S. 67. Weimar, 1838. § Revue Medicale, Fevrier, 1836. |j Riecke, Die neuern Arzneimittel, S. 334, and 2te Auflage, S. 511. Stutt- gart, 1840. STRYCHNIA. 545 two cases, the severity of the paroxysms abated, but it was thought necessary to have recourse to sulphate of quinia ; in two others, no effect was produced, and in one, the disease was ag- gravated. Gouzee infers, that these cases prove the febrifuge properties of chlorinated soda to be less marked than those of sulphate of qninia, and, therefore, that it ought not to be trusted to, except in the slighter cases, and where the patients are easily susceptible of the effects of medicine, — as women and children. In like manner, it has been found useful in scrophulous affec- tions, and in various diseases in which chlorinated lime has proved serviceable. See Calx Chlorinata. MODE OF ADMINISTERING. From ten drops to a dram, mixed with plain or sugared water, may be given internally for a dose. The form in which it was prescribed by Gouzee, in inter- mittent s, was a mixture, composed of half a dram to four ounces of distilled water. This wastaken by spoonfuls during the apyrexia; so that the last dose should be swallowed shortly before the next paroxysm was expected. The patients were re- stricted to their beds, or at least to their chambers. When applied externally, it is rarely used pure or diluted with so little as one-half water, except in cases of asphyxia, and gan- grene, and for dressing old ulcers, &c. Most commonly it is diluted with ten to thirty parts of water, and in this strength is applied to ulcers of various kinds, burns, cutaneous diseases, &c. When used as a disinfecting agent, it is generally diluted with ten, twenty or thirty times its weight of water.* STRYCHNIA ET EJUS SALES. Synontme. Strychnia and its salts. CXXXII1. STRYCHNIA. Synontmes. Strychnina, Strychniuni, Strychninum, Strychnia, Strychna, Strychnine, Vaucjueline. French. Strychnine. German. Strychnin, KrahenaugenstofiT, Kriihenaugenbitter. This alkaloid was discovered by Pellet ier and Caventou,t in nux vomica, St. Ignatius's bean, upas tieutc, and in the wood * Payan, Revue Medicale, Aout, 1839. t Annates de Chimie, torn. viii. ix. and x. 46* 546 STRYCHNIA. of strychnos colubrina ; and experiment has shown, that these substances are indebted for their medicinal properties to it.* In those different substances, strychnia is found associated with another principle analogous to it in its properties — brucia.t In St. Ignatius's bean, there is less brucia than in mix vomica, so that it is best adapted for the preparation of strychnia ; but it is not as easily obtained, and consequently mix vomica is almost always — if not always — used. METHOD OF PREPARING. According to one form of preparation, a solution of liquid subacetate of lead is added to a solution of the alcoholic extract ofnux vomica in water, until a precipitate is no longer thrown down ; the foreign matters being thus precipitated, the strychnia remains in solution with a portion of colouring matter, and sometimes an excess of acetate of lead. The lead is now sepa- rated by sulphxiretted hydrogen ; and the fluid is filtered and boiled with magnesia, which unites with the acetic acid, and precipitates the strychnia. The precipitate is next washed in cold water, and redissolved in alcohol to separate it from the excess of magnesia, and by evaporating the alcohol, the strych- nia is obtained. If it be not perfectly white, it must be redis- solved in acetic, or hydrochloric acid, and be reprecipitated by means of magnesia. The modes of preparation recommended in the Pharmaco- poeias of London, Edinburgh, and the United States, differ from each other. The following is that contained in the last work (1842) : — Take of Nux vomica, rasped, foiv. ; Lime, in powder, 5VJ. ; Muriatic acid, f.giij. ; Alcohol, Dilute sulphuric acid, So- lution of ammonia, Purified animal charcoal, Water, each a sufficient quantity. Digest the nux vomica in two gallons of water, acidulated with a fluid ounce of the muriatic acid, for twenty-four hours; then boil for two hours, and strain with ex- pression through a strong linen bag. Boil the residuum twice successively in the same quantity of acidulated water, each time straining as before. Mix the decoctions, and evaporate to the consistence of thin syrup ; then add the lime previously mixed with a pint of water, and boil for ten minutes, frequently stirring. Pour the mixture into a double linen bag, and, having washed the precipitate well with water, press,dry, and powder it. Treat the powder repeatedly with boiling alcohol until deprived of its bitterness j mix the liquors ; and distil off the alcohol by means * Magendie, Annales de Chimie, x. 176, 1819. I See page 111. STRYCHNIA. 547 of a water bath. Mix the residue with water, and, having ap- plied heat, drop in sufficient diluted sulphuric acid to neutralise and dissolve the strychnia ; then add purified animal charcoal, boil for a few minutes, filter, evaporate and crystallize, Dissolve the crystals in water, and add sufficient solution of ammonia to precipitate the strychnia. Lastly, dry the precipitate on bibulous paper.* As thus prepared, it is in the form of a white powder. Strychnia, obtained by crystallisation from an alcoholic solu- tion, which has been diluted by means of a small quantity of water, and left to itself, appears under the form of microscopic crystals, constituting four-sided prisms, terminated by pyramids with four flattened or depressed faces. When crystallised ra- pidly, it is white and granular, is insupportably bitter to the taste, and leaves an after taste similar to that caused by certain metallic salts ; it has no smell, and is not changed by exposure to the air ; is neither fusible nor volatile ; for, when subjected to the action of heat, it does not fuse until the moment of its de- composition and carbonisation, and it is decomposed by a degree of heat inferior to that which destroys most vegetable substances. When exposed to the naked tire, it swells, becomes black, and yields an empyreumatic oil, a little water, acetic acid, carbonic acid, and carburetted hydrogen. Distilled with deutoxide of copper, it gives out much carbonic acid, and only slight traces of azote. It is composed, therefore, of oxygen, hydrogen and carbon. Although strychnia has so strong a taste, it is scarcely soluble in water. At 50° Fahr., 6667 parts of water dissolve but one of it; boiling water dissolves a little more than double, so that it may be said to be soluble in 2500 parts of boiling water. It is remarkable, however, that a solution made in the cold, and con- taining, therefore, only T oW n P art °f i ts weight, may be diluted 100 times, and still retain a very decidedly bitter taste. It is more soluble in strong alcohol, little so in weak, and not much so in ether or fixed oils,although they acquire a bitter taste from it. On the other hand, it is very readily soluble in volatile oils, and the hot saturated solution, on cooling, deposits crystals. It has an alkaline reaction, and forms, with acids, salts which are mostly crystallisable, and insupportably bitter, and are more solu- ble than pure strychnia. t Strychnia, being sold at a high price, is liable to adulteration. A respectable druggist of Philadelphia informed the author, that one of his customers was offered strychnia by another house at a price considerably below what he had to pay for it when pur- • Pharmacop. of the United States, p. 184. Philad. 1842. | Magendie's Formulaire, &c. 548 STRYCHNIA. chased even in large quantities from respectable sources. He purchased an eighth of an ounce of it at the rate of five dollars the ounce ; when pure strychnia could not be afforded at less than nine dollars per ounce. Some of this was tested, when it was found to consist of equal parts of flour or starch, and pure strychnia. EFFECTS ON THE ANIMAL ECONOMY IN HEALTH. The effects of strychnia on man and animals resemble, on the whole, those of the spirituous extract of nux vomica, except that they are more intense. According to Magendie, one-eighth of a grain is sufficient to kill a strong dog. Pope, who made experi- ments on dogs, found, that T Vth of a grain was enough to para- lyse the lower limbs of a small dog in four or five minutes, and in half an hour to kill it. Christison* considers strychnia the strongest poison after hydrocyanic acid. He injected a solution of a third of a grain in alcohol into the thorax of a wild boar, and in ten minutes the animal died. A dog was destroyed by |th of a grain in two minutes; and he believes, that the same effect would be induced on man by half a grain introduced into a wound. Lembertt observed similar results from placing a grain in the thorax of a small dog, and from three grains introduced into the cellular tissue of a larger animal, on which tetanic spasms were induced in the thoracic muscles. Mr. BlakeJ injected a grain of strychnia, dissolved in a small quantity of acetic acid, into the veins of a dog. The first effect of the poison was to induce general convulsions in about thirty seconds after its injection, the action of the heart being at the same time rendered irregular, which Mr. Blake presumes was owing to the convulsive struggles of the animal. All external signs of life ceased in about a minute and a half after the injec- tion of the poison — the heart still continued to beat. He found, that whenstrychnia was introduced into the circulationin so small a quantity as not to produce any general symptoms, it did not appear to exert the least influence on the heart. That the action of strychnia is analogous to that of nux vomica, has been proved by the experiments of Segalas,§ Andral,|| Bard- * Treatise on Poisons, 3d edit. Edinb. 1836; and Dispensatory, p. 895. Edinb. 1842. t Essai stir la Methode Endermique, Paris, 1828, 8vo. j Edinburgh Medical and Surgical Journal, Apl. 1839, p. 338. § Magendie's Journal de Physiologie, ii. 4. II Ibid. Juillet, 1823. STRYCHNIA. 549 sley,* Redlich, Sandras, Liiders, Hennemann, and numerous others.t It affects especially the spinal marrow, and the gangli- onic system — less strikingly the brain; small doses excite the ganglionic system; larger, the spinal marrow ; consequently, it has been imagined, that it might be an efficacious remedy in nervous diseases, which are dependent upon spasmodic disorder in the ganglionic system, or on diminished sensibility and torpor of the nerves of motion. The following are the effects observed by Oppler from the in- ternal use of nitrate of strychnia : — a sensation of warmth and itching in the epigastrium : eructation ; nausea ; vertigo ; slight excitement like that of intoxication ; great vividness, with more or less confusion of mind ; dull pain over the eyes ; spots before the same ; dilatation of the pupils ; diplopia ; tinnitus aurium ; difficult articulation and deglutition ; slight trismus : sense of for- mication in the paralysed parts ; convulsive motions or twitch- ings, at times, in those parts ; at others, over the whole body, similar to electric shocks ; tremors of the muscles ; occasionally, violent spasms ; tetanus ; asthma ; palpitations ; febrile heat ; general sweating ; prostration ; pale or livid countenance ; pulse sometimes full and frequent, at others small and contracted ; great sensibility over the whole body ; involuntary laughter, succeeded always by difficulty of breathing and convulsions. The sleep was generally interrupted by convulsions ; the secretion of urine scanty, and occasionally suppressed. These symptoms came on gradu- ally, and disappeared in the same manner, when the dose was moderate, in the course of some hours. Large doses induce death by a sudden shock to the nervous system ; smaller doses, when continued for a long time, may destroy by causing apo- plexy, of which Oppler saw many examples in his experiments on animals.^ Dr. Blumhardt§ has published a case of poisoning by strych- nia, which occurred to him in Stuttgart. He was called to a young man, seventeen years old, who had swallowed two scru- ples of strychnia after dinner. A short time afterwards, expe- riencing great restlessness, he repented of what he had done, and immediately took four grains of tartar emetic, which excited considerable vomiting. When the physician arrived, about a quarter of an hour after he had taken the strychnia, he found the patient on his back in bed, with his head thrown back, rigid * Hospital Facts and Observations, Illustrative of the Efficacy of Strychnia, Brucia, &c. Lond. 1830. f Petref|uin, Gazette Mddicale de Paris, No. 44, Nov. 1838. £ See, also, Tanquerel des Planches, Essai sur la Paralysie de Plomb. Paris, 1834. $ Medicinisch. Correspondenz-Blatt, in Encyclog. des Sciences Mcdicales, Sept. 1837. 550 STRYCHNIA. and incapable of motion, but with a constant inclination to turn towards the right side. He could only move the upper limbs freely. The countenance was pale and haggard ; the tempera- ture of the skin natural, and the pulse quick and contracted. Consciousness remained unaffected ; the speech was rendered difficult by an occasional contraction of the muscles that move the lower jaw ; but it could not properly be said to be inter- rupted ; deglutition was untouched. The trismus, however, be- came more and more frequent and violent, and the respiration thereby unequal and suspended ; the pulse was small, suppressed and quick. The remedies — employed to save him — as the tincture of iodine and the acetate of morphia, were of no avail. With the periodical trismus was now associated spasmodic agi- tation of the whole body, to which — after a short interval — suc- ceeded opisthotonos with violent symptoms of suffocation ; the trismus attained the highest degree, and the upper extremities were deprived of the influence of volition. With the increase of the general tonic spasm, the respiration was always more diffi- cult and oppressed, and for a time wholly ceased; the pulsation of the heart and arteries became irregular, less distinct, and at length imperceptible. In this condition the skin acquired a bluish appearance ; the countenance was puffed, and of a violet hue ; the lips dark blue, the neck swollen, the eyes protruded, fixed and directed towards the right side ; the pupils enlarged and immovable, and the conjunctiva injected. At this period, the patient was entirely unconscious ; but from this condition he awoke once, and all the symptoms became mitigated ; during this remission, the muscles, influenced by the spinal marrow, remained cramped, except the upper extremities, which could be moved voluntarily. In a quarter of an hour, the tetanic attack returned in its violence, with intense commotion of the whole body ; this ended in asphyxia, from which he again re- covered to consciousness. The same thing happened in a third attack. In the fourth, he succumbed under the power of the poison. The whole scene, from the taking of the poison to the occurrence of death, lasted an hour and a half. During the last attack, as doubt existed whether he were really dead, the median vein of the left arm, which was turgid, was opened, and after the vessel was emptied of its thick, black blood, which resembled that of an animal, several bubbles of air, from the size of a pea to that of a small cherry, were forced out by pressure. The dissection was made twenty hours after death. In spite of the elevated summer heat there were no signs of putrefaction : the whole of the body was uncommonly rigid. The muscles of the back were of a brownish-red colour, almost like that of smoked meat. On opening the spinal canal, a considerable STRYCHNIA. 551 quantity of thick, dark coloured blood, like that of an animal, flowed out. The plexus venosi spinales were turgid with the same kind of blood, as well as the vessels of the pia mater. Under this mem- brane, especially in the cervical portion, some watery fluid was effused. The upper portions of the spinal marrow were soft, even pappy in some places, but lower down it became gradually harder. Within the cavity of the cranium, the same turgid con- dition of vessels existed; all the veins of the dura mater appeared as if injected ; the veins of the pia mater were likewise engorged ; and the whole mass of the brain indicated an unusual supply of blood, so that the cortical substance appeared quite blue. The cerebellum was softer than usual. In the cavities of the abdomen and thorax, a striking poverty of blood was perceptible. The heart was shrunken and empty, as well as the large vessels of the thorax. The stomach was full of solid food, which appeared to have undergone no change ; its bloodvessels contained a consi- derable quantity of blood, and the mucous coat exhibited marked redness over its whole surface ; but this was especially concen- trated about the cardia and the fundus ; the small intestine was likewise redder than natural, as is commonly the case in those who have died whilst digestion was going on. The liver was tolerably supplied with blood ; the gall-bladder empty. When strychnia is used endermically, as is not unfrequently done, the course of the phenomena is somewhat different. G. H. Richter employed it in this way in many cases of hemiple- gia, in one of which it occasioned symptoms of actual poisoning. When the dose exceeded a quarter of a grain, a feeling arose in the part to which it was applied as if needles were run into the skin ; this gradually spread over the whole limb; the temper- ature of the body was augmented ; the pulse was quickened, full and hard; the breathing constrained ; pain was experienced in the same side of the head ; the secretion of urine was increased, and a general perspiration broke out, which persisted for about an hour, after which the pricking of the surface, and the excite- ment of the vessels ceased. To these symptoms — and seldom later than two hours after the application of the agent — convul- sive movements succeeded in the paralysed limbs like those in- duced by electricity, which augmented in violence and frequency with the increase of the dose, — being strongest and most severe during the night, at which time the limbs were moved involun- tarily. When awake, a feeling of stiffness was experienced in all the limbs, which passed off when they were used. On diges- tion, defecation, and the appetite, the nitrate of strychnia seldom exerted any influence. Only in one case — in which no effects were induced on the nervous system, when the dose was gra- 552 STRYCHNIA. dually carried to three grains — was obstinate constipation pro- duced. In general, when it was begun with in the dose of one- eighth of a grain, and on the next day one-fourth was given, on the third day one-half, and afterwards the dose was increased daily by one-fourth of a grain, until one and a quarter were given, — the following unpleasant symptoms supervened. The patient experienced twitchings earlier than before, and first in the paralysed limbs. As these became, from minute to minute, more violent, a penetrating pain was felt in the occiput, with vertigo and tinnitus aurium. The twitchings now extended over the affected arm, and, subsequently, to the sound side, whereupon the vertigo and headach augmented, and insensi- bility, with difficult and stertorous breathing, ensued. The pulse now became very full, hard, slow, and intermitting ; the countenance bluish-red and turgid ; the paralysed lower extre- mities of a marbled blue ; the pupils very much dilated, and the mouth open, — the convulsions being occasionally so strong as to toss him to and fro on the bed. When these phenomena de- clared themselves, Richter removed the dressing from the sur- face, which appeared inflamed, and still contained a quantity of strychnia, that had not been absorbed ; the parts were then washed, and sprinkled immediately — according to Lembert's and Lesieur's recommendation — with two grains of the acetate of morphia ; the face was washed with cold water, the soles of the feet brushed, and other excitants administered.* Dr. Christisont considers, that strychnia is not a cumulative poison ; yet the Author has seen one or two cases, which would favour the contrary opinion.^ •Morphia appears to be the most powerful antidote : under its use, the dangerous symptoms rapidly disappear, consciousness returns; the patient sleeps for some hours, and a general perspi- ration breaks out, after which he awakes with a feeling of dul- lness, and with stiffness of the limbs, which soon, however, vanish. In respect to the topical application of strychnia by the endermic method, A. L. Richter§ remarks, that the preparations of strych- nia produce much more powerful local effects than those of mor- phia ; they maintain the abraded portions of the skin in an in- flamed state, promote suppuration more than morphia, and oc- casion violent itching a were run into the skin. * See some experiments, relative to the action of strychnia on the nervous system, by Dr. H. Stannius, in Miiller's Archiv. Heft. ii. 1837; and Brit, and For. Med. Review for Jan. 1838, p. 221. t Dispensatory, p. 895. Edinb. 1842. X See, also, Pereira, Elements of Mat. Med. and Therap. ii. 1310, Lond. 1842; or Amer. edit, by Dr. Carson^Philad. 1843. § Die Endermatische Methode, u. s. w. Berlin, 1835. STRYCHNIA. 553 Artus recommends, from his investigations, pure baryta {Jletz- baryt) as an antidote. It forms an insoluble precipitate with strychnia, and he esteems it to be more certain than the tinc- tures of iodine and bromine recommended by Donne,* the chlo- ride of barium, or the infusions of tar and galls recommended by Raspail.t The effects, referred to above, were chiefly obtained from the administration of th6 nitrate of strychnia, but they may be es- teemed applicable to all the preparations of strychnia, as we know nothing of any difference in their agency. It is probable, however, that the salts of strychnia, owing to their greater solu- bility, may have more action than strychnia itself, although the muriatic, and acetic, or lactic acids, which are almost always present in the stomach, it might be presumed, would readily unite with it. EFFECTS ON THE ECONOMY IN DISEASE. The following remarks apply equally to pure strychnia, and its salts, and to the alcoholic extract of nux vomica, to which the reader is referred, (see page 446,) and which is preferred by some.l It has been administered in 1. Paralysis, especially in that arising from the action of lead, in which Bally, Lembert, Bardsley, Andral, Rayer, and Tan- querel,§ have employed it beneficially. In paraplegia and he- miplegia, it has been prescribed by Lesieur, G-. H. Richter, Rom- berg, Bardsley, Bally, Lafaye, Oesterlen, Reinhardt, Heyfelder, Faye, Mart, Schaible, Raciborski, A. T. Thomson,|| Gellie,f Pe- trequin,** Toulmouche,tt and numerous others.JJ From the results of their observations it would seem, that strychnia is most efficacious in paraplegia ; less so in hemiple- gia, although it has often been given with advantage in the latter affection ; but its administration in hemiplegia requires special circumspection, particularly when the paralysis has succeeded to apoplexy. §§ * Journal de Chirnie Me"d. v. 494, Paris, 1829. •j- Nouveau Systeme de Chirnie Orjranique. Paris, 1833. % Petrequin, Bulletin General de Therapeutique, Mars, 1840. § Gazette Medicale, pour 1835, p. 383. || London Med. Gaz. April, 1S31. \ La Lancette Franchise, Aout 29, 1837. ** Op. citat. \\ Gazette Med. do Paris, No. 5, 1841, and Encycl. des Sciences Mod. Mars, 1841, p. 438. XX Petrequin, Gazette Medicale, Nov. 1838. §§ See Bally, Considerations sur la Strychnine, &c. in Bulletin General de Therapeutique, Fev. 1838. 47 554 STRYCHNIA. The results of the recent observations of M. Toulmouche in- duce him to believe, that strychnia will only succeed in paralysis or other affections " that proceed from some lesion of spinal in- nervation, occasioned by excessive masturbation or indulgence in venereal pleasures, by the abuse of spirituous or narcotic liquors, by the action of the emanations of lead, &c. ;" and that it is never successful in paralysis, which is owing to an inflamma- tory condition of the brain or spinal marrow. He is of opinion, that strychnia has a directly excitant effect upon the spinal marrow, and secondarily on the organs that receive their nerves from it. Romberg affirms, that, as a general rule, in cases of paralysis dependent upon disease of the central organs of the nervous sys- tem, he has never seen any striking effect from the endermic use of strychnia, and that great care is needed lest it should react injuriously on the brain. He considers it especially adapted for cases of paralysis, that are dependent upon some affection of the spinal marrow induced by mechanical concussion ; as well as for the local paralysis that succeeds to rheumatism, suppressed exanthems, &c. Dr. Pereira* has seen it very serviceable in that shaking or trembli?2g action of the muscles, which is pro- duced by habitual intoxication. G. H. Richter cured a case of aphonia by it, and it has been much used, and successfully, in amblyopia and amaurosis, by Short, Liston,f Guthrie, Middle- more,! Henderson, Furnari,§ Mart, Petrequin,|| and others. Mr. Tyrrell and Mr. Lawrence,1T however, affirm, that they have found it inefficacious in amaurosis. In these cases, it is generally used endermically on the temporal region. Dr. Stevenson** derived benefit from it — when applied in this way — in cases of amaurosis of many years' duration. Half a grain was re- peated twice a day until tremors of the limbs were produced. He employed it in the same manner in other cases of local paralysis. In cases of amaurosis, Henderson advises, in addition, that a solution of strychnia should be dropped into the eye. It has likewise been given successfully in paralysis of the bladder by Schaible, Bally, Hennemann, Behrend,tt and others, and in paralysis of the facial nerve.%% In two cases of paralysis * Medical Gazette, vol. xix. f Lnnd. Med. Gaz. v. 541 and 575. X Midland Med. and Surg. Reporter, May and August, 1831. § A. Bouchardat, Annuaire de Therap. pour 1841, p. 8. Paris, 1841. || Bulletin General de Therapeutique, Juillet, 1838. ^ A Treatise on Diseases of the Eye, Amer. edit, by Dr. Hays, p. 519. Philad. 1843. ** Transactions of the Medical and Physical Society of Calcutta, vol. v. ft Medicin. Zeitung, Sept. 1837, S. 190. XX Dr. O'Brien, Med. Chirurg. Review, and L'Experience, Nov. 1838 ; and Beales, New York Journal of Med. and Surg. July, 1839, p. 201. STRYCHNIA. 555 of the rectum in elderly people, accompanying a disordered state of the bowels, the Author found the best effects from the endermic use of strychnia — in the quantity of a quarter of a grain, night and morning, to a blistered surface on the sacrum. In high grades of paraplegia, the internal use of the remedy is to be preferred, but in general the endermic administration is more advisable. In paralysis of the limbs, a spot is selected in the vicinity of the spinal marrow. Strychnia is likewise given in other affections. Very favoura- ble reports have been made as to its efficacy in 2. Neuralgia. Mart found it beneficial in tic douloureux and in nervous headach ; Magnus, in a case of neuralgia of the arm, and several successful cases have been published by Dr. Pidduck.* 3. Traumatic tetanus. In this disease, it has been recom- mended by Liiders. 4. In Hysteria, Hypochondriasis, and Dyspepsia,\ it has been advised by Schmidtmann and Basedow, but morphia appears to render more essential service. 5. In Chorea, Romberg saw good effects from it. It has like- wise been advised in epilepsy\ and catalepsy. In a successful case related by Dr. Weyland, nitrate of strychnia was taken in such quantity as to produce the peculiar tetanic effects of strych- nia. Fricke has administered it successfully in — 6. Syphilitic Osteocopi. It has also been given with benefit in cases of 7. Dysentery and Diarrhoea, by Bardsley, Recamier, Ged- dings,§ and others ; and has been used endermically in cholera — two or three grains being applied to a blistered surface on the nape of the neck. By MM. Dreyfus, Grimaud d' Angers and Potton it was given internally in the same affection to allay vo- miting : — a quarter to half a grain being added to three ounces of water, and prescribed in the dose of a spoonful every hour. j| Dr. Ryan!! asserts, that he has repeatedly known a few of the pills — the formula for which is given below — check a profuse diarrhoea with rice coloured evacuations, and even when the ex- tremities were blue in malignant cholera. 8. Amenorrhea. Of twelve cases of suppressed menstrua- * Lond. Med. Gazette, Augr. 7, 1840, p. 759. f Dr. Melcombe, in Lond. Med. Gaz. for Mar. 4, 1837, p. 850. % Brofferio, in Repertorio Medico-chir. di Torino, 1825, and Revue Medi- cale, iv. 488, Paris, 1825; and Weyland, Woc.henschrift fur die gesammte Heilkunde, cited in Encyclograph. des Sciences Med. Janvier, 1841, p. 65. $ N. American Archives, No. 2, Nov. 1834. \ Mcrnt and De Lens, Diet, de Mat. Med. Art. Strychnine. T Formulary, 3d edit. p. 335, Lond. 1839. 556 STRYCHNIA. tion, treated by Bardsley, ten were cured, and two relieved. Dr. Churchill* had also two cases, in which the cure by it was com- plete and permanent. Lastly. From its efficacy in analogous affections of the diges- tive mucous membrane, Dr. Stokest thinks there is good reason to hope, that it may prove useful in bronchitis. It has been employed, indeed, in all the cases in which the alcoholic extract of nux vomica has been found of service, than which it is of course to be more relied upon, in consequence of its greater uni- formity ; nux vomica itself being often found unequal. MODE OF ADMINISTERING. Pure strychnia is best exhibited internally, in the form of pill, or in spirituous solution ; but if a little acid, especially the acetic, be added to it, it may be given in watery solution, as in this way a salt of strychnia may be formed extemporaneously. The dose is from one-sixteenth to one-eighth of a grain, which may be gradually increased until a grain is taken. In ordinary cases, it will be sufficient to raise the dose to half a grain, two or three times a day ; but if any circumstance should arise to cause its discontinuance, it ought not to be recommenced in doses as large as the last, but with small doses, as at the beginning. In the endermic application of the remedy, we sprinkle, twice a day, a quarter of a grain on the denuded surface, and slowly increase the quantity to half a grain or more should this be necessary. If the larger doses do not act more beneficially, it will be advi- sable to discontinue the remedy for a few days — after which the smaller doses may again exert a signal influence — rather than to carry the dose still higher. M. Petrequinf thinks, that the endermic use of strychnia frequently fails owing to the vesi- cated surface, to which it is applied, becoming covered with a layer of coagulable lymph, in consequence of which the strych- nia is unable to make its appropriate impression. This layer of lymph should be removed as far as possible at each application ; and as the vesicated surface daily becomes less and less sensible, the dose must be proportionably increased. M. Petrequin re- commends, that a third or a fourth of a grain of strychnia should be mixed with two or three grains of powdered nux vomica, and the compound be sprinkled on the surface ; but it would seem to be far preferable to increase the dose of strychnia than * Outlines of the Principal Diseases of Females, Dunglison's Amer. Med. Library edit., p. 54. Philad. 1839. | Treatise on Diseases of the Chest, p. 125, Dublin, 1837, and Amer. Med. Library edit., Philad. 1838. X Bulletin de Therapeutique, Mars, 1840. STRYCHNIA. 557 to place so much insoluble and irritating powder on the sensitive surface. Pilnlse strychnia. Pills of strychnia. R. Strychniae pur. gr. ij. Confect. rosae, 3ss. Divide in pilulas xxiv. Dose. — One to two, morning and evening. Magendie. R. Strychnine, gr. j. Confect. ros. 5 SS « Glycyrrhiz. pulv. J^ss. Divide in pilulas xij. Dose. — One, night and morning. The quantity may be in- creased to four or five daily. Ryan. R. Strychniae, gr. ij. Extract, valerian, q. s. ut riant pil. xxxij. Dose. — One, every morning fastingfor five days — afterwards one, morning and evening, in torpid amaurosis. Furnari. Tinctura strychniae. R. Strychniae pur. gr. iij. Alcohol, 36° (.837) f.gj. M. Dose. — Six to twenty-four drops, twice or thrice a day. Magendie. Mistnra strychnia. Mixture of strychnia. {Potion stimulante.) R. Aq. destillat. f.,5ij. Strychniic, gr. i. Sacch. 5'j- Acid. acet. gtt. ij. M. Dose. — A dessert-spoonful, morning and evening. Magendie. 47* 55S strychnijE acetas. Collyrinm strychnia Collyrium of strychnia. R. Strychnise,gr. ij. — iv. — vj. — viij. Acid. acet. dil. Aq. destillat. aa. f.5j. M.- Two drops to be let fall into the eye, a few times a day, in amaurosis. Henderson. Linimentum strychnise. Liniment of strychnia. R. Strychnise, gr. xxiv. 6l.olir.gj. M. Twelve drops of the oil to be rubbed on the temples four times a day in cases of amaurosis. Cnnier. CXXXIV. STRYCH'NIiE ACETAS. Synonvmes. Strychninae Acetas, Strychnium Aceticum, Acetas Strychnii seu Strychnicus, Acetate of Strychnia or Strychnine. German. Essigsaures Strychnin, Strychninacetat. In addition to the acetate, formed extemporaneously, as men- tioned under strychnia, the proper acetate of strychnia has been administered, especially by Luders and Fricke. It may be made, like the acetate of quinia, from the direct combination of strychnia with acetic acid. According to Thenard, it is very soluble, and crystallises with difficulty. Even when diluted 40,000 times, its solution occasions a sense of bitterness on the tongue. The following formulas have been given by the physicians cited. Guttae acetatis strychnia;. Drops of acetate of strychnia. R. Strychnia? acet. gr. iij. Alcohol. f.Jj. Aq. cinnam. f>3 V U • M. Dose. — Five drops, twice a day, gradually increasing the dose. Luders. STRYCHNIA IODAS. 559 Tinetnra acetatis strychnia, Tincture of acetate of strychnia. R. Strychniae acet. gr. iss. Alcohol, f.gss. M. Dose. — From three or four to twenty or thirty drops, to be taken at bed-time, in oases of syphilitic pains of the bones. Fricke. CXXXV. STRYCH'NIiE FODAS. Synonymes. Strychninae Iodas, Strychnina Iodata, Strychnium lodicum, Iodas Strychnii seu Strychnicus, Iodate of Strychnia or Strychnine. German. Iodsaures Strychnin, Strychninjodat. METHOD OF PREPARIM, The preparation of this salt, according to Magendie, is easy. It is sufficient to add a concentrated solution of iodic acid to powdered strychnia ; in a moment, the mass swells up, absorbs water, becomes thicker and at times very consistent. It is now treated with boiling alcohol, filtered, and left to spontaneous evaporation. In this way, beautiful crystals of iodate of strych- nia are obtained. The iodic acid ; proper for this preparation, is obtained, according to Geiger, in the following manner. Nine parts of iodate of baryta are boiled with two parts of oil of vitriol, previously diluted with ten times as much water, for half an hour. It is then filtered, and evaporated by a gentle heat to the consistence of a thin syrup, and is exposed to the air for spontaneous evaporation. Iodate of strychnia may likewise be formed by double de- composition, by mixing a soluble iodate, as iodate of soda, with a solution of sulphate or muriate of strychnia. The iodate of strychnia is precipitated, which may be treated with boiling alcohol, and crystallised as above directed. The iodate is of a white colour, and crystallises in beautiful prismatic needles : it is but slightly soluble in cold water, but more so in boiling water and alcohol. 560 STRYCHNIiE NITRAS. EFFECTS ON THE ECONOMY. " This salt," says Magendie, " is one of the most active poi- sons with which I am acquainted. A single grain is sufficient to destroy a strong dog under tetanic symptoms. It acts, like- wise, powerfully on the diseased organism. I gave it to seve- ral persons with a success which far exceeded my expecta- tions. It proved effectual in some old paraplegic affections, which had been esteemed incurable, and after all the usual re- medies had been administered in vain." He gave it in pills, each of which contained one-eighth of a grain. One of these was prescribed night and morning, and the dose was gradually increased, until ultimately a grain was taken in the twenty-four hours. The greatest circumspection was, however, necessary in its use. Magendie is of opinion, that the Hydriodate of Strychnia, Strychnhim Hydroiodicum, Hydriodas seu Iodhydras Strych- nii seu Strychnicus ; Germ. Iodwasserstoffsaures Strychnin, Iodwasserstoff Strych?iin, might be advantageously introduced into medicine. It is prepared by mixing a solution of iodide of potassium, with a concentrated solution of acetate of strychnia : a white crystalline powder is precipitated, which is soluble in alcohol, and is pure hydriodate of strychnia. It does not appear to have been as yet used in medicine. CXXXVI. STRYCH'NI^ NITRAS. Synonymes. Strychninae Nitras, Stryclinium Nitricum, Nitras Strychnii seu Strychnicus, Nitrate of Strychnia or Strychnine. German. Saltpetersaures Strychnin, Strychnin Nitrat. This preparation of strychnia has been more used in Germany than any other. It has been received into the Prussian Phar- macopoeia, (Landespharmakopbe,) where it is directed to be prepared in the following manner : METHOD OF PREPARING. On eight pounds of nux vomica, sixteen pounds of spirit of wine (Kornbranntivein) are poured, and the liquid is distilled to one-half. The nux vomica is then freed from the liquor by filtering, is dried and reduced to coarse powder. This is digest- ed two or three times, with a sufficient quantity of the spirit, STRYCHNLE SULPHAS. 561 and after digestion it is strained. The tinctures are then sub- jected to distillation, and what remains is evaporated along with the fluid that remained after the boiling ; to this, acetate of lead, dissolved in a sufficient quantity of distilled water, is added so long as a precipitate falls. The fluid, separated as much aspos- sible from the precipitate, by means of the filter, is now evapo- rated to one-half, by a gentle heat. When cold, it is mixed with two ounces of calcined magnesia, and is suffered to stand for three days, when the deposit is separated by the aid of the filter, and is washed, and dried. This, after having been rubbed to powder, is digested two or three times in alcohol, and the tinc- tures are subjected to distillation, until only a few ounces remain. The strychnia, which on cooling appears in the retort in the form of a white powder, is separated by the filter, washed two or three times with rectified spirit of wine diluted with an equal quantity of common water, and is neutralised by a proper quan- tity of dilute nitric acid. The filtered fluid is evaporated by a gentle heat so as to allow the formation of crystals. These crys- tals are needle-shaped, colourless, of a silky splendour, and a very bitter taste ; they are soluble with difficulty in alcohol, but dissolve in ether. METHOD OF ADMINISTERING. The dose and mode of administering the nitrate of strychnia are the same as in the case of pure strychnia. Its endermic application will sometimes succeed when the internal adminis- tration has been more limited in its results. The experiments instituted by Dr. Stannius, and others, and referred to in a former page (552), were with nitrate of strychnia. Magendie found, in his experiments, that this salt completely prevented the coagulation of the blood. * CXXXVII. STRYCH'NIiE SULPHAS. Synonymes. Strychnina: Sulphas, Strychnium Sulphuricum, Sulphas Strych- nii seu Strychnicus, Sulphate of Strychnia or Strychnine. German. Schwefelsaures Strychnin, Strychninsulphat. The same effects have been observed from this preparation as from the others. It is also dispensed in the same forms and doses. It may be obtained by the simple union of strychnia with sul- * Lemons sur le Sang ; and translation in Lond. Lancet, Jan. 26, 1839, p. 637. 562 SULPHURIS CARBURETUM. j)huric acid. According to Pelletier, 100 parts of the alkaloid saturate 10.486 of the acid. It is soluble in less than sixteen parts of cold water, and crystallises, when neutral, in transpa- rent cubes; when acid, in needles. Its taste is extraordinarily- bitter. It is decomposed by every soluble salifiable base. CXXXVIII. SUL'PHURIS CARBURETUM. Svnonymes. Sulphuretum Carbonii seu Carbonei,Carbonium seu Carboneura Sulphuratum, Alcohol Sulpliuris, Bisulphuretum Carbonii, Sulphuret of Carbon, Bisulphuret of Carbon, Carburet of Sulphur. French. Sulfure de Carbon, Carbure de Soufre, Soufre Carbure, Alcool de Soufre. German. Schwefelalcohol, Schwefelkohlenstoff, flussiger Kohlenschwefel, Kohlensulfurid. Carburet of sulphur or sulphuret of carbon was discovered by Lampadius in the year 1796. It is a transparent and colourless fluid at the ordinary temperature ; has a very penetrating and disagreeable odour ; and a taste cooling at first, but afterwards burning, acrid, and somewhat aromatic. Its specific gravity is 1.263. It boils at 134° of Fahrenheit. It is not decomposed at the highest temperatures ; but volatilises rapidly in the air, and burns readily. It is not soluble in water, but is so in alcohol, ether, and in the fixed and volatile oils. Water separates it im- mediately from those solutions. It unites intimately with the alkalies ; but, of the acids, the aqua regia — which is a mixture of the nitric and muriatic acids — alone lays hold of it. It dis- solves potassa, camphor, sulphur, and phosphorus. Lampadius, in the first instance, regarded sulphuret of carbon as a Compound of sulphur and hydrogen; it is now, however, decided, that it consists of sulphur and carbon, — according to Vauquelin,in the proportion of 85 or 86 to 15 or 14; according to Berzelius, and Marcet, of 84.84 to 15.16. MODE OF PREPARING. The following method is recommended by Mitscherlich :* The temperature at which sulphur enters into ebu lition is not sufficient to make the two substances combine, but if burning coals be placed in contact with vapours of sulphur,the combina- * Elemens de Chimie, traduits par M. B. Valerius, i. 156. Bruxelles, 1835. SULPHURTS CARBURETTTM. 563 tion takes place immediately. With this view, a tube of porce- lain may be used, or, what is better, one of cast iron, lined inter- nally with a coating of clay by running it several times through a paste of clay and water, and heating the tube each time. In this manner, the crust of dry clay will become strong enough to prevent the sulphur from attacking the iron. The tube is then filled with strongly calcined coals, and is heated to redness in an oblong furnace. One end of the tube is closed by a cork, and a small hole is made at the upper part of the tube, through which the sulphur is introduced, and which is closed by a plug. The other end, which has passed through the furnace, is likewise closed by a large cork, traversed by a glass tube. To make the stoppers close the tube hermetically, they are boiled with glue. The long glass tube passes into a large jar, through a hole in which it is adapted hermetically by means of a cork. The ordi- nary aperture of the jar is closed by a cork in which a tube is fitted hermetically, which passes through the window. At the bottom of the jar is contained a little water. The long tube passing from the furnace to the jar, may be kept cool by water made to drop upon it, or by covering it with v snow or ice. When the charcoal is heated to redness, small fragments of sulphur are dropped in, from time to time, by means of the aper- ture before mentioned, which must be carefully closed each time afterwards. The sulphur, in melting, runs towards the hottest parts of the tube, to which a slight inclination has been given on placing it in the furnace. It enters into ebullition, and is trans- formed into sulphureous vapour, which, bypassing over the hot coals, combines with them : the sulphuret of carbon, or carburet of sulphur, formed, condenses in the long tube, from which it runs into the jar, and falls to the bottom of the water. As the coal always retains a little hydrogen, the sulphur likewise unites with it, to form a gaseous body, which is carried off by the tube passing through the window. Carburet oi* sulphur is preserved in well-stopped bottles, and is covered with about an inch of water, whence it can be best obtained for use by means of a small glass or ivory syringe. EFFECTS ON THE ECONOMY. Carburet of sulphur holds a place amongst the transient or diffusible stimulants.* Its most marked effects are said to con- sist in its " exciting the function of cutaneous transpiration to * Wulzer, Journal de Chimie AI6d. ; and Amer. Journ. Med. Sciences, Nov. 1831, p. 215. 564 SULPHTJRIS CARBURETUM. copious sweating ; increasing the secretion of urine, elevating the temperature of the body, quickening the pulse, and causing congestions towards the head and those parts of the body whose vitality may have been already somewhat augmented."* Its most striking agency is exhibited in the more active exercise of the functions of the skin. According to Mansfeld, it acts like- wise as an emmenagogue ; but, in this respect, probably only like similar excitants. On account of its great volatility, it produces on the skin the feeling of considerable cold. The discoverer of the carburet of sulphur first recommended it as a remedial agent.t He particularly advised it, both inter- nally and externally, in rheumatic and gouty affections. In Freiberg, a mixture of one part of camphor, two of carburet of sulphur, and four of alcohol, is a very common external appli- cation in rheumatic pains. Kappe found decided advantage from it in gout and rheumatism, and Mansfeld and Wutzer, resting upon a series of observations, maintain, that in rheuma- tism unaccompanied by fever, or where the fever is slight, it ex- ceeds every other remedy of the class. Dr. Otto,J of Copenha- gen, prescribes four drops of a mixture, composed of one part of carburet of sulphur, and four parts of highly rectified spirit of wine, to be taken every two hours : and he directs the affect- ed parts to be rubbed with an embrocation, composed of one part of sulphuret of carbon, and four parts of olive oil. The cure, he states, is ordinarily effected in from eight to fifteen days. In deep-rooted dyscrasies, however, these gentlemen found no advantage from it. On the other hand, in trials at the Ber- lin Charity, it was found to be of no avail in chronic rheuma- tism, although it was used for a long time, and given in by no means small doses. Mansfeld, also, employed it in cases of after-pains, rubbed, without admixture, on the abdomen ; and he affirms, that good effects resulted from it, even when ergot had failed. In hysteric fainting, the same gentleman found it very use- ful when internally exhibited. Lampadius, likewise, recom- mended it in fainting, as well as in asphyxia. Krimer found it extremely efficacious in asphyxia from carbonic acid, but he frequently thought it necessary to premise bloodletting. In this way, he treated eleven cases, and only one — in which apo- plexy had already supervened — terminated fatally. The same * Riecke, Die neuern Arzneimittel, S. 109 ; and 2te Auflage, S. 166. Stutt- gart, 1840. f Lampadius, in Bulletin des Sciences Medicales de Ferussac, xi. 315. X Annales de Chimie Medicale, and Araer. Journal of the Med. Sciences, for Nov. 1836, p. 222. STJLPHTJRIS CARBTJRETUM. 565 physician exhibited it in some cases of drunkenness, attended with loss of consciousness, and found its effects very beneficial. He gave it with great advantage once in a case of goitre ; and, in incarcerated hernia, no agent, he says, facilitates so much the taxis as the cold produced by dropping carburet of sulphur on the tumour.* Lampadius found, that slight burns were instantaneously cured by it. Clarus recommends it in hy- pertrophy of the coats of the stomach, and in contraction of the oesophagus — administered according to the formula given below. Every thing, indeed, says Riecke, encourages its further trial as a remedial agent.t MODE OF ADMINISTERING. Internally, carburet of sulphur may be given in doses of from one drop to four, every five or ten minutes, in cases of faint- ing and asphyxia ; but where such a rapid analeptic agency is not demanded, it may be given every two or three hours. It may be administered dropped on sugar or in a spoonful of su- gared water or barley water. Clarus thinks it is best given in cow's milk. Externally, it is either applied pure, when a rapid develop- ment of cold is needed — as in cases of burns and incarcer- ated hernia — or dissolved in alcohol or oil. Guttse sulphuris carbnreti. Drops of carburet of sulphur. R. Sulphur, carbur. f.Jij. jEther. sulphur. f-5J. M. Dose. — A few drops on sugar. Lampadius. R. Sulphur, carbur. f.^j. Alcohol. f.3ss. M. Dose. — Four to six drops, every two hours, in rheumatism. Wutzer. R. Sulphur, carbur. f.^j. Alcohol, f.^ij. M. Dose. — Five, ten, or fifteen drops, three times a day, in cases of rheumatism. Wutzer. * Journ. de Pharmacie, and Amer. Journal of Pharmacy, ix. 264. f Die neuern Arzneimittel, u. s. w. S. 110. 48 566 SULPHURIS CARBURETUM. Mistura sulphuris carbureti. Mixture of carburet of sulphur. R. Sulphur, carbur. 9j. Lact. vaccin. f.^vj. Sacch. 5U- M. Dose. — A table-spoonful, four times a day, or oftener. Clarus. Embrocatio snlphuris carbureti. Embrocation of carburet of sulphur. R. Sulphur, carbur. gss. Olei amygd. dulc. ^j. M. To be rubbed in, in cases of old gouty nodes. Mansfeld, and Otto* R. Sulphur, carbur. f.3 U - 01. oliv. seu Linim. ammon. camphor, f.gij. M. Wutzer. To be rubbed in , in cases of rheumatism. R. Camphor. 3'j. Solve in Sulphur. carbur. f.^ss. Adde Alcohol. f.gj. M. To be used in friction, in cases of rheumatism, and especially in rheumatic odontalgia. Lampadius. * Bibliothek for Laeger, 1835, and Brit, and For. Med. Review, July, 1836, p. 252. STJLPHURIS IODIDUM. 567 CXXXIX. SULTHURIS IO'DIDUM. Synonymes. Sulphuris Ioduretum, Sulphur Iodatum, Ioduret, or Iodide of Sulphur. French. Soufre Iodur£, Iodure de Soufre. German. Iodschwefel, Iodinschwefel, Schwefeliodiire. MODE OF PREPARING. Iodide of sulphur is prepared by heating slightly a mixture of four parts of iodine, and one of sublimed sulphur. The ex- cess of iodine is driven off, and the iodide of sulphur remains as a grayish-black mass, very deliquescent, and readily decomposed by water. M. G. Van Melekebeke,* has recently proposed the following form : — Take of Iodine, two parts ; Washed sulphur, one part. Bruise them together, and introduce the mixture into a glass tube, pressing it down until the tube is well filled ; then seal hermetically. Heat at first gently, until the mixture begins to become of a darker colour; then augment the heat so as to fuse the iodide ; keep it for some time in this state, and turn the tube constantly, that the action may be uniform ; remove it from the fire, and shake it until the iodide begins to congeal, and until vapours of iodine no longer form ; open the tube, and compress again the iodide, in order to have it in fine cylinders. M. Van Melekebeke recommends this as a very expeditious process, and one which enables the pharmacien to prepare the iodide in very small quantity. The committee of the Societe des Sciences M&dicales et Naturelles de Malines approve of the process, but suggest, that the proportion of iodine to sulphur should be three to one. The following form for its preparation has been introduced into the last edition of the Pharmacopoeia of theUnited States : — Take of Iodine, 3iv.; Sulphur, 3j. Rub the iodine and sulphur together in a glass, porcelain, or marble mortar, until they are thoroughly mixed. Put the mixture into a matrass ; close the orifice loosely, and apply a gentle heat so as to darken the mass without melting it. When the colour has become uniformly dark throughout, increase the heat so as to melt the iodide; then incline the matrass in different directions, in order to return into the mass any portion of iodine which may have condensed on the inner surface of the vessel : lastly, allow the matrass to cool, break it, and put the iodide into bottles, which are to be well stopped. * Archives de la Mcdecine Beige, Mars, 1842, p. 307. 568 STXLPHURIS IODIDUM. EFFECTS ON THE ECONOMY. Biett has used this agent in squamous, pustular, and papular diseases of the skin. It has been found especially effective in psoriasis, in the form of friction. Patients, who had been long affected with diseases of this kind, which had resisted every other remedy, were cured in four or five months by iodide of sulphur alone. To prevent relapses, Biett advises that the frictions should be continued after the eruptions have scaled off. He found it equally efficacious in the lepra vulgaris of Willan ; and in acne — the gut ta rosacea of Alibert — when the inflammation of the skin had passed away. Even acne indurata was often completely cured by it.* He found it also beneficial in inveterate porrigo of the scalpA At times, after the rubbing, a diffuse red inflam- mation of the skin arises, with subsequent desquamation ; and, in particular cases, the inflammation extends even to the subjacent cellular membrane. In old standing lepra, RayerJ prefers it for external use to calomel and white precipitate ; and he ranks it highly, with the iodides of mercury, for the cure of lupus non exedens ; and by Dr. Volmar§ it has been used, with great suc- cess, in herpes pustulosus labialis. Iodide of sulphur is likewise extolled by Lugol as a very active therapeutical agent. Cless affirms, that in chronic squa- mous affections of the ski?i, especially in psoriasis, he has em- ployed it with advantage, but he was not able to cure lepra vul- garis with it. It has been strongly recommended in Tinea capitis, in the proportion of ten grains of the iodide to an ounce of lard. A writer, in an English periodica^ affirms, that he was induced to make trial of it in some obstinate cases, and was much astonished at the remarkable power it possessed over the disease. He rubbed it on the head, night and morning, and increased the strength of the ointment according as the affected part was able to bear the stimulus, until the iodide bore the proportion of half a dram to the ounce of lard or spermaceti cerate. * See, also, Rayer, Traite Thecrique et Pratique des Maladies de la Peau ; and Copland, Dictionary of Practical Medicine, Art. Jlcne. f Cazenave et Schedel, Maladies de la Peau, p. 219 ; and Cogswell on Iodine, p. 120. Edinb. 1837. X Diseases of the Skin, p. 634. § Die neuesten Entdeckung. in d. Mat. Med.; cited by Pereira, Elements of Materia Medica, ii. 477, 2d edit. Lond. 1842 ; or Amer. edit, by Dr. Car- son, Philad. 1843. || Lond. Med. Gazette, for Sept. 9, 1837, p. 879. See, also, M. Cazenave, cited in Amer. Journ. Med. Sciences/Oct. 1841, p. 460. and Dr. W. Davidson, Lond. and Edinb. Monthly Journ. of Med. Sciences, Dec. 1841. UREA. 569 The inhalation of the vapour of this substance has been em- ployed in humoral asthma, by Dr. Copland,* with temporary benefit, and fumigations of iodine and sulphur have been used advantageously in certain atonic ulcers, and chronic cutaneous diseases.^ With this view, the sulphur and iodine may be com- bined extemporaneously, — say four parts of iodine to one part of sulphur. MODE OF ADMINISTERING. Ungnentum sulphuris iodidi. Ointment of iodide of sulphur. R. Sulphur, iodid.^j. — Jss. Adipis, §j. M. et fiat unguentum. Biett, — Rayer. CXL. URE'A. Synonvmes. Ureum, Uricum, Nephrine, Nephrin. French. Uree, Extrait Savonneux de PUrine. German. Harnstoff. This immediate principle of the urine of man and quadrupeds was discovered in an impure state by Rouelle, in 1773; and since then it has been studied by Cruickshanks, Fourcroy and Vauquelin,Berzelius, Proust, and Liebig more especially.^ METIIOD OF PREPARING. Urea is obtained by placing a mixture of equal volumes of urine, reduced to the consistence of syrup, and nitric acid at 20° in a refrigerative bath ; by which means crystallised nitrate of urea is precipitated. On decomposing this — washed in the cold and dissolved in water — by carbonate of potassa, reducing it almost to dryness, and treating the residue by alcohol at 40°, * Diet, of Practical Medicine, Art. Asthma. f London Lancet, vol. 1, 1838, and Encyclographie des Sciences Medicales, Aout, 1838. X Annales de Cliimie et de Physique, x. 369, and Murat and De Lens, Art. Utfe. 4S* 570 UREA. which takes up the urea, crystals may be obtained by evapora- tion, which may subsequently be procured colourless by the agency of animal charcoal. M. Henry,* who was not satisfied with the scanty product yielded by this process, recommends the following: — Add to fresh urine a slight excess of subacctafe of lead ; a precipitate is thus formed, which consists of oxide of lead united to the various acids of the urine, together with the mucus, and a great part of the animal matter; the decanted liquid is then treated with sul- phuric acid in slight excess to separate the lead, and afterwards, in the progress of the evaporation, to decompose the acids of soda and lime, that may have been formed. After having sepa- rated the white precipitate, concentrate rapidly over a steady fire, adding a portion of animal charcoal during the ebullition. When the whole has become a clear syrup, pass it through linen of close texture, and then reduce it one-third by evaporation. On cooling, the liquid is converted into a yellow mass, crystal- lised in needles, formed of a great proportion of urea and some salts. The crystals, being drained and pressed, are added to those obtained from the mother waters treated in a similar man- ner. They are next treated with a very small quantity of car- bonate of soda, with the view of separating any remaining ace- tate of lime, and then digested in alcohol of 3S° to 40°. The alcoholic solution being filtered, and the alcohol separated by distillation, the urea remains, which may be crystallised afresh from water, if necessary.! Urea, thus obtained, is in silky or prismatic needles, very soluble, and of a cooling taste. The following improved method of preparation has been pro- posed by Prof. Liebig.J Twenty-eight parts of ferrocyanuret of potassium perfectly dried are mixed with fourteen parts of per- oxide of manganese, both being reduced to as fine a powder as possible; the mixture is then heated on an iron plate, not in a crucible, over a coal fire to a feeble red heat. At this tempera- ture it inflames, and is gradually extinguished. By shaking it several times at intervals, it is prevented from becoming agglu- tinated, and the access of air is facilitated. The mass on cooling is treated with cold water, and the liquor is mixed with twenty parts and a half of dry sulphate of ammonia of commerce, pre- pared by saturating sulphuric acid with carbonate of ammonia, and evaporating it to dryness. It is well to put to one side the * Journal de Pharmacie, xi. 161, Paris, 1829. f Manual of Materia Medica and Pharmacy ; by MM. H. M. Edwards and P. Vavaseur, p, 231. Philad. 1829. \ Annalen der Chimie und Pharmacie B. xxxviii.; and Journal de Pharmacie, Aout, 1841, p. 502. UREA. 571 first concentrated washings afforded by the ferrocyanuret of potassium; and to dissolve in the last washings, in the cold, the sulphate of ammonia, and to mix them with the first. Com- monly, an abundant precipitate of sulphate of potassa forms immediately. The supernatant liquid is poured off, and eva- porated in a salt water bath, or rather in a warm place, — .care being taken to prevent ebullition. Fresh crystalline plates of sulphate of potassa are deposited, and the liquor is decanted as far as possible. The decanted liquor is then evaporated to dry- ness, and the residuum is treated with boiling alcohol of eighty to ninety per cent. This dissolves the urea, which crystallises by the cooling and evaporation of the alcohol, whilst the sul- phates do not dissolve^ EFFECTS ON THE ECONOMY. The experiments of M. Segalas have established, that urea is devoid of any noxious action on animals into whose veins it has been injected, and, consequently, that we cannot ascribe the se- rious symptoms to it, which arise from the absorption of urine in certain morbid cases. They demonstrate farther, what has been confirmed by the trials of Fouquier, that urea is a diuretic, and, therefore, might be useful in dropsy : the latter gentleman employed it, also, but unsuccessfully, in diabetes.* Laennec used it with advantage in a case of dropsy. According to Prof. Fee,t urea is received into the lists of the materia medica in the Batavian Pharmacopoeia, and in some others less known. It has also been admitted into the French Pharmacopoeia. MODE OF ADMINISTERING. Urea has been given in solution in distilled water, sweetened, in the dose of twenty-four to thirty grains, and even as high as several drams, in the day. * Journal de Physiol, de Magendie, ii. 344, and Formulaire pour la Prepa- ration, &c, de plusiers nouveaux Medicameris. | Cours d'Hist. Naturelle Pharm. ii. 7G4 : cited in Merat and De Lens, Diet, de Mat. M6d. Art. Uree. 572 VERATRIA. CXLI. VERATRIA. Svnonymes. Veratrina, Veratrinum, Veratrium, Veratrine. French. Veratrine. German. Veratrine, Niesswurzstoff. This alkaloid, which was discovered in 1819, by MM. Pelle- tier and Caventou,* and almost at the same time by Meissneiyl" is commonly prepared from the seeds of veratrum sabadilla — Sabadilla or Cevadilla, of the Pharmacopoeia of the United States. It is contained in several of the plants belonging to the family Colchicacese. METHOD OF PREPARING. Cevadilla is repeatedly treated with boiling alcohol. The tinctures, filtered, when almost boiling, allow whitish flakes of wax to be deposited on cooling; the dissolved matters, brought to the consistence of an extract,are now dissolved in cold ivater, and filtered, whereby a small quantity of fatty matter remains on the filter. The solution is then slowly evaporated, when a yellowish orange-coloured precipitate is formed, which possesses the characters of the colouring matter found in almost all woody vegetables. On adding a solution of acetate of lead to the still deeply coloured liquid, a new and very abundant yellow preci- pitate is thrown down, which can be separated by means of the filter. The liquor, now nearly colourless, contains, besides other substances, acetate of lead, which had been added in excess ; this is separated by means of a stream of sulphuretted hydrogen : the liquor is then filtered, and concentrated by evaporation ; treated by magnesia, and again filtered. The magnesian preci- pitate is digested in boiling alcohol, and on evaporating the alcoholic liquors, a pulverulent, extremely acrid matter is ob- tained, which possesses all the properties of the alkalies. It appears at first yellowish; but, by solutions in alcohol, and sub- sequent precipitations, caused by pouring water into the alcoho- lic solutions, it is obtained in the form of a very white and per- fectly inodorous powder.J Veratria has been received into the London and United States§ * Annales de Chimie et de Physique, xiv. 69. t Gilbert's Annalen der Physik, lxv. 335. X Magendie's Formulaire pour la Preparation, &c, de plusieurs nouveaux Medicamens. \ Pharm. of the United States, p. 237, Phila. 1842. VERATRIA. 573 Pharmacopoeias.* In these it is directed to be prepared as follows: — Take of Cevadilla, bruised, two pounds; Alcohol, three gallons; Diluted sulphuric acid, Solution of ammonia, Purified animal charcoal, Magnesia, each a sufficient quantity. Boil the cevadilla in a gallon of the alcohol, in a retort with a receiver attached, for an hour, and pour off the liquor. To the residue add another gallon of the alcohol, together with the portion recently distilled, again boil for an hour, and pour off the liquor. Repeat the boiling a third time with the remaining alcohol, and with that distilled in the previous operation. Press the cevadilla, mix and strain the liquors, and by means of a water bath distil off the alcohol. Boil the residue three or four times in water acidulated with sulphuric acid, mix and strain the liquors, and evaporate to the consistence of syrup. Add Mag- nesia in slight excess, shake the mixture frequently, then express, and wash what remains. Repeat the expression and washing two or three times, and, having dried the residue, digest it with a gentle heat several times in alcohol, and strain after each digestion. Distil off the alcohol from the mixed liquors, boil the residue for fifteen minutes in water with a little sulphuric acid and purified animal charcoal, and strain. Having thoroughly washed what remains, mix the washings with the strained liquor, evapo- rate with a moderate heat to the consistence of syrup, and then drop in as much solution of ammonia as may be necessary to precipitate the veratria. Lastly, separate and dry the preci- pitate. The following is the rationale of this process. The cevadilla gives up its veratria united with a vegetable acid to the alcohol; and when the alcoholic extract is treated with water and sul- phuric acid, an impure solution of sulphate of veratria is ob- tained. The magnesia decomposes this, setting free the veratria, which is taken up by alcohol. The alcohol is then distilled off, and the extract is boiled in water with sulphuric acid and animal charcoal : the acid unites with the veratria, whilst the charcoal abstracts the colouring matter. Ammonia, added to the strained solution, unites with the sulphuric acid, and the veratria is pre- cipitated.! Veratria — commercial or medicinal veratria — as prepared by the last process, is pulveruleDt, of a grayish-white colour, in- odorous, and of a bitter acrid taste, causing a sensation of tingling with numbness in the tongue. Veratria is scarcely at all soluble in cold water; but boiling water dissolves one-thousandth part * For M. Riprhini's method of obtaining whnt M. Soubeiran calls " medicinal veratrine," see Journal de Pharmacie, Oct. 1837. f Pereira, Elements of Mat. .Med. and Therap. 2d edit. ii. 9G1 ; orAmer. edit, by Dr. Carson, Philad. 1843. 574 VERATRIA. of its weight, and becomes sensibly acrid. It is very soluble in ether, and still more so in alcohol. It is not soluble in alkalies, but is so in all the vegetable acids: with these it forms uncrys- tallisable salts, which, on evaporation, present the appearance of gum. The sulphate alone affords rudiments of crystals, when its acid is in excess. Nitric acid combines with it; but, if added in excess, it does not colour it red, as in the case of morphia, brucia, and impure strychnia, but very rapidly resolves the vegetable substance into its elements, and gives rise to a yellow detonating matter. Veratria has an alkaline reaction, When exposed to heat, it liquefies at a temperature of 122° Fahrenheit, and has then a waxy appearance. On cooling, it forms a translucent mass, having the appearance of amber. When distilled on the naked fire, it swells up, is decomposed, and forms water, much oil, and leaves behind a bulky coal. According to Couerbe,* when prepared in the modes above mentioned, it still contains several other substances, sabadi/lina, vera trin, gum resin of sabadilla, and a black, greasy substance, which unites the other matters, and conceals their properties. These may be separated from each other by the successive action of water, ether and alcohol, as in the following table : f 1. Sabadillina, which • !■..,.,. crystallises on cooling. yieldsto boiling water ^ 2 Lin of veratriaMt Commercial veratria insoluble in water . . boiling in the cold solution. 3. Veratria, soluble in ether. 4. Gum resin of veratria, insoluble in ether, but soluble in alcohol. On account of its very high price, and the want of well de- fined external characters, the veratria of the shops is said to be very subject to adulteration ; and there would not seem to be any good criterion for ascertaining its degree of purity.t Simon, an apothecary of Berlin, has affirmed, that he has found two alkaloids in veratrum album ; one of which possesses the property of being precipitated from its solution in acetic or phosphoric acid by sulphuric acid and its salts, like baryta; hence he has given it the name barytin.% * Annales de Chimie et de Physique, ii. 308. f Christison, Dispensatory, p. 806, Edinb. 1842. | Pharmaceut. Centralblatt. 1837, p. 191, and Medicinische Annalen B. iv. H. i. S.9. Heidelb. 1838. VERATRIA. 575 EFFECTS ON THE ANIMAL ECONOMY. Regarding the effects of veratria on animals, Magendie* has the following remarks : — A very small quantity of acetate of veratria, placed in the nostrils of a dog, instantly excited violent sneezing, which continued for a long time. One or two grains, placed in the mouth, immediately occasioned profuse ptyalism. When a small quantity was introduced into any part of the intes- tinal canal, and the body was opened to notice its effects, the intestine was observed to be much indurated, and to relax and contract alternately for a certain length of time. The part of the mucous membrane, with which the veratria is made to come in contact, is inflamed ; the irritation spreads, and vomiting and purging are excited. In much stronger doses, the circulation is accelerated, as well as the respiration, and tetanus supervenes, soon followed by death. The effects are still more rapid, if one or two grains be thrown into the cavity of the pleura, or tunica vaginalis. In less than ten minutes, death occurs, preceded by tetanic convulsions. The same quantity, thrown into the jugular vein, induced tetanus and death in a few seconds. Dissection showed, that, even in this case, the veratria had acted on the intestinal canal, the mucous membrane of which was found in- jected. The lungs, also, exhibited traces of inflammation and engorgement. Veratria, in large doses, would, doubtless, exhibit the same effects on the human organism. The taste is very acrid, but without bitterness : it excites a copious flow of saliva, even when a small quantity only has been introduced into the mouth. Al- though it has no smell, it must not be brought too close to the nose, when in the state of powder, as it occasions, even in very minute quantity, violent sneezing, which may prove dangerous. A quarter of a grain immediately induces copious evacuations, and, in a somewhat larger dose, more or less violent vomiting. According to Tumbull, who has immoderately extolled this remedy, its effect is very different, according as it is exhibited internally, or externally. Externally, it may be applied for weeks and months, without the supervention of any of the effects that succeed its internal administration. Exhibited in this way, it diminishes internal nervous excitement, assuages pain, but does hot act on the intestinal canal. In dropsical cases, it is stated to be one of the greatest promoters of the urinary secretion that we possess. The part of the skin on which it is rubbed, either * Journal do Physiolorjie Experiment, i. 5G ; and Formulaire pour la Prepa- ration, &e., de plusieurs M<:dicamens. 576 VERATRIA. in solution or ointment, even when the friction has been con- tinued for a long time, exhibits no evidence of irritation : when, however, the dose of veratria has attained a certain extent, the patients feel a considerable degree of heat, and a kind of pricking sensation in the rubbed part, whence it may be concluded, that the veratria is active, pure and genuine : under a more prolonged use of the remedy, this feeling of warmth and pricking extends over the surface of the whole body ; and, in some cases, involun- tary twitchings have been observed in the muscles of the mouth and eyelids. These symptoms, however, pass off, when the frictions are discontinued for a day or two. Only in a few cases, according to Turnbull, was any eruption induced by its applica- tion. The endermic use of the remedy always, however, ex- cited so much irritation as to prevent its repetition. Thus much for Turnbull : — His views and experience have by no means been confirmed by the generality of observers. The external application of veratria cannot always be used without local irritation ensuing. An English physician, labouring under rheumatism of the arm, rubbed upon it an ointment composed of twenty grains of veratria to an ounce of lard ; and, immediately afterwards, so much pain was induced in the part, that he was obliged to take opium to obtain rest ; an eczematous eruption sub- sequently appeared on the arm, but the rheumatism remained un- cured. Ebers applied it endermically, but witnessed nothing more than a violent burning in the part, such as is commonly the case with other agents. He frequently observed the pricking sensation mentioned by Turnbull, and it was often to such an extent as to be almost insupportable. According to the trials of Ebers, its diuretic effect was not restricted to dropsy, but was usually evinced in other diseases. The sensorium appears never to have been implicated, but when applied in small doses over the pit of the stomach it produced striking effects on the spinal marrow, and the nerves connected therewith, — as the nerves of the thorax and abdomen : violent pain was experienced, which spread through the whole extent of the nerves distributed to the parietes of the abdomen, with a sense of traction along the spinal marrow, twitchings, great anxiety, orthopnoea, nausea and vomiting, and a feeling, which the patient was unable to describe, except that it was almost intolerable. When given internally, veratria speedily caused nausea, retch- ing, vertigo, and complete loss of appetite ; so that Ebers soon abandoned its internal use, and, like Turnbull, gave the prefer- ence to the external. Owing to its presumed effects on the nervous system, and especially on the spinal marrow, and the nerves connected with it, its use was suggested in nervous diseases — particularly in neuralgia, prosopalgia, and ischias — in which it is said to have VERATRIA. 577 been found most efficacious by Turnbull, Ebers,* Briick, Suffert,t Professor S. Jackson,J Cunier,§ and others. In no class of dis- eases, according to the first of these writers, have the beneficial effects of the ointment of veratria exhibited themselves more strikingly, and by no other remedy has the same amount of relief been induced in so short a time. Even in tic douloureux, a single friction is said to have been sufficient to remove the dis- ease without relapse. Two circumstances chiefly have here to be borne in mind, — first, the extent of the pain, for when it is not concentrated on a point, but spreads along the branches of the nerves, the cure is easier, and a weaker ointment is needed; and, secondly, the duration of the affection. In long protracted cases, a complete cure is far more difficult, and can, in general, be effected only after a long period. The paroxysms, however, may be relieved by an ointment composed of from twenty to forty grains to an ounce of lard. In this case, it must be strongly rubbed in, so as to excite itching of the skin : care must be taken, however, that the ointment does not touch the conjunc- tiva, as the smallest quantity of veratria would induce violent inflammation. Ebers, likewise, found advantage from its use in chorea, hypochondriasis, and hysteria ; and Turnbull in paralysis. Both extol it in rheumatism and gout, in relation to which Ebers remarks, that the remedy has appeared to him more efficacious when the nervous system, or some nervous branches, were predominantly affected, and when the gastric affection was entirely removed. In the cases treated by veratria, relief was sooner obtained, and the cure was more speedy and complete, than when other agents were employed ; the secretion of urine was augmented ; restlessness disappeared ; and sleep returned, without any evidences of narcosis. As regards acute rheumatism, Turnbull remarks, that veratria is not to be pre- ferred to antiphlogistics ; in these cases, a weaker ointment must be used (ten grains to the ounce) : in chronic cases, the quantity may be carried much higher; and — especially when extensive organic changes have supervened in the parts — it must be continued for a great length of time. In lumbago, ischias, and rheumatism of the chest, not more than one or two rubbings were generally necessary. In gout, according to Turn- bull, it may be exhibited both internally and externally ; in the * Casper's Wochenschrift, 1837, No. 47. f Berlin, Medicin. Centralzeitung, 1837, p. 670, and Heidelberg. Medicin. Annal.B. iv. H. 1,8. 11. | Amer. Journ. of Pharmacy, vol. iii. new series, p. 186. Pliilad. 1838. § Bulletin Medical Beige, Dec. 1837, and Bullet. General de Therap. Dec. 1838. See, also, Forcke, Physiologisch-lherapeutische Untersuchungen liber das Veratria, Hannov. 1837; cited in Bib. (Jcncrale, Encyclog. des Sciences Medicales, Aout, 1838. 49 57S VERATKIA. former mode of administration, he compared its efficacy with that of colchicum : the latter method has been recommended, also, by Sir C. Scudamore. It was, likewise, found very advanta- geous by Bardsley* in chronic rheumatism. Dr. Bushnan has strongly recommended the ointment of veratriain dysmenorrhea, which he supposes may be frequently owing to perversion of the nervous action of the lower portion of the spinal nerves ; and in certain spasmodic affections of the larynx, presumed by Dr. Tunstallt to be connected with a mor- bid condition of the superior portion of the spinal marrow, it is asserted to have been efficacious. It has also been used in amaurosis, the ointment being rubbed on the temples and forehead for a few minutes, once or twice in twenty-four hours. The friction should be continued until it causes redness, heat, and stinging. Messrs. Lawrence! and Tyrrel affirm, however, that it is wholly inefficacious. Veratria would seem to have been most efficacious in cases of dropsy. "Unadulterated veratria," says Ebers, "acts often on the urinary secretion with magical powers, and it may seem fabulous, when I remark, that friction with a very weak ointment of veratria two or three times in the twenty- four hours on the inner part of the thigh, or the back, epigastric region, or around the navel, has excited such a copious secretion of urine, that the patients, under its long continuance, began to feel weak; and the anasarca, and even the dropsical accu- mulation, in the abdomen, in a short time almost disappeared — circumstances which indicate the caution that ought to be ob- served in apportioning the dose, when we are satisfied of the goodness of the article." He properly remarks, however, that veratria, by augmenting the secretion of urine, may not remove the dropsy, but, by occasioning the absorption of the effused fluid, it allows the physician to examine as to the existence of organic mischief. Ebers gave it in many of the lighter hydro- pic cases, which follow intermittents and other forms of fever, and often with great and rapid success ; likewise, in twenty-four more serious cases, fifteen of which recovered, and one experi- enced relief: eight very complicated cases terminated fatally, and in four of these diuresis occurred ; in four not. Fricker§ likewise obtained very good effects from the use of * Hospital Facts and Observations, Illustrative of the Efficacy of Strychnia, Brucia, Veratria, Iodine, &c. Lond. 1830. f Provincial Med. and Surg. Journ. Au